Proteinuria-associated renal magnesium wasting leads to hypomagnesemia: a common electrolyte abnormality in chronic kidney disease
Oka T, Hamano T, Sakaguchi Y, Yamaguchi S, Kubota K, Senda M, Yonemoto S, Shimada K, Matsumoto A, Hashimoto N, Mori D, Monden C, Takahashi A, Obi Y, Yamamoto R, Takabatake Y, Kaimori JY, Moriyama T, Horio M, Matsui I, Isaka Y
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 50 citas
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Cómo se estudió
- Diseño
- Ensayo controlado aleatorizado (indexado por PubMed)
- Estudiado en
- Personas
- Resultado principal
- Marcadores de salud y funcionamiento
Quién lo pagó
- Financiación
- Financiación no declarada
Publicación
- Publicado
- 2018-04-12 · Nephrol Dial Transplant · vol. 34 · número 7 · págs. 1154–1162
- Editorial
- Oxford University Press
- Citado
- 72 citas · más que el 92% de estudios similares · 3.1× el promedio de su campo
- Impacto
- Entre el 10 % más citado de su campo
- Referencias
- 41 trabajos
- Acceso
- De pago
- Áreas de investigación
- Magnesium in Health and Disease · Parathyroid Disorders and Treatments · Potassium and Related Disorders
- Palabras clave
- Medicine, Proteinuria, Internal medicine, Kidney disease, Hypomagnesemia, Gastroenterology, Odds ratio, Endocrinology, Creatinine, Urology, Kidney, Magnesium
- MeSH
- humans, renal tubular transport, inborn errors, proteinuria, disease progression, electrolytes, magnesium, magnesium oxide, kidney function tests, prevalence, retrospective studies, follow-up studies, cross-sectional studies, adult, middle aged, outpatients, japan, female, male, renal insufficiency, chronic, biomarkers
21 autores
- Tatsufumi Oka🇯🇵The University of Osaka
- Takayuki Hamano🇯🇵 · autor de correspondenciaThe University of Osaka
- Yusuke Sakaguchi🇯🇵The University of Osaka
- Satoshi Yamaguchi🇯🇵The University of Osaka
- Keiichi Kubota🇯🇵The University of Osaka
- Masamitsu Senda🇯🇵The University of Osaka
- Sayoko Yonemoto🇯🇵The University of Osaka
- Karin Shimada🇯🇵The University of Osaka
- Ayumi Matsumoto🇯🇵The University of Osaka
- Nobuhiro Hashimoto🇯🇵The University of Osaka
- Daisuke Mori🇯🇵The University of Osaka
- Chikako Monden🇯🇵Osaka Kaisei Hospital
- Atsushi Takahashi🇯🇵The University of Osaka
- Yoshitsugu Obi🇺🇸University of California, Irvine
- Ryohei Yamamoto🇯🇵Osaka Health Science University; The University of Osaka
- Yoshitsugu Takabatake🇯🇵The University of Osaka
- Jun-Ya Kaimori🇯🇵The University of Osaka
- Toshiki Moriyama🇯🇵Osaka Health Science University; The University of Osaka
- Masaru Horio🇯🇵The University of Osaka
- Isao Matsui🇯🇵The University of Osaka
- Yoshitaka Isaka🇯🇵The University of Osaka
Resumen
El texto original del estudio, en el idioma en que se publicó.
Background
Hypomagnesemia (Hypo-Mg) predicts mortality and chronic kidney disease (CKD) progression. However, in CKD, its prevalence, kidney-intrinsic risk factors, and the effectiveness of oral magnesium (Mg) therapy on serum Mg levels is uncertain.
Methods
In a cross-sectional study enrolling pre-dialysis outpatients with CKD, the prevalence of electrolyte abnormalities (Mg, sodium, potassium, calcium and phosphorus) was compared. In an open-label randomized controlled trial (RCT), we randomly assigned CKD patients to either the magnesium oxide (MgO) or control arm. The outcome was serum Mg levels at 1 year.
Results
In 5126 patients, Hypo-Mg was the most common electrolyte abnormality (14.7%) with similar prevalence across stages of CKD. Positive proteinuria was a risk factor of Hypo-Mg (odds ratio 2.2; 95% confidence interval 1.2-4.0). However, stratifying the analyses by diabetes mellitus (DM), it was not significant in DM (Pinteraction = 0.04). We enrolled 114 patients in the RCT. Baseline analyses showed that higher proteinuria was associated with higher fractional excretion of Mg. This relationship between proteinuria and renal Mg wasting was mediated by urinary tubular markers in mediation analyses. In the MgO arm, higher proteinuria or tubular markers predicted a significantly lower 1-year increase in serum Mg. In patients with a urinary protein-to-creatinine ratio (uPCR) <0.3 g/gCre, serum Mg at 1 year was 2.4 and 2.0 mg/dL in the MgO and control arms, respectively (P < 0.001), with no significant between-group difference in patients whose uPCR was ≥0.3 g/gCre (Pinteraction=0.001).
Conclusions
Proteinuria leads to renal Mg wasting through tubular injuries, which explains the high prevalence of Hypo-Mg in CKD.
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