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Clinical impact of hypermagnesemia in acute kidney injury patients undergoing continuous kidney replacement therapy: A propensity score analysis utilizing real-world data.

  • 2025-02
  • Journal of critical care 85
    • Ming-Jen Chan
    • Jia-Jin Chen
    • Cheng-Chia Lee
    • Pei-Chun Fan
    • Yi-Jiun Su
    • Ya-Lien Cheng
    • Chao-Yu Chen
    • VinCent Wu
    • Yung-Chang Chen
    • Chih-Hsiang Chang

Study Design

Type
Observational
Sample size
n = 2,625
Population
2625 patients who underwent continuous kidney replacement therapy (CKRT)
Methods
retrospective analysis using data from a multicenter medical repository spanning from 2001 to 2019; patients categorized into normomagnesemia (<2 mEq/L) and hypermagnesemia (≥2 mEq/L) groups based on levels at CKRT initiation

Purpose

While hypomagnesemia is known to be a risk factor for acute kidney injury (AKI), the impact of hypermagnesemia on prognosis in AKI patients undergoing continuous kidney replacement therapy (CKRT) remains unclear. This study investigates the relationship between hypermagnesemia and clinical outcomes in this patient population.

Methods

A retrospective analysis was conducted using data from a multicenter medical repository spanning from 2001 to 2019, involving patients who underwent CKRT. Patients were categorized into normomagnesemia (<2 mEq/L) and hypermagnesemia groups based (≥2 mEq/L) on their levels at CKRT initiation.

Results

Among the 2625 patients, 1194 (45.5 %) had elevated serum magnesium levels. The hypermagnesemia group exhibited a similar rate of non-recovery of renal function at 90-days compared to the normomagnesemia group (63.1 % vs. 62.8 %, odds ratio [OR] = 1.01, 95 % confidence interval [CI] 0.90-1.14). Furthermore, the high magnesium group demonstrated higher one-year all-cause mortality (hazard ratio [HR] 1.14, 95 % CI 1.07-1.21) and an elevated risk of one-year arrhythmia (HR 4.77, 95 % CI 1.59-14.29). There was no difference of incidence of seizure between hypermagnesemia and normomagnesemia group.

Conclusions

Our study suggests that hypermagnesemia in AKI patients undergoing CKRT is not associated with improved renal recovery but is linked to worse clinical outcomes, including all-cause mortality and arrhythmia. Close monitoring of serum magnesium levels is recommended in this population for optimizing clinical outcomes.

Research Insights

  • Magnesium→Reduced One-Year All-Cause Mortality

    the high magnesium group demonstrated higher one-year all-cause mortality (hazard ratio [HR] 1.14, 95% CI 1.07-1.21)

    Effect
    Harmful
    Effect size
    Small
  • Magnesium→Reduced One-Year Arrhythmia

    an elevated risk of one-year arrhythmia (HR 4.77, 95% CI 1.59-14.29)

    Effect
    Harmful
    Effect size
    Large
  • Magnesium→Reduced Renal Recovery

    The hypermagnesemia group exhibited a similar rate of non-recovery of renal function at 90-days compared to the normomagnesemia group (63.1% vs. 62.8%, odds ratio [OR] = 1.01, 95% confidence interval [CI] 0.90-1.14).

    Effect
    Neutral
    Effect size
    Small
  • Magnesium→Reduced Seizure Incidence

    There was no difference of incidence of seizure between hypermagnesemia and normomagnesemia group.

    Effect
    Neutral
    Effect size
    Small
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