Kidney Medicine最新文献

{"title":"RECOVID: Retrospective Observational Study of Renal Outcomes and Long-Term Mortality in Patients With COVID-19-Associated AKI, A Comparison Between Vaccinated and Unvaccinated Patients","authors":"Niloofar Nobakht , Charley Jang , Tristan Grogan , Peter Fahim , Ira Kurtz , Joanna Schaenman , James Wilson , Mohammad Kamgar , RECOVID Investigators","doi":"10.1016/j.xkme.2025.101020","DOIUrl":"10.1016/j.xkme.2025.101020","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Acute kidney injury (AKI) is a common complication in patients with Coronavirus disease-2019 (COVID-19) infections, with rates as high as 32% to 46%, and it has been associated with poor outcomes. However, the long-term renal and survival outcomes among hospitalized patients with COVID-19 and AKI are not fully understood.</div></div><div><h3>Study Design</h3><div>A single-center cohort study.</div></div><div><h3>Setting & Participants</h3><div>Total of 972 adult patients admitted with COVID-19 infection and AKI at a single large urban academic medical center from March 1, 2022, to March 30, 2022. Among these, 411 (42.3%) did not receive a dose of a US FDA-approved COVID-19 vaccine, and 467 (48.0%) had completed the primary vaccine series.</div></div><div><h3>Exposure</h3><div>Patients admitted with COVID-19 infection and AKI were analyzed using vaccination status as the exposure. Additional exposures included demographics, comorbid conditions, and need for continuous renal replacement therapy (CRRT) during hospitalization.</div></div><div><h3>Outcome</h3><div>The primary outcome was in-hospital mortality. Secondary outcomes included long-term mortality, length of hospital stay, and the need for renal replacement therapy (RRT) at discharge.</div></div><div><h3>Analytical Approach</h3><div>The vaccinated and unvaccinated cohorts were characterized using descriptive analyses. The cohorts were analyzed using the Kaplan-Meier method and groups were compared using the log-rank test. Multivariable cox, logistic, and linear regression models were used for mortality, RRT status at discharge, and length of stay, respectively.</div></div><div><h3>Results</h3><div>Among 3,527 hospitalized patients with a COVID-19 infection, AKI occurred in 972 patients. Of the 972 patients with AKI, 411 (42.3%) did not receive a dose of a US FDA-approved COVID-19 vaccine and 467 (48.0%) had completed the primary vaccine series. Unvaccinated patients had a higher rate of requiring CRRT during their hospitalization compared with vaccinated patients (15.8% vs 10.9%, <em>P</em> <!-->=<!--> <!-->0.03). The CRRT during hospitalization was significantly associated with in-hospital death (adjusted HR 2.82; 95% CI, 1.88-4.25) and long-term follow-up death (adjusted HR 2.44; 95% CI, 1.73-3.42). Unvaccinated patients also had a 2.56 (95% CI, 1.52-4.30) times higher odds of being discharged on RRT when compared with those who were vaccinated. In an adjusted multivariable analysis, those who were unvaccinated had both significantly increased in-hospital mortality (adjusted HR 5.54; 95% CI, 3.36-9.13) and long-term follow-up mortality (adjusted HR 4.78; 95% CI, 3.39-6.73) when compared with those who were vaccinated.</div></div><div><h3>Limitations</h3><div>There was a lack of data on the ventilation status and other indicators of infection severity in patients in intensive care unit who received CRRT. In addition, data on booster COVID-19 v","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 7","pages":"Article 101020"},"PeriodicalIF":3.2,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply: Comment on “Kidney Function and Incident Stroke and Dementia Using an Updated Estimated Glomerular Filtration Rate Equation Without Race: The Multi-Ethnic Study of Atherosclerosis”","authors":"Samuel Moen MPH, James Pankow PhD, Sanaz Sedaghat PhD","doi":"10.1016/j.xkme.2025.101034","DOIUrl":"10.1016/j.xkme.2025.101034","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 6","pages":"Article 101034"},"PeriodicalIF":3.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144184777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to the letter by Ito","authors":"Maxime Ingwiller MD , Thierry Hannedouche MD, PhD","doi":"10.1016/j.xkme.2025.101032","DOIUrl":"10.1016/j.xkme.2025.101032","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 6","pages":"Article 101032"},"PeriodicalIF":3.