Shah Chintan V, Robbins T Scott, Sparks Matthew A
Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, Gainesville, Florida.
Division of Nephrology and Department of Medicine, Duke University, Durham VA Health Care System.
Kidney Med. 2022 Aug 12;4(10):100533. doi: 10.1016/j.xkme.2022.100533. eCollection 2022 Oct.
Sodium-glucose cotransporter 2 (SGLT2) inhibitor have become widely used in patients with diabetes, heart failure, and kidney disease to improve clinical outcomes and diminish hospitalizations. They have also been associated with increased serum magnesium levels in patients with type 2 diabetes. The use of SGLT2 inhibitors resulted in improved magnesium homeostasis in a series of patients with refractory hypomagnesemia with urinary magnesium wasting. However, the role of SLGT2 inhibitors in patients with hypomagnesemia without urinary magnesium wasting remains unexplored. We report 2 cases with refractory hypomagnesemia without significant urinary magnesium wasting and dramatically improved serum magnesium levels after the initiation of SGLT2 inhibitors. Case 1 achieved independence from weekly intravenous magnesium infusions and reached sustainably greater serum magnesium levels with decreased oral magnesium supplementation and increased urinary fractional excretion of magnesium. Case 2 demonstrated improved serum magnesium levels with reduced oral magnesium supplementation without significant reduction in urinary fractional excretion of magnesium. These findings not only expand the use of SGLT2 inhibitors but also open the door for further studies to better understand the pathophysiology of how magnesium homeostasis is altered with inhibition of SGLT2.
钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂已广泛应用于糖尿病、心力衰竭和肾脏疾病患者，以改善临床结局并减少住院次数。它们还与2型糖尿病患者血清镁水平升高有关。在一系列伴有尿镁流失的难治性低镁血症患者中，使用SGLT2抑制剂可改善镁稳态。然而，SGLT2抑制剂在无尿镁流失的低镁血症患者中的作用仍未得到探索。我们报告了2例难治性低镁血症患者，他们无明显尿镁流失，在开始使用SGLT2抑制剂后血清镁水平显著改善。病例1不再需要每周静脉输注镁，口服镁补充剂减少，尿镁分数排泄增加，血清镁水平持续升高。病例2口服镁补充剂减少，血清镁水平改善，但尿镁分数排泄无显著降低。这些发现不仅扩大了SGLT2抑制剂的应用范围，也为进一步研究更好地理解抑制SGLT2后镁稳态如何改变的病理生理学打开了大门。
