NDT Advance Access originally published online on April 19, 2005
Nephrology Dialysis Transplantation 2005 20(7):1456-1462; doi:10.1093/ndt/gfh831
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Low serum magnesium is associated with decreased graft survival in patients with chronic cyclosporin nephrotoxicity
1 Department of Medicine and 2 Department of Biostatistics, University of Wisconsin, Madison, WI, USA
Correspondence and offprint requests to: Arjang Djamali, MD, 3034 Fish Hatchery Road, Suite B, Madison, WI 53713, USA. Email: axd{at}medicine.wisc.edu
Background. Hypomagnesaemia is a common side effect of cyclosporin A (CsA) therapy. Animal studies suggest that magnesium (Mg) supplementation inhibits chronic CsA nephropathy.
Methods. To determine if low Mg levels correlate with true CsA-induced nephrotoxicity in humans, we examined kidney transplant biopsy records at our centre for all transplant biopsies performed between 1990 and 2002. We simultaneously reviewed the medical records to determine whether serum Mg levels were checked at the time of biopsy. Those individuals with histologically proven CsA nephrotoxicity were studied.
Results. Serum total Mg levels were available for 320 patients, 60 of whom were diagnosed with chronic CsA-mediated nephropathy. Patients were divided in two groups, a low Mg [n = 29, 1.8 (1.67–1.9) mg/dl or 0.74 (0.68–0.78) mmol/l] and a normal Mg group [n = 31, 2.2 (2.0–2.4) mg/dl or 0.9 (0.82–0.98) mmol/l, P<0.05] based on the median Mg level in the entire cohort (2 mg/dl or 0.82 mmol/l). Both groups were analysed for disease progression and graft loss using the slope of creatinine clearance (CCR) and multivariate analyses. Although the CCR at the time of biopsy was greater in the low Mg group [44.3 (36.3–64.3) ml/min vs 37.8 (25.2–47.3) ml/min, P<0.05), the decline in graft function was faster in this group (–8.9±3.5 vs 1±2.7 ml/min/year; P = 0.02) compared with the normal Mg cohort. Using Cox proportional hazards analyses, the adjusted graft survival was significantly reduced in the low Mg group 5 years after biopsy.
Conclusions. Our study demonstrates that low serum Mg levels were associated with a faster rate of decline in kidney allograft function and increased rates of graft loss in renal transplant recipients with chronic CsA nephropathy. This suggests that hypomagnesaemia could potentiate CsA-mediated nephropathy.
Keywords: allograft; cyclosporin; kidney; magnesium; outcomes; transplantation
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