Ghaddar Malak, Hatab Taha, El-Kaakour Adel, Tamim Hani, Makki Maha, El-Halabi Tasnim, Rifaii Khalid, Sfeir Pierre, Hoteit Mayssaa, Koubar Sahar H
Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Cleveland Clinic Foundation, Cleveland, Ohio.
Kidney360. 2025 Feb 1;6(2):219-226. doi: 10.34067/KID.0000000628. Epub 2024 Oct 23.
The incidence of hypermagnesemia after cardiovascular surgeries using cardiopulmonary bypass is 53.2%. Most patients had mild hypermagnesemia. Cardioplegic solutions with higher magnesium content and lower eGFR were independently linked to an increased risk of hypermagnesemia. Large multicenter studies should explore the effects of hypermagnesemia on clinical outcomes in patients with advanced CKD undergoing cardiopulmonary bypass surgeries.
Magnesium (Mg) administration is a common practice in cardiovascular surgeries using cardiopulmonary bypass (CPB). However, concerns persist regarding the risk of hypermagnesemia, particularly in patients with kidney dysfunction. The aims of this study were to determine the incidence of postoperative hypermagnesemia in CPB-assisted cardiovascular surgeries and identify the associated risk factors.
This was a retrospective cohort study conducted at a tertiary medical center. Data from adult patients undergoing open-heart surgery using CPB between 2018 and 2020 were analyzed. Sociodemographic, perioperative, and clinical variables were collected from electronic medical records. Logistic regression was used to identify independent risk factors of hypermagnesemia.
Of the 278 patients analyzed, 53.2% developed postoperative hypermagnesemia (Mg ≥2.5 mg/dl). Mild hypermagnesemia (Mg, 2.5–3.9 mg/dl) was most common with no significant effect on clinical outcomes observed. Patients with hypermagnesemia were older, with higher comorbidity burdens and lower baseline eGFR. Cardioplegic solutions with higher Mg content and lower baseline eGFR were independently associated with hypermagnesemia (odds ratio [OR], 64.3; 95% confidence interval [CI], 12.9 to 501.1 and OR, 1.3; 95% CI, 1.1 to 1.5, respectively). Notably, ultrafiltration on CPB was associated with low risk of hypermagnesemia (OR, 0.4; 95% CI, 0.1 to 1.0; value, 0.048).
This study highlights the importance of mindful Mg supplementation strategies in those with advanced kidney disease. Future large-scale prospective multicenter studies should validate these findings and explore the extended effects of hypermagnesemia on clinical outcomes in patients with advanced CKD undergoing CPB surgeries.
在使用体外循环的心血管手术后，高镁血症的发生率为53.2%。大多数患者为轻度高镁血症。镁含量较高且估算肾小球滤过率（eGFR）较低的心脏停搏液与高镁血症风险增加独立相关。大型多中心研究应探讨高镁血症对接受体外循环手术的晚期慢性肾脏病（CKD）患者临床结局的影响。
在使用体外循环（CPB）的心血管手术中，给予镁是一种常见做法。然而，对于高镁血症的风险，尤其是肾功能不全患者的风险，人们一直存在担忧。本研究的目的是确定CPB辅助心血管手术后高镁血症的发生率，并确定相关危险因素。
这是一项在三级医疗中心进行的回顾性队列研究。分析了2018年至2020年间接受CPB心脏直视手术的成年患者的数据。从电子病历中收集社会人口统计学、围手术期和临床变量。采用逻辑回归分析确定高镁血症的独立危险因素。
在分析的278例患者中，53.2%发生了术后高镁血症（血清镁≥2.5mg/dl）。轻度高镁血症（血清镁2.5 - 3.9mg/dl）最为常见，对观察到的临床结局无显著影响。高镁血症患者年龄较大，合并症负担较重，基线eGFR较低。镁含量较高且基线eGFR较低的心脏停搏液与高镁血症独立相关（比值比[OR]分别为64.3；95%置信区间[CI]为12.9至501.1和OR为1.3；95%CI为1.1至1.5）。值得注意的是，CPB期间的超滤与高镁血症风险较低相关（OR为0.4；95%CI为0.1至1.0；P值为0.048）。
本研究强调了对晚期肾病患者谨慎补充镁策略的重要性。未来大规模前瞻性多中心研究应验证这些发现，并探讨高镁血症对接受CPB手术的晚期CKD患者临床结局的广泛影响。