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144184776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on “Kidney Function and Incident Stroke and Dementia Using an Updated Estimated Glomerular Filtration Rate Equation Without Race: The Multi-Ethnic Study of Atherosclerosis”","authors":"Paul T. Williams PhD","doi":"10.1016/j.xkme.2025.101033","DOIUrl":"10.1016/j.xkme.2025.101033","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 6","pages":"Article 101033"},"PeriodicalIF":3.2,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144166416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re: “Kidney Biopsy-Proven Diabetic and Non-Diabetic Kidney Diseases and Outcomes in Patients With Type 2 Diabetes Receiving Dialysis: The REIN Registry” by Ingwiller et al.","authors":"Hiroki Ito MD, PhD","doi":"10.1016/j.xkme.2025.101031","DOIUrl":"10.1016/j.xkme.2025.101031","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 6","pages":"Article 101031"},"PeriodicalIF":3.2,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144166422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Variation in Management of CKD-Associated Pruritus: Results From a Multinational Survey of Kidney Units","authors":"Sreeram Venugopal , Daniel V. O’Hara , Neeru Agarwal , Barnaby D. Hole , Charlotte M. Snead , Elizabeth Stallworthy , Fergus J. Caskey , Kathryn Ducharlet , Brendan Smyth","doi":"10.1016/j.xkme.2025.101028","DOIUrl":"10.1016/j.xkme.2025.101028","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Chronic kidney disease-associated pruritus (CKDaP) is a distressing symptom affecting a significant proportion of people with advanced kidney disease. There are many studies of varying quality in the literature testing a wide variety of CKDaP therapies and no evidence-based consensus guidelines for management. We aimed to describe the breadth of treatments in use for CKDaP in real-world practice.</div></div><div><h3>Study Design</h3><div>A cross-sectional online survey.</div></div><div><h3>Setting & Participants</h3><div>Kidney care units in Australia, New Zealand (NZ), and the United Kingdom (UK). Surveyed from April 2022, to December 2022.</div></div><div><h3>Outcomes</h3><div>Usage of 28 CKDaP therapies (excluding emollients/moisturizers) was categorized as “first-line,” “second-line,” “refractory symptoms only,” “rarely used,” or “never used.”</div></div><div><h3>Analytical Approach</h3><div>Descriptive analysis with differences between categories assessed by Fisher exact test.</div></div><div><h3>Results</h3><div>One hundred four responses were received from 171 contacted kidney units (Australia 51 [49%], NZ 6 [6%], and UK 47 [45%]) with an overall response rate of 61%. Including \"other\" responses, 35 treatments were in first-line or second-line use. Gabapentinoids (gabapentin or pregabalin) were the most widely used first-line systemic agent (49 units [47%]), followed by antihistamines (27 [26%]). Menthol was the predominant first-line topical agent (41, [39%]). Significant inter-country disparities were noted: doxepin, evening primrose oil, sertraline, and topical γ-linolenic acid were more frequently used in Australia than in NZ, and the UK, whereas hydroxyzine was preferentially used in UK units (<em>P</em> <!--><<!--> <!-->0.05). Units with a kidney supportive care service were more likely to use gabapentinoids, 5-hydroxytryptamine<sub>3</sub> receptor antagonists, hydroxyzine, and topical therapies, and less likely to use promethazine (<em>P</em> <!--><<!--> <!-->0.05).</div></div><div><h3>Limitations</h3><div>Difelikefalin was not widely available during the survey period, which may limit generalizability.</div></div><div><h3>Conclusions</h3><div>There is considerable variation in the management of CKDaP. Unexplained clinical variation suggests a need for the development of evidence-based guidelines and additional high-quality studies to inform care.