Lower serum magnesium is a predictor of left ventricular hypertrophy in patients on dialysis.

PURPOSE: Left ventricular hypertrophy (LVH) represents one of the main risk factors for cardiovascular mortality in dialysis patients. Low serum magnesium Mg is related with increased mortality in general and dialysis population. Aim of our study was to evaluate the association of Mg with LVH and cardiac geometry in dialysis patients. METHODS: Hemodialysis (HD) and peritoneal dialysis (PD) patients from nine nephrology departments were included. Echocardiographic LVH was defined by LV mass index > 95 g/m2 in women and > 115 g/m2 in men. Four LV geometric patterns were defined: normal, concentric remodeling, eccentric LVH and concentric LVH. Demographic and laboratory data were collected. RESULTS: 133 patients (68 HD, 65 PD) with a median age of 63 years (IQR 52-74) were studied. Mg correlated positively with creatinine, HDL and negatively with CRP levels and BMI. There were no significant differences in Mg between the modality groups. 80 patients presented LVH (43 HD and 37 PD patients). Patients with LVH were older (median age 68 vs 55 years, p < 0.001), with higher BMI (median 26.9 vs 24.7 kg/m2, p = 0.009), had a history of PVD or CAD (55% vs 30.2%, p = 0.003), had higher pulse pressure (median 60 vs 50, p = 0.017), MIS score (median 5 vs 4, p = 0.011), lower albumin (median 3.5 vs 3.8 g/dl, p = 0.011) and Mg levels (median 2.1 vs 2.4 mg/dl, p < 0.001). In univariate analysis age, CVD comorbidities, pulse pressure, CRP, BMI, albumin, Mg, MIS and use of b-blockers or calcium blockers were LVH predictors. In multivariate analysis, Mg was an independent predictor of LVH, adjusted for age, MIS and b-blockers. Considering LV geometry, lower Mg levels were mainly correlated with concentric LVH. CONCLUSION: Low serum magnesium levels seem to be an independent factor for LVH in hemodialysis and peritoneal dialysis patients.

Case Report of Cardiorenal Syndrome with Ascites and Listeria monocytogenes Peritonitis: The Role of Large-Volume Paracentesis and Albumin Replacement.

BACKGROUND Spontaneous bacterial peritonitis is a common infection in hospitalized patients with ascites, particularly in patients with cirrhosis. Spontaneous bacterial peritonitis is often associated with acute kidney injury. The causative agents of spontaneous bacterial peritonitis are usually gram-negative bacteria, but lately, the prevalence of spontaneous bacterial peritonitis caused by gram-positive bacteria is rising. CASE REPORT In this report, we present the case of a 77-year-old woman with a history of cardiorenal syndrome with ascites and chronic kidney disease who was admitted with diarrhea, fever, and abdominal pain. Ascitic fluid paracentesis revealed spontaneous bacterial peritonitis due to Listeria monocytogenes. During hospitalization, her ascites gradually enlarged and her kidney function deteriorated. The deterioration of kidney function was at least partially attributed to sepsis caused by spontaneous bacterial peritonitis. In addition to proper antibiotic therapy with ampicillin and daily hemodialysis sessions, large-volume paracentesis and albumin infusions were instituted. After 5 days, she showed a fast improvement, the ascites subsided, and her renal function returned to baseline. CONCLUSIONS Spontaneous bacterial peritonitis caused by Listeria monocytogenes is associated with a poor outcome. Acute kidney injury in patients with spontaneous bacterial peritonitis is common and related with a poor outcome. Data about the role of large-volume paracentesis and albumin replacement in patients with spontaneous bacterial peritonitis are still ambiguous. In the literature, all patients with spontaneous bacterial peritonitis due to Listeria monocytogenes who underwent large-volume paracentesis survived.