646 SGLT2 inhibitor alleviates hypomagnesemia in patients with chronic kidney disease: a retrospective observational study

Abstract Background and Aims Magnesium (Mg2+) is a critical component in numerous biological processes. Hypomagnesemia is associated with an increased risk of cardiovascular events and vascular calcification in individuals with and without chronic kidney disease (CKD). Sodium-glucose cotransporter-2 (SGLT2) inhibitors have been proposed for treating CKD, based on their reported benefits to the kidney and cardiovascular system and in increasing serum Mg2+ levels in patients with type 2 diabetes mellitus. However, the underlying mechanisms remain unclear. In this retrospective observational study, we aimed to investigate the changes in serum Mg2+ levels after administering SGLT2 inhibitors and to identify factors contributing to these changes. Method We retrospectively examined 57 patients with CKD who received treatment at Wakayama Medical University between January 1, 2017, and December 31, 2022. We assessed changes in serum Mg2+ levels at baseline and 1, 3, and 6 months post-treatment. Patients were stratified into tertiles based on baseline Mg2+ levels. Multivariate regression analyses were conducted to identify factors associated with changes in Mg2+ levels. Results SGLT2 inhibitor treatment was associated with a significant increase in serum Mg2+ levels in the low and intermediate tertiles but not in the high tertile. Multivariate analysis revealed that gender, baseline serum Mg2+, and sodium-chloride difference were independent predictors of the increase in serum Mg2+ levels. Conclusion SGLT2 inhibitor treatment in CKD patients is associated with an increase in serum Mg2+ levels, particularly in those with lower baseline levels. The serum Mg2+-improving effect of SGLT2 inhibitors is influenced by baseline serum Mg2+ levels, sodium-chloride difference, and gender. These findings suggest the potential utility of SGLT2 inhibitors for treating hypomagnesemia in CKD.