Use of Proton Pump Inhibitors is Associated withSevere Hypomagnesemia in Kidney TransplantRecipients

Hypomagnesemia is common in the early post-transplant period and is often associated with CNI use. PPIs are preferred choice of agents for stress ulcer prophylaxis and have been associated with hypomagnesemia especially when coupled with diuretic use. We postulated that PPI use in the post-transplant setting increases the severity of hypomagnesemia associated with CNI use compared to H2B. A total of 83 patients were included in the study, 43 were on PPI and 40 on H2B. There was a statistically significant difference between the two groups with mean magnesium levels being 1.70 ± 0.12 mg/dL in PPI group vs. 1.79 ± 0.17 mg/dL in H2B group (P = 0.006). Severe hypomagnesemia (defined as serum magnesium of <1.3 mg/dl) was more common in the PPI group than H2B (9/43 [21%] vs. 2/40 [5%], P = 0.03) despite oral magnesium supplementation being higher in PPI group (47% vs. 21%, P = 0.02). In conclusion, severe hypomagnesemia and oral magnesium supplementation are associated with the use of PPIs in renal transplant patients.