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Association of magnesium abnormalities at intensive care unit admission with kidney outcomes and mortality: a prospective cohort study

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Abstract

Background

Magnesium abnormalities have been associated with adverse kidney outcomes and mortality in critically ill patients, however, this association remains inconsistent. This study aimed to investigate the association of magnesium abnormalities at intensive care unit (ICU) admission with kidney outcomes (i.e., acute kidney injury (AKI) and kidney function recovery) and mortality risk in a large cohort of critically ill patients.

Methods

A prospective cohort study was conducted by collecting data from three ICUs in Brazil. The ICU admission serum magnesium level was used to define hypomagnesemia (< 1.60 mg/dL) and hypermagnesemia (> 2.40 mg/dL). The Kidney Disease Improving Global Outcomes AKI Guideline was used to define AKI based on serum creatinine levels. Kidney function recovery was defined as full recovery, partial recovery, and non-recovery at ICU discharge. Mortality was screened up to 28 days during ICU stay.

Results

A total of 7,042 patients was analyzed, hypomagnesemia was found in 18.4% (n = 1,299) and hypermagnesemia in 4.4% (n = 311). Patients with hypomagnesemia were 25% more likely to develop AKI after adjustment for confounding variables (OR = 1.25; 95% CI 1.08–1.46). No significant association was found for hypermagnesemia and AKI (OR = 1.18; 95% CI 0.89–1.57). Kidney function recovery was similar among groups but hypermagnesemia had lower non-recovery rates. Both hypomagnesemia and hypermagnesemia were associated with 65 and 52% higher mortality risk after adjustments for confounders, respectively (HR = 1.65; 95% CI 1.32–2.06 and 1.52; 95% CI 1.01–2.29).

Conclusions

Hypomagnesemia, but not hypermagnesemia, at ICU admission was associated with AKI development. On the other hand, both hypomagnesemia and hypermagnesemia were associated with higher mortality risks.

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Data availability

The authors declare that if requested the data may be available following all ethical concerns.

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Acknowledgements

We are grateful to the entire data collection team involved in this research: Rafael Reis, Marcus Santos, Marvery Duarte, Lucas Almeida, and Gustavo Dourado. We also would like to thank the intensive care doctors, nephrologists, and nurses who helped in the study.

Funding

This study was supported by the Fundação de Apoio à Pesquisa do Distrito Federal (FAPDF) (Grant 193.001.558/2017).

Author information

Authors and Affiliations

  1. Interdisciplinary Research Department, University Center ICESP, Brasília, Brazil

    Heitor S. Ribeiro, Edilene A. Vieira, Aparecido P. Ferreira & Antônio J. Inda-Filho

  2. University of Maia, Maia, Portugal

    Heitor S. Ribeiro

  3. LIM 12, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil

    Emmanuel A. Burdmann

  4. Santa Lúcia Hospital, Brasília, Brazil

    Mateus L. Ferreira

Authors
  1. Heitor S. Ribeiro
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  2. Emmanuel A. Burdmann
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  3. Edilene A. Vieira
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  4. Mateus L. Ferreira
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  5. Aparecido P. Ferreira
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  6. Antônio J. Inda-Filho
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Heitor S. Ribeiro, Mateus L. Ferreira and Edilene A. Vieira. The first draft of the manuscript was written by Heitor S. Ribeiro and Antônio J. Inda-Filho. Supervision and final contributions were done by Emmanuel A. Burdmann and Aparecido P. Ferreira. All authors read and approved the final manuscript version.

Corresponding author

Correspondence to Antônio J. Inda-Filho.

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Conflict of interest

The authors have no conflicts of interest to declare. Informed consent was obtained from the ICU units and hospital, but not directly from the patients, and the data was collected only from medical records in the electronic system anonymously. This ethical approach was approved by the Research Ethics Committee of the University Center ICESP (#3.608.561).

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Ribeiro, H.S., Burdmann, E.A., Vieira, E.A. et al. Association of magnesium abnormalities at intensive care unit admission with kidney outcomes and mortality: a prospective cohort study. Clin Exp Nephrol 26, 997–1004 (2022). https://doi.org/10.1007/s10157-022-02245-6

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