| |
|
|
| Year : 2009 | Volume
: 20
| Issue : 5 | Page : 766-769 |
|
| Relation of magnesium level to cyclosporine and metabolic complications in renal transplant recipients |
|
|
Farrokhlagha Ahmadi, Rozita Naseri, Mahbob Lessan-Pezeshki
Department of Nephrology, Tehran University of Medical Sciences, Imam Khomeni Medical Center Keshavarz Blvd, Tehran, Iran
Click here for correspondence address and email
| Date of Web Publication | 2-Sep-2009 |
|
|
 |
|
 Abstract | | |
Cyclosporine is the main immunosuppressive drug used for renal transplant recipients in order to prevent transplant rejection. Although the drug has increased the survival of patients and grafted organ, it has some side effects independent of its effect on the immune system. This study was done to evaluate the effect of cyclosporine on serum Mg level and its metabolic side effects in renal allograft patients. 157 (62 female and 95 male) renal transplant recipients treated with cyclosporine to prevent transplant rejection were included in the study. Clinical and biochemical data along with cyclosporine levels was documented. Mean serum Mg level was 196 ± 0.31 mg/dL and mean serum cyclosporine level was 371 ± 192 µg/dL. Hypomagnesemia was detected in 16 (10.2%) with a negative significant correlation with cyclosporine levels, serum creatinine, plasma LDL, fasting Blood sugar and uric acid. In conclusion according to the results of this study there is a significant correlation between cyclosporine and hypomagnesemia. Therefore, routine measurement of serum Mg and its treatment seems necessary to prevent its complications.
How to cite this article:
Ahmadi F, Naseri R, Lessan-Pezeshki M. Relation of magnesium level to cyclosporine and metabolic complications in renal transplant recipients. Saudi J Kidney Dis Transpl 2009;20:766-9 |
How to cite this URL:
Ahmadi F, Naseri R, Lessan-Pezeshki M. Relation of magnesium level to cyclosporine and metabolic complications in renal transplant recipients. Saudi J Kidney Dis Transpl [serial online] 2009 [cited 2021 Oct 26];20:766-9. Available from: https://www.sjkdt.org/text.asp?2009/20/5/766/55358 |
| Introduction | |  |
One of the main goals of renal transplant team is increasing the survival of allograft and improving recipient quality of life. Therefore cyclosporine is a drug of special interest in this population. [1] Although cyclosporine initially seemed to have improved the survival of grafted organ and recipient, it has some side effects which may adversely affect the life quality. Independent from its effect on immune system, Cyclosporine has some side effects which are usually ignored.
Since serum Mg is not routinely tested in renal transplant recipients and some metabolic complications are attributed to hypomagnesemia in some studies, we have attempted to determine the rate of hypomagnesemia in renal transplant recipients who were taking cyclosporine and also the correlate it with other metabolic complications.
| Material and Methods | | |
This cross- sectional study was performed on 157 living unrelated renal transplant recipients who were treated by cyclosporine and their renal functions were stable for at least 6 months (serum creatinine < 2 mg/dL).
All patients were examined for height, weight, systolic and diastolic pressure. Biochemical tests included CBC, fasting blood sugar, triglycerides, cholesterol, high density lipoprotein (HDL), low density lipoprotein (LDL) blood creatinine, serum Magnesium, calcium, phosphorus and serum cyclosporine level 2 hour after cyclosporine intake (C2) were measured. Serum Mg was measured using spectrophotometery and blood cyclosporine using radioimmunoassay.
Data analysis was done by SPSS 11 (Chicago, USA) to compare mean values, samples T test and ratios were compared with chi-square test. To determine correlation between quantitive variables Pearson's coefficient of determination were used. To evaluate the normal distribution of quantative variables Kolmogrov Smirnov test was done. A P value of < 0.05 was considered as statistically significant.
| Results | | |
All patients had their investigations and clinical examination done according to the study protocol. 95 patients (61%) were men and 62 patients (39%) were women. Mean age of the patients was 43.4 ± 12.3 year. Mean total serum Mg was 1.96 ± 0.031 mg/dL. Considering normal range of total serum Mg about 1.6 mg/dL, hypomagnesemia was detected in 10.2% of recipients (16 patients) (CI 95%, 5.514.9%).