</div></div><div><h3>Plain-Language Summary</h3><div>People with chronic kidney disease often experience severe itching, which can significantly affect their well-being. There's no clear consensus on the best approach. This study surveyed 104 kidney care units in Australia, New Zealand, and the United Kingdom to understand how they treat this condition in practice. More than 35 different treatments were in use as first-line or second-line therapies with wide variation in treatment approaches both between units and countries. The 3 most ","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 7","pages":"Article 101028"},"PeriodicalIF":3.2,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144329678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19 Hospitalization and Mortality Trends Among US Dialysis Patients by Race/Ethnicity and Vaccination Status","authors":"Monica M. Shieu , Daniel E. Weiner , Nien Chen Li , Harold J. Manley , Antonia Harford , Caroline M. Hsu , Dana Miskulin , Doug Johnson , Eduardo K. Lacson Jr.","doi":"10.1016/j.xkme.2025.101026","DOIUrl":"10.1016/j.xkme.2025.101026","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>The coronavirus disease 2019 (COVID-19) pandemic disproportionately affected vulnerable individuals, including people with kidney disease. We elucidated longitudinal trends in hospitalization and mortality among individuals receiving maintenance dialysis before and during the pandemic and explored how universal vaccine availability affected COVID-19 outcomes by race/ethnicity.</div></div><div><h3>Study Design</h3><div>A retrospective cohort study.</div></div><div><h3>Settings & Participants</h3><div>Adult maintenance dialysis patients between 2018-2023 at a national not-for-profit US provider.</div></div><div><h3>Predictors</h3><div>COVID-19 era (2020-2023), race/ethnicity.</div></div><div><h3>Outcomes</h3><div>COVID-19 vaccination status; hospitalization and death (COVID-related, all-cause).</div></div><div><h3>Analytical Approach</h3><div>Zero-inflated Poisson models and logistic regression models were used to calculate hospitalization and mortality rates, respectively, adjusted for age, sex, race/ethnicity, dialysis vintage, and number of comorbid conditions.</div></div><div><h3>Results</h3><div>Among 41,257 patients receiving maintenance dialysis, all-cause hospitalization dropped abruptly in March/April 2020 and increased thereafter, albeit remaining below prepandemic rates. All-cause mortality exhibited typical seasonal variability during 2018-2019, subsequently increasing with onset of the COVID-19 pandemic in March 2020. Mortality peaked in January 2021 at 228 deaths per 1,000 person-years before declining to 151 deaths per 1,000 person-years in March 2021. Subsequently, mortality transiently increased during the Delta and Omicron variant periods, peaking at 188 and 189 deaths per 1,000 person-years, respectively. Thereafter, all-cause mortality remained below prepandemic levels. After widespread SARS-CoV-2 vaccine availability in 2021 with vaccine provision in dialysis facilities, the COVID-19 mortality rate among all race/ethnicity groups declined significantly (b<!--> <!-->=<!--> <!-->−5.3; <em>P</em> <!--><<!--> <!-->0.001). There were no statistically significant differences by race/ethnicity in the vaccination status at each year’s end.</div></div><div><h3>Limitations</h3><div>Potential residual confounders and underreporting of COVID-19–related outcomes.</div></div><div><h3>Conclusions</h3><div>All-cause mortality increased sharply in 2020 and early 2021, reflecting COVID-19-related deaths, whereas non–COVID-19 mortality declined during the early phase of the pandemic and subsequently remained below prepandemic levels. After introduction of SARS-CoV-2 vaccines, all-cause mortality declined to below prepandemic levels, likely reflecting the impact of widespread vaccination in the dialysis population.</div></div><div><h3>Plain-Language Summary</h3><div>This study evaluated trends for mortality, hospitalization, and vaccination status, before and during the coronavirus disease 2019 (C","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 7","pages":"Article 101026"},"PeriodicalIF":3.2,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144329496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal Trends in Acute Kidney Injury in Hospitalizations From 2009-2018 in Alberta: A Retrospective Population-Based Cohort Study","authors":"Anita Dahiya , Natasha Wiebe , Tyrone G. Harrison , Matthew T. James , Neesh Pannu , Alberta Kidney Disease Network","doi":"10.1016/j.xkme.2025.101029","DOIUrl":"10.1016/j.xkme.2025.101029","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Studies have reported an increase in acute kidney injury (AKI) incidence; however, they are limited by administrative codes. We aimed to identify trends in AKI incidence, severity, and mortality using Kidney Disease: Improving Global Outcomes (KDIGO)-based definitions.