Siren Sezer1, Bahar Gurlek Demirci1, Mehtap Erkmen Uyar1, Saliha Uyanik2 and. Mehmet Haberal3. 1Baskent University Faculty of Medicine, Department of ...
Nephrology Dialysis Transplantation 30 (Supplement 3): iii348–iii376, 2015 doi:10.1093/ndt/gfv185.71
RENAL TRANSPLANTATION. CLINICAL - 1 FP882
IMPACT OF PROTON POMP INHIBITORS ON HYPOMAGNESEMIA AND ARTERIAL STIFFNESS IN RENAL TRANSPLANT RECIPIENTS
Siren Sezer1, Bahar Gurlek Demirci1, Mehtap Erkmen Uyar1, Saliha Uyanik2 and Mehmet Haberal3 1 Baskent University Faculty of Medicine, Department of Nephrology, Ankara, Turkey, 2Baskent University Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey, 3Baskent University Faculty of Medicine, Department of General Surgery, Ankara, Turkey Introduction and Aims: Hypomagnesemia predicts cardiovascular morbidity and mortality in the general population and accelerated loss of kidney function in renal transplant recipients (RTRs). Proton pomp inhibitors (PPIs) or H2 receptor blockers (H2RBs) are frequently used agents after RT. Recent studies highlighted the association between hypomagnesemia and PPIs in healthy population and patients ongoing hemodialysis. The aim of this study was to evaluate the effects of PPIs on serum magnesium levels and arterial stiffness in RTRs. Methods: : We performed a retrospective study of 354 maintenance RTRs (mean age:
38.6 ± 10.7 years) with stable allograft function who had received their transplant at least 36 months previously. All acute cellular and humoral rejections were excluded. According to using stomach-protecting agents (SPAs), patients were divided in to three groups: PPIs (Group 1, n: 164), H2RBs (Group 2, n: 96) and control group who don’t receive SPAs (Group 3, n: 94). Clinical and laboratory parameters (complete blood count, creatinine, calcium, phosphorus, magnesium, vitamin B12, folic acid, lipid profile) were noted from recorded data. Estimated glomerular filtration rate (eGFR) was calculated by using the MDRD4 equation. Pulse wave velocity (PWv) was determined from pressure tracing over carotid and femoral arteries using the SphygmoCor system. Results: Groups were similar in means of demographic characteristics (age, gender, duration of dialysis before transplantation) and biochemical parameters as serum calcium, phosphorus, parathyroid hormone, CRP, lipid profile and eGFR levels. Mean serum magnesium levels were significantly lower in group 1, however similar in group 2 and 3 (1.5 ± 0.04 mg/dl, 1.7 ± 0.02 mg/dl and 1.7 ± 0.01 mgdl, respectively). PWv values were significantly higher in group 1, whereas similar in group 2 and 3 (7.3 ± 0.2 cm/sec, 6.3 ± 0.1cm/sec and 6.2 ± 0.1 cm/sec, retrospectively). In linear regression analysis; type of SPAs ( p: 0.001), serum calcium ( p: 0.031), magnesium ( p: 0.07) and folic acid levels ( p: 0.013) were detected as the predictors of PWv. Conclusions: We concluded that PPIs inhibit magnesium absorbtion independent from calcium metabolism in RTRs. Moreover, PPIs leads to increased arterial stiffness and cardiovascular risk in RTRs. Thus physicians should be aware of the side effects of PPIs to scale down the cardiovascular morbidity and mortality.
© The Author 2015. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.