Mean age of hypomagnesemic patients was 50.7 ± 12.4 years vs 42.9 ± 12.1 years with normal magnesium levels (P= 0.02)
The evaluation of correlation of serum Mg level with cyclosporine and other metabolic variables using linear correlation evaluation methods, showed a direct linear significant correlation between serum Mg and Ca level and a converse linear statistically significant correlation between serum Mg level and C2 level, creatinine, fasting blood sugar, LDL, uric acid, systolic and diastolic blood pressure and cyclosporine dose (mg/kg/day) [Table 1].
Evaluation of correlation of other studied variables with hypomagnesemia showed again statistically significant correlation to age, C2 level, serum creatinine, fasting blood sugar, LDL, systolic and diastolic blood pressure and uric acid [Table 2].
No differences were noted among males and females in term of hypomagnesemia.
| Discussion | | |
The rate of hypomagnesemia among the patients was 10.2% in our study while in the study of Baharat KG et al it was 7.1%. [3] In their study 198 patients entry criteria were the same as our study except a higher serum creatinine of < 3 mg/dL. In the study by Mazzaferro, 38 renal transplant recipients treated by cyclosporine had 26% of patients with hypomagnesemia.
They calculated that measuring ionized Mg instead of total serum Mg the hypomagnesemia rate would be lesser around 10%. [4]
In our study, serum Mg level had an inverse significant correlation with age of patients (P= 0.042, r= -0.52) and hypomagnesemia should therefore be watched more closely in recipients older than 50 years of age. Serum Mg and serum creatinine had an inverse significant correlation in this study as well (P= 0.21, r= - 0.61) contrary to the study of MazzaFerro. [4] In other similar studies by Asai T from Japan, prescribing Mg supplements and correcting hypomagnesemia in recipients taking cyclosporine prevented cyclosporine nephrotoxicity. [5] These findings suggest that hypomagnesemia, the same as increased blood creatinine, can be a poor prognostic criterion for graft survival. More studies about correlation of hypomagnesemia and renal function can determine the role of serum Mg in prognosis of renal function.
In our study, systolic and diastolic blood pressure in hypomagnesemic patients were higher (in order P= 0.002 and r- 0.48 and; P= 0.006 and r= 0.50 respectively)
Our findings, in comparison with those of Thakur study from India on 31 renal transplant recipients, are similar. [6] Pere AK, in their experimental models showed that Mg supplementation in hypomagnesemic model, using cyclosporine, did significantly reduce hypertension. [7]
We found significant correlation between LDL only and serum Mg levels compared to study by Bharat where hypomagnesemia was associated with higher cholesterol, LDL and total cholesterol/HDL ratio. [3] In yet another study by Markell, there was a significant correlation between hypercholesterolemia, cyclosporine dose and serum Mg levels. [8]
In our study patients serum Mg had a significant inverse correlation with blood sugar amounts (P= 0.03 and r= 0.61). Morever, in hypomagnesemic recipients, mean blood sugar was higher than recipients with normal blood Mg similar to reported by Vannini et al. [9]
We found no significant correlation between blood calcium, phosphorus and serum Magnesium similar to other reports. [10] There are other reports however such as by Cavdar et al showing that hypomagnesemia accompanying hypocalcemia is produced in patients receiving cyclosporine that was not corrected without Mg supplementation.
The results of our study showed that patient's serum Mg have a moderate, inverse significant correlation with blood uric acid (P< 0.001, r= 0.36). This association needs further clarification and its implications need to be studied in larger studies.