</div></div><div><h3>Study Design</h3><div>This is a retrospective, population-based cohort study.</div></div><div><h3>Setting & Population</h3><div>Hospitalized adult patients in Alberta, Canada from 2009-2018.</div></div><div><h3>Exposures</h3><div>AKI episodes were identified using validated KDIGO definitions.</div></div><div><h3>Outcomes</h3><div>We assessed in-hospital and 90-day all-cause mortality.</div></div><div><h3>Analytical Approach</h3><div>Generalized linear models with a Gaussian family were used to determine absolute rates of AKI and mortality. Rates of AKI and mortality were adjusted for patient demographics and comorbid conditions.</div></div><div><h3>Results</h3><div>There were 339,986 hospitalizations with an episode of AKI (12.7%, 2,668,954 hospitalizations) with a median age of 70 years (56, 82) and 152,115 (44.7%) women. AKI rates increased by an unadjusted relative increase of 5.5% (95% confidence interval [CI], 4.2-6.9). When fully adjusted, a relative decrease of 11.2% (95% CI, 9.2-13.2) was seen in rates of AKI. Stage 1 AKI was most common (unadjusted mean rate, 659 per 100,000 person-years [95% CI, 655-662]). In-hospital mortality decreased across all stages of AKI with the greatest decrease noted in stage 3 AKI requiring kidney replacement therapy (unadjusted relative decrease 29.9% [95% CI, 20-38.6]). Similar trends were identified in 90-day mortality.</div></div><div><h3>Limitations</h3><div>The primary strength of this paper is that it involves a large cohort of patients from a diverse population. The use of KDIGO definition of AKI is limited by the reliance on serum creatinine values.</div></div><div><h3>Conclusions</h3><div>Although rates of AKI appear to be increasing, this seems to be largely driven by patient comorbid condition with the highest rates seen in stage 1 AKI. Furthermore, there was an overall increase in rates of AKI in patients aged younger than 60 and a decrease in the most elderly of patients in both the crude and adjusted data, suggesting potential changes in practice patterns and patient characteristics. Despite this increase, there was an overall decrease in mortality, especially in severe forms of AKI.</div></div><div><h3>Plain Language Summary</h3><div>Acute kidney injury (AKI) is the sudden decrease in kidney function. It is common and reported to be increasing in the literature; however, previous studies are limited by their definitions of AKI. In this study, we looked at changes in the number of AKIs and death rates in hospitalized patients with AKI in Alberta, Canada from 2009-2018. We found that when we accounted for the fact that patients are getting sicker, the rates of AK","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 7","pages":"Article 101029"},"PeriodicalIF":3.2,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144329679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kidney Outcomes in Patients With Advanced Heart Failure Treated With Ventricular Assist Devices","authors":"Lyle W. Baker , Tambi Jarmi , Michael A. Mao , Ivan E. Porter , Christopher L. Trautman , Parag C. Patel , Yaohua Ma , David O. Hodge , Nabeel Aslam","doi":"10.1016/j.xkme.2025.101027","DOIUrl":"10.1016/j.xkme.2025.101027","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Ventricular assist devices (VADs) are used for advanced heart failure, but their impact on kidney function remains unclear. This study evaluated changes in kidney function following VAD implantation, including acute kidney injury (AKI) incidence and need for kidney replacement therapy (KRT).</div></div><div><h3>Study Design</h3><div>A retrospective cohort study analyzing longitudinal kidney function outcomes post-VAD placement.