Abstract: FR-PO128
Hypomagnesemia in Critically Ill Patients Undergoing Continuous and Prolonged Intermittent Kidney Replacement Therapies: Still a Matter of Debate?
Session Information
- AKI: Outcomes, RRT
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Di Mario, Francesca, Parma University Hospital, Parma, Italy
- Maggiore, Umberto, Parma University Hospital, Parma, Italy
- Regolisti, Giuseppe, Parma University Hospital, Parma, Italy
- Menegazzo, Brenda, Parma University Hospital, Parma, Italy
- Pacchiarini, Maria Chiara, Parma University Hospital, Parma, Italy
- Greco, Paolo, Parma University Hospital, Parma, Italy
- Maccari, Caterina, Parma University Hospital, Parma, Italy
- Fiaccadori, Enrico, Parma University Hospital, Parma, Italy
Background
Hypomagnesemia may represent a fearsome complication in critically ill patients undergoing Continuous and Prolonged Intermittent Kidney Replacement Therapy (CKRT, PIKRT). Given its negative impact on morbidity and mortality, strategies aimed at reducing its incidence should be timely implemented. We carried out a prospective observational study aimed at assessing the incidence and outcome of hypomagnesemia in ICU patients undergoing CKRT and PIKRT with Regional Citrate Anticoagulation.
Methods
KRT was performed by the Prismax system and AN69 filters (Baxter), combining a trisodium citrate solution (Regiocit 18/0, Baxter) with a Mg-containing solution used as dialysis and/or post-dilution replacement fluid (Mg2+ 0.75 mmol/L; Biphozyl, Baxter). Each patient underwent 72-h CKRT or 3 consecutive 8-h SLED sessions. Mg losses were replaced, when needed, with Mg sulphate. We used linear mixed-effects and time-varying Cox multiple regression models to assess s-Mg level and its association with mortality.
Results
We enrolled 47 patients on CVVH, CVVHDF and SLED (mean APACHE II 25+7.0); s-Mg was 2.07±0.48 mg/dL at baseline and decreased by -0.25 mg/dL during KRT (P=0.0003, Figure 1), with the nadir being reached since the first KRT session. Hypomagnesemia (s-Mg<1.6 mg/dL) was observed, at least once, in 46.8% of patients, despite an average supplementation of 1.18 g/day. There was a trend, albeit not statistically significant, of lowest s-Mg values to be associated with increased mortality,after adjusting for potential confounders.
Conclusion
Hypomagnesemia is an incident complication of CKRT and PIKRT, mainly depending on baseline s-Mg. It seems associated with ICU mortality. Among preventive strategies, the evaluation of ionized s-Mg levels may represent a useful tool to better clarify Mg mass transfer during KRT.