Cyclosporine dose in our hypomagnesemic patients was higher (P= 0.045, r= 0.63) this was also shown in higher C2 levels This aspect of cyclosporine toxicity presenting as hypomagnesemia is well known and is corrected by decreasing the cyclosporine dose and therefore its levels. [8],[9],[10] In conclusion, the results of our study suggest that measurement of total and ionized Mg level in addition to routine biochemical tests in patients with recipients of renal allograft being treated with cyclosporine should be routine. It will help to detect hypomagnesemic patients early and prevent its metabolic complication.
| References | | |
| 1. | Gods AJ. Renal transplantation in Iran. Nephrol Dial Transplant 2002;17:222-80.  |
| 2. | Bahrat KC, Daniel G. Screening for hypomagnesemia in cyclosporine or FK 506 treated renal transplant recipients. Transplantation 1999;67(7):5152. |
| 3. | Mazzaferro S, Baraberi S, Sacarda A. Ionized and total Mg in renal transplant patients. J Nephrol 2002;15:275-80. |
| 4. | Asai T, Nakatani T, Yamanaka S, et al. Magnesium supplementation prevents experimental chronic cyclosporine nephrotoxicity via rennin angiotensin system independent mechanism. Transplantation 2002;74(6):754-5. |
| 5. | Takur V, Kumar R, Dhawan IK. Correlation between serum Mg and blood cyclosporine A concentrations in renal transplant recipients. Ann Clin Biochem 2002;36:70-2. |
| 6. | Pere AK, Lindgren L, Toumainen P. Dietary potassium and magnesium supplementation in cyclosporine-induced hypertension and nephrotoxicity. Kidney Int 2000;58(6):2462-72. |
| 7. | Markell MS, Altura BT, Barbour RL, Altura BM. Inoized and total magnesium levels in cyclosporine treated renal transplant recipients: relationship with cholesterol and cyclosporine levels. Clin Sci (loud) 1993;88(3):315-8. |
| 8. | Vannini SD, Mazzola BL, Rodoni L, et al. Permanently reduced plasma ionized Mg among renal transplant recipients on cyclosporine. Transpl Int 1999;12:244-9. [PUBMED] [FULLTEXT] |
| 9. | Freundlich M. Bone mineral content and mineral metabolism during cyclosporine treatment of nephritic syndrome. J Pediatr 2006; 149(3);383-9. |
| 10. | Cavdar C, Sifil A, Sanli E, et al. Hypomagnesemia and mild rhabdomyolysis in living related donor renal transplant recipients treated with cyclosporine A. Scand J Urol Nephrol 1998;32(6):415-7. |
Correspondence Address:
Farrokhlagha Ahmadi
Department of Nephrology, Tehran University of Medical Sciences, Imam Khomeni Medical Center Keshavarz Blvd, Tehran
Iran
  | Check |
PMID: 19736470 
[Table 1], [Table 2] |
|
| This article has been cited by | | 1 |
Systematic review: Hypomagnesaemia induced by proton pump inhibition |
|
| Hess, M.W. and Hoenderop, J.G.J. and Bindels, R.J.M. and Drenth, J.P.H. | | Alimentary Pharmacology and Therapeutics. 2012; 36(5): 405-413 | | [Pubmed] | | | 2 |
Drug-induced alterations in Mg 2+ homoeostasis |
|
| Lameris, A.L. and Monnens, L.A. and Bindels, R.J. and Hoenderop, J.G.J. | | Clinical Science. 2012; 123(1): 1-14 | | [Pubmed] | | | 3 |
Effect of mycophenolate mofetil on plasma bioelements in renal transplant recipients |
|
| Kamińska, J. and Sobiak, J. and Suliburska, J.M. and Duda, G. and Głyda, M. and Krejpcio, Z. and Chrzanowska, M. | | Biological Trace Element Research. 2012; 145(2): 136-143 | | [Pubmed] | | | 4 |
Magnesemia in renal transplant recipients: Relation with immunosuppression and posttransplant diabetes |
|
| Osorio, J.M. and Bravo, J. and Pérez, A. and Ferreyra, C. and Osuna, A. | | Transplantation Proceedings. 2010; 42(8): 2910-2913 | | [Pubmed] | | | 5 |
Drug-induced hypomagnesaemia |
|
| Hassam, R. and Arulanantham, N. | | Adverse Drug Reaction Bulletin. 2010; (262): 1007-1010 | | [Pubmed] | |
|
|
|
|
|
|
|
|
|
|
|
|
| Article Access Statistics | | | Viewed | 4963 | | | Printed | 81 | | | Emailed | 0 | | | PDF Downloaded | 643 | | | Comments | [Add] | | | Cited by others | 5 | | |
|
|
