Department of Nephrology, Dialysis and Kidney Transplantation, UHC Rijeka, Croatia; Department of Gastroenterology, UHC Rijeka, Croatia.
Department of Gastroenterology, UHC Rijeka, Croatia.
Eur J Intern Med. 2016 May;30:99-103. doi: 10.1016/j.ejim.2016.01.026. Epub 2016 Feb 19.
We investigated the association among long-term proton-pump inhibitors (PPIs) use with serum magnesium (Mg) levels in chronic hemodialysis (HD) patients, as well as possible association among PPI use and increased risk of cardiovascular (CVD) morbidity in HD patients.
Of 418 HD patients that were screened for inclusion, 136 were excluded due to incomplete medical data, duration of renal replacement therapy (RRT) for less than 12months, use of Mg-based-phosphate binders or other Mg-based medications or either to presence of chronic increased GI losses. Among 282 patients included in the study, 170 patients were on PPIs.
Serum Mg levels were significantly lower among PPI users vs. non-users (0.94±0.2 vs. 1.03±0.2mmol/L; p<0.0001). The median duration of PPI use was 27±9.6months (range from 12 to 108) and it was not significantly associated with Mg levels (r=0.116; p=0.167). Additionally, residual renal function didn't show a significant correlation with Mg concentration (r=-0.102; p=NS) in both groups of patients. The use of PPIs was an independent and strong predictor of low Mg concentrations even in multivariate analysis (OR 3.05; 95% CI 1.2498-7.4594, p=0.01). On the other hand, the daily dose of PPIs was not associated with low Mg levels. PPI users had a higher rate of adverse CVD events during the 1 year of follow-up in comparison to non-PPI users but that difference wasn't statistically significant (17.6% vs. 10.7%; p=0.110).
We have found a significant association between PPI use and lower serum Mg levels in chronic HD patients.
我们研究了长期使用质子泵抑制剂（PPIs）与慢性血液透析（HD）患者血清镁（Mg）水平之间的关系，以及 PPI 使用与 HD 患者心血管（CVD）发病率增加之间的可能关系。
在筛选出的 418 名 HD 患者中，由于医疗数据不完整、肾脏替代治疗（RRT）时间不足 12 个月、使用 Mg 基磷酸盐结合剂或其他 Mg 基药物或慢性胃肠道损失增加，有 136 名患者被排除在外。在纳入研究的 282 名患者中，有 170 名患者正在使用 PPI。
与非使用者相比，PPIs 使用者的血清 Mg 水平显著降低（0.94±0.2 与 1.03±0.2mmol/L；p<0.0001）。PPI 使用的中位时间为 27±9.6 个月（范围为 12 至 108 个月），与 Mg 水平无显著相关性（r=0.116；p=0.167）。此外，残余肾功能在两组患者中均与 Mg 浓度无显著相关性（r=-0.102；p=NS）。即使在多变量分析中，PPI 的使用也是低 Mg 浓度的独立且强有力的预测因素（OR 3.05；95%CI 1.2498-7.4594，p=0.01）。另一方面，PPI 的日剂量与低 Mg 水平无关。与非 PPI 使用者相比，PPI 使用者在 1 年的随访期间发生不良 CVD 事件的比例更高，但差异无统计学意义（17.6%与 10.7%；p=0.110）。
我们发现慢性 HD 患者中 PPI 使用与血清 Mg 水平降低之间存在显著关联。