</div></div><div><h3>Setting & Participants</h3><div>Adult patients who underwent durable VAD placement (2009-2019) at a single center were included. Patients were stratified into chronic kidney disease (CKD) (estimated glomerular filtration rate [eGFR]<!--> <!--><60<!--> <!-->mL/min/1.73m<sup>2</sup>) and non-CKD (eGFR<!--> <!-->≥60<!--> <!-->mL/min/1.73m<sup>2</sup>) groups.</div></div><div><h3>Exposures & Predictors</h3><div>The VAD implantation was the primary intervention, with baseline kidney function modifying its impact on post-VAD kidney function.</div></div><div><h3>Outcomes</h3><div>Primary outcomes were changes in eGFR and creatinine at 3-months and 12-months post-VAD. Secondary outcomes included AKI incidence, KRT requirement, and postdischarge AKI within 1 year.</div></div><div><h3>Analytical Approach</h3><div>Descriptive statistics and comparative analyses, including Wilcoxon rank sum, χ<sup>2</sup>, and paired <em>t</em> tests, were used to assess differences. Significance was set at <em>P</em> <!--><<!--> <!-->0.05.</div></div><div><h3>Results</h3><div>Among 160 patients (82% male and 69% White), patients with CKD were older with a higher prevalence of diabetes, vasodilator use, and inotrope use. At 3 months, kidney function improved in patients with CKD (eGFR<!--> <!-->+17, <em>P</em> <!--><<!--> <!-->0.001) but declined by 12 months (eGFR<!--> <!-->+7, <em>P</em> <!-->=<!--> <!-->0.03). The non-CKD group had a smaller improvement at 3 months (eGFR<!--> <!-->+8, <em>P</em> <!-->=<!--> <!-->0.004) that was not sustained. AKI requiring KRT occurred in 14%, with 45% in-hospital mortality; and 41% discontinued KRT before discharge. Post-VAD AKI occurred in 21%. Half of the patients underwent heart transplant, which was associated with worsening kidney function at 1-year.</div></div><div><h3>Limitations</h3><div>Single-center design limits generalizability.</div></div><div><h3>Conclusions</h3><div>The VAD placement initially improves kidney function, particularly in CKD patients, but this effect diminishes over time. AKI and KRT use are common, highlighting the need for close kidney monitoring post-VAD.</div></div><div><h3>Plain-Language Summary</h3><div>Ventricular assist devices (VADs) help patients with advanced heart failure by supporting heart function, but their impact on kidney health is not well understood. Because kidney disease is common in heart failure and linked to worse outcomes, we studied how kidney function changes after VAD placement","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 7","pages":"Article 101027"},"PeriodicalIF":3.2,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144329781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypomagnesemia With Metformin Use in Diabetes Mellitus: A Case and Narrative Review","authors":"Eric J. Xu,&nbsp;David J.R. Steele,&nbsp;Andrew Z. Fenves","doi":"10.1016/j.xkme.2025.101030","DOIUrl":"10.1016/j.xkme.2025.101030","url":null,"abstract":"<div><div>Hypomagnesemia is defined as a serum magnesium level<!--> <!-->&lt;1.7<!--> <!-->mg/dL, and it can be induced by gastrointestinal losses or renal wasting of magnesium. This is a common electrolyte abnormality in patients with diabetes mellitus. Refractory hypomagnesemia presents a significant challenge in clinical management, because some patients are prone to developing severe, recurrent hypomagnesemia that is refractory to aggressive repletion. In diabetes, insulin resistance in renal tissue inhibits magnesium reabsorption and contributes to the hypomagnesemia observed in these patients. Hypomagnesemia has also been reported with use of metformin and may be because of gastrointestinal wasting and intracellular accumulation. Chronic use of metformin suppresses transient receptor potential cation channel subfamily M member 6 in the kidneys, although it also appears to reduce urinary magnesium excretion. In addition to repletion aadnd using potassium-sparing diuretics, substituting sodium-glucose cotransporter 2 inhibitors for metformin may be helpful in managing refractory hypomagnesemia in patients with diabetes.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 7","pages":"Article 101030"},"PeriodicalIF":3.2,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144329681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}