P254
THE EFFECT OF AMILORIDE ON TACROLIMUS-INDUCED HYPOMAGNESAEMIA
Abdulnabi, K, Moberly, J, El-Bakry, A, Mehra, S, Sharma,A, Ridgway, D, Hammad, A, Howse, M
Department of Kidney Transplantation. The Royal Liverpool Hospital
INTRODUCTION:
Hypomagnesaemia happens in more than 50% of Tacrolimus treated patients. There is growing evidence that
supplementing Mg in those patients has very little effect if any. Amiloride was used successfully in treating
amphotericin B-induced hypomagnesaemia and in Gitleman’s syndrome. It is hypothesised that Amiloride
stimulates magnesium reabsorption within the distal tubule through sensoring Ca2+/Mg+2 receptors. This study
aim is to assess the effect of Amiloride on refractory hypomagnesaemia in Tacrolimus-treated kidney transplant
patients.
METHODS:
A prospective audit of 13 patients with low Mg secondary to Tacrolimus. Inclusion criteria were refractory
hypomagnesaemia in spite of Mg supplementation or intolerance of oral Mg. Data on baseline Mg, potassium, Cr,
Mg dose and duration of treatment were collected.
RESULTS:
Mg1(mmol/l)
Mg2 (mmol/l)
K1 (mmol/l)
K2 (mmol/l)
Amiloride dose (mg/day)
Mg supplement
(mmol/day)
F/u Duration ( week)
Creatinine mmol/l
Minimu
m
0.38
0.40
2.9
3.6
2.5
0
Maximum Mean
SD
0.59
0.61
5.2
5.9
5.0
40
0.48
0.50
4.26
5.08
3.46
11.69
0.07
0.07
0.67
0.61
1.26
12.16
2
70
5
420
3.23
193
1
91
No significant correlation was noticed between follow up mg level and Amiloride dose, duration of treatment, Mg
dose or Creatinine. Paired T Test shows no significant change in Mg mean (mg1= 0.48±0.07, mg2= 0.50±0.07, p=
0.17). However, significant rise in potassium level was observed (K1= 4.26±0.67, K2=5.08±0.61, p<0.0001).
CONCLUSION:
Amiloride failed to increase Mg levels using a dose of 2.5 to 5 mg daily over short period follow up. Audit was
stopped early due to Mg no- effect results and significant rise in potassium levels.