HYPOMAGNESEMIA AFTER KIDNEY TRANSPLANTATION IN CHILDREN: A RETROSPECTIVE SINGLE CENTER EXPERIENCE

Introduction:

Hypomagnesemia is among the common complications that are seen after kidney Transplantation (KTX). It has been traditionally linked to the chronic use of calcineurin inhibitors (CNIs), particularly Tacrolimus. It’s usually noticed in the first few days after KTX, and continues to be there chronically, which requires chronic Magnesium supplements. Magnesium supplements have been associated with diarrhea in some patients. Our aim is to identify the incidence of hypomagnesemia after KTX, its time of first occurrence after the start of CNIs, its management, and the potential side effects of chronic Magnesium supplements. 

Methods:

A retrospective study of children underwent KTX between 2009-2023. We collected their Baseline demographics, type of KTX, their primary kidney diseases, initial serum Magnesium level, initial levels of Parathyroid hormone, 25 OH vitamin D, Calcium, and Phosphorus, dosage of Magnesium supplements, potential side effects. 

Results:

A total of 84 children underwent KTX between 2009 and 2023, their baseline demographics are shown in Table 1. 69 (82%) of children developed hypomagnesemia with a mean of occurrence at 9 days after initiation of CNIs after KTX, and range of 4 to 23 days. The average serum Magnesium level in the hypomagnesemic group group was 0.62 mmol/l with a range of 0.49 to 0.69 mmol/l. 56 (67%) of children continued to require Magnesium at 12 months after KTX. All the patients were managed with oral Magnesium Oxide (400 mg Tablet) with a mean of dose of 800 mg/day and range of 400 mg/day to 1600 mg/day. None of the normal Magnesium group developed Hypomagnesemia or required Magnesium supplement during the first 12 months after KTX. No significant side effects have been observed secondary to chronic use of Magnesium supplement, apart from short episodes of loose to watery stools in 13 (15%) children, that responded to adjustment of either the dosage or frequency of Magnesium Supplement. The associated levels of serum Phosphate, serum Calcium, 25 OH vitamin D, and PTH for both hypomagnesemic group and normal Magnesium group are shown in table 2 and 3 respectively. 

Conclusions:

Hypomagnesemia is a commonly seen after kidney transplantation, in association with the chronic use of Calcineurin inhibitors. Our findings can be biased by small sample size and the retrospective design, so prospective large sample study can delineate this area more clearly. 

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.