Proton Pump Inhibitor Use and Magnesium Concentrations in Hemodialysis Patients: A Cross-Sectional Study

• Published in: PloS one Vol. 10; no. 11; p. e0143656
• Main Authors: Nakashima, Akio, Ohkido, Ichiro, Yokoyama, Keitaro, Mafune, Aki, Urashima, Mitsuyoshi, Yokoo, Takashi
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 30.11.2015; Public Library of Science (PLoS)
• Subjects: Acids; Aged; Analysis; Blood pressure; Calcification; Cardiac arrhythmia; Cross-sectional studies; Diabetes; Dialysis; Diuretics; Drug dosages; Epidemiology; Family medical history; Female; Health aspects; Hemodialysis; Histamine; Humans; Hypertension; Hypomagnesemia; Inhibitors; Internal medicine; Kidney diseases; Laboratories; Magnesium; Magnesium (Metal); Magnesium - blood; Magnesium Deficiency - blood; Magnesium Deficiency - epidemiology; Male; Medical research; Medicine; Metabolism; Middle Aged; Mortality; Multiple regression models; Nephrology; Patients; Potassium; Proton pump inhibitors; Proton Pump Inhibitors - adverse effects; Regression analysis; Regression models; Renal Dialysis - statistics & numerical data; Variance analysis; Japan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0143656

Magnesium concentration is a proven predictor of mortality in hemodialysis patients. Recent reports have indicated that proton pump inhibitor (PPI) use affects serum magnesium levels, however few studies have investigated the relationship between PPI use and magnesium levels in hemodialysis patients. This study aimed to clarify the association between PPI use and serum magnesium levels in hemodialysis patients. We designed this cross sectional study and included 1189 hemodialysis patients in stable condition. Associations between PPI and magnesium-related factors, as well as other possible confounders, were evaluated using a multiple regression model. We defined hypomagnesemia as a value < 2.0 mg/dL, and created comparable logistic regression models to assess the association between PPI use and hypomagnesemia. PPI use is associated with a significantly lower mean serum magnesium level than histamine 2 (H2) receptor antagonists or no acid-suppressive medications (mean [SD] PPI: 2.52 [0.45] mg/dL; H2 receptor antagonist: 2.68 [0.41] mg/dL; no acid suppressive medications: 2.68 [0.46] mg/dL; P = 0.001). Hypomagnesemia remained significantly associated with PPI (adjusted OR, OR: 2.05; 95% CI: 1.14-3.69; P = 0.017). PPI use is associated with an increased risk of hypomagnesemia in hemodialysis patients. Future prospective studies are needed to explore magnesium replacement in PPI users on hemodialysis.