Hypomagnesemia is a risk factor for nonrecovery of renal function and mortality in AIDS patients with acute kidney injury

The objective of the present study was to determine the prevalence of electrolyte disturbances in AIDS patients developing acute kidney injury in the hospital setting, as well as to determine whether such disturbances constitute a risk factor for nephrotoxic and ischemic injury. A prospective, observational cohort study was carried out. Hospitalized AIDS patients were evaluated for age; gender; coinfection with hepatitis; diabetes mellitus; hypertension; time since HIV seroconversion; CD4 count; HIV viral load; proteinuria; serum levels of creatinine, urea, sodium, potassium and magnesium; antiretroviral use; nephrotoxic drug use; sepsis; intensive care unit (ICU) admission, and the need for dialysis. Each of these characteristics was correlated with the development of acute kidney injury, with recovery of renal function and with survival. Fifty-four patients developed acute kidney injury: 72 percent were males, 59 percent had been HIV-infected for >5 years, 72 percent had CD4 counts <200 cells/mm³, 87 percent developed electrolyte disturbances, 33 percent recovered renal function, and 56 percent survived. ICU admission, dialysis, sepsis and hypomagnesemia were all significantly associated with nonrecovery of renal function and with mortality. Nonrecovery of renal function was significantly associated with hypomagnesemia, as was mortality in the multivariate analysis. The risks for nonrecovery of renal function and for death were 6.94 and 6.92 times greater, respectively, for patients with hypomagnesemia. In hospitalized AIDS patients, hypomagnesemia is a risk factor for nonrecovery of renal function and for in-hospital mortality. To determine whether hypomagnesemia is a determinant or simply a marker of critical illness, further studies involving magnesium supplementation in AIDS patients are warranted.

Association between admission hypomagnesemia mortality or mortality of critically ill patients in intensive care unit

Up to now there is no study evaluating correlation between serum magnesium and morbidity or mortality in patients admitted in intensive care unit. The aim of this study is to determine the prevalence of hypomagnesemia in critically ill patients and to evaluate its association with organ dysfunction, hospitalization period and mortality. We conducted a retrospective trial including 100 patients aged 16 years and above admitted to the medico-surgical intensive care unit over 2 years. Firstly, total serum magnesium was determined and then is correlation with ventilator need, duration of mechanical ventilation, hospitalization period, and demographic characteristics were evaluated. At the time of admission, 51% and 49% of the patients showed hypomagnesia and normomagnesia, respectively. Significant difference was observed in mortality rate, hospitalization period, or hospitalization in intensive care unit between the two groups [P<0.05, each]. Hypocalcemia, hypokalemia, and hypmonatremia were frequently observed in hypomagnesemic patients, The patients with hympomagnesemia in intensive care unit demonstrated higher Acute Physiology And Chronic Health Evaluation II [APACHE-2] and Sequential Organ Failure Assessment [SOFA] scores at time of admission [P<0.01], a higher maximum SOFA score during hospitalization in intensive care unit, higher requirement to ventilator, and longer duration to mechanical ventilation than the other patients. The ROC curve of SOFA score in the hypomagnesemia generated significant results compared to APACHE-2. An increase of 5 units in the APACHE-2 or SOFA measured during admission increased relative probability of hypomagnesemia by 0.12 and 0.16, respectively. Hypomagnesemia during hospitalization in intensive care unit was associated with a poor prognosis. Monitoring of serum magnesium may have prognostic and therapeutic implications

Magnesium supplementation and the potential association with mortality rates among critically ill non-cardiac patients

Recent literature showed that development of hypomagnesemia is associated with higher mortality. The objective of this study is to evaluate the impact of magnesium supplementation on mortality rates of critically ill patients. All patients admitted to the Intensive Care Unit [ICU] of King Abdul-Aziz Medical City, Riyadh, Saudi Arabia since September 2003 were included. We recorded the demographics data, APACHE score, daily magnesium levels and magnesium supplementation. We collected the data for 30 days or until discharge from ICU. Statistical analysis was performed using the student t-test for continuous data and the Fischers exact test for categorical data. Nothing was carried out to influence the behavior of intensivists in replacing magnesium. During the study period, 71 patients [45 males and 26 females] were admitted to the ICU, the mean age was 54 +/- 18 years for males and 56 +/- 19.2 years for females. The mean magnesium level on admission was 0.78 +/- 0.2 mmol/L and the majority of the patients were medical admissions. Approximately 39.4% had hypomagnesemia on admission and the overall mortality rate was 31%. In able to standardize the supplementation of magnesium among groups, the daily magnesium supplementation index [DMSI = total magnesium supplement in grams/length of stay in days] was calculated. The mortality rates for DMSI with <1 grm/day [low groups] was statistically significant higher than that of DMSI with >1 grm/day [high group] [43.5% versus 17%, p=0.035]. There was no statistically significant differences between magnesium levels of both groups of DMSI except at admission where DMSI group had higher magnesium levels [<1 grm/day]. Daily magnesium supplementation index higher than 1 grm/day is associated with lower mortality rates for critically ill patients. This effect was not found to be independent and may be related to severity of illness. Given that magnesium levels were similar between the 2 groups of DMSI at almost all points of the study, magnesium supplementation per se may be beneficial in lowering mortality rates. The exact cause of this effect is unknown. An aggressive magnesium supplementation protocol may be warranted. A larger scale randomized study is necessary to evaluate this effect

Valor predictivo del magnesio sérico en el niño críticamente enfermo / Predictive value of the seric magnesium in the criticament ill child

En el presente estudio, se determinó la relación entre hipomagnesio y mortalidad, en pacientes pediátricos, ingresados en la UCIP, del Hospital JM de los Ríos, entre los meses de septiembre-noviembre de 1995, se cuantificaron los niveles séricos de Mg++ y su asociación con la mortalidad; así como, se determinó el puntaje promedio del TISS, correlacionando el grado de severidad de la enfermedad, encontrando que, la hipomagnésemia es frecuente al ingresar los pacientes a la UCIP (40,63 por ciento); el valor predictivo de mortalidad de los niveles séricos de Mg++, fué baja probablemente porque el tamaño de la muestra fué pequeña; la hipomagnésemia se relacionó con mayor mortalidad (38,46 por ciento); el 71,43 por ciento de los que fallecieron estaban hipomagnesémicos, 28,57 por ciento normomagnésicos, y pertenecían ambos grupos a la clase III-IV del TISS; los que evolucionaron satisfactoriamente, a la clase I-II; la mayoría de los pacientes que ingresó, fueron lactantes, y no hubo diferencia en la mortalidad entre los grupos etarios; todos los pacientes que evolucionaron satisfactoriamente, egresaron con Mg++ sérico en el paciente pediátrico críticamente enfermo, con su concomitante restitución y mantenimiento en la nutrición y fluidoterapia parenteral