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Background <p>Post‑transplantation diabetes mellitus (PTDM) is common after kidney transplantation, and older recipients are particularly vulnerable. Hypomagnesemia occurs frequently early after transplantation, but whether persistently low serum magnesium in the first 90 days is associated with subsequent PTDM is unclear.</p> Methods <p>We conducted a single‑center ambispective cohort study of kidney‑only recipients aged ≥ 65 years transplanted between January 2014 and June 2024, using a prespecified day‑90 landmark. Serum magnesium measured during post‑transplant days 0–90 was summarized as a time‑weighted average (TWA‑Mg90) using trapezoidal integration. Low magnesium exposure was defined as TWA‑Mg90 below the laboratory lower limit of normal (LLN; 0.72 mmol/L). PTDM was adjudicated using standard venous plasma glucose criteria. Diabetic‑range glycemia in days 0–45 was classified as early post‑transplant hyperglycemia rather than PTDM. Adjusted cause‑specific Cox models including baseline metabolic risk, immunosuppression, day-90 kidney function, and transplant year estimated adjusted hazard ratio (aHR) of incident PTDM after day 90. Modified Poisson regression estimated adjusted risk ratios (aRR) for PTDM occurring between day 90 and day 365.</p> Results <p>Of 742 screened recipients, 652 were eligible at day 90. After excluding 61 PTDM cases on days 46–90, 591 entered the landmark cohort. Magnesium was measured a median of 9 times during days 0–90, and 306/591 (51.8%) had low magnesium exposure. After day 90, 160/591 (27.1%) developed PTDM (138 by day 365). Low magnesium exposure was associated with higher PTDM hazard (aHR 1.52, 95% CI 1.14–2.03; <i>p</i> = 0.004) and higher day 90–365 risk (aRR 1.23, 95% CI 1.05–1.44). Each 0.1 mmol/L lower TWA‑Mg90 was associated with increased PTDM hazard (aHR 1.19, 95% CI 1.05–1.35), with no strong evidence of nonlinearity (<i>p</i> = 0.21).</p> Conclusions <p>In older kidney transplant recipients, a higher persistent low‑magnesium during days 0–90 was associated with later PTDM. Because magnesium is routinely monitored after transplantation, sustained early hypomagnesemia may serve as a pragmatic risk marker to support targeted, guideline-consistent glycemic assessment within routine follow-up.</p>

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Association of 90-day post-transplant low magnesium exposure with new-onset post-transplant diabetes mellitus in older kidney transplant recipients

  • 期刊论文

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  • 发表日期：

    2026年5月20日

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  • Rongxin Chen,
  • Zebin Guo,
  • Guanghui Li,
  • Jiali Fang,
  • Jialin Wu,
  • Luhao Liu,
  • Zheng Chen

摘要

Background

Post‑transplantation diabetes mellitus (PTDM) is common after kidney transplantation, and older recipients are particularly vulnerable. Hypomagnesemia occurs frequently early after transplantation, but whether persistently low serum magnesium in the first 90 days is associated with subsequent PTDM is unclear.

Methods

We conducted a single‑center ambispective cohort study of kidney‑only recipients aged ≥ 65 years transplanted between January 2014 and June 2024, using a prespecified day‑90 landmark. Serum magnesium measured during post‑transplant days 0–90 was summarized as a time‑weighted average (TWA‑Mg90) using trapezoidal integration. Low magnesium exposure was defined as TWA‑Mg90 below the laboratory lower limit of normal (LLN; 0.72 mmol/L). PTDM was adjudicated using standard venous plasma glucose criteria. Diabetic‑range glycemia in days 0–45 was classified as early post‑transplant hyperglycemia rather than PTDM. Adjusted cause‑specific Cox models including baseline metabolic risk, immunosuppression, day-90 kidney function, and transplant year estimated adjusted hazard ratio (aHR) of incident PTDM after day 90. Modified Poisson regression estimated adjusted risk ratios (aRR) for PTDM occurring between day 90 and day 365.

Results

Of 742 screened recipients, 652 were eligible at day 90. After excluding 61 PTDM cases on days 46–90, 591 entered the landmark cohort. Magnesium was measured a median of 9 times during days 0–90, and 306/591 (51.8%) had low magnesium exposure. After day 90, 160/591 (27.1%) developed PTDM (138 by day 365). Low magnesium exposure was associated with higher PTDM hazard (aHR 1.52, 95% CI 1.14–2.03; p = 0.004) and higher day 90–365 risk (aRR 1.23, 95% CI 1.05–1.44). Each 0.1 mmol/L lower TWA‑Mg90 was associated with increased PTDM hazard (aHR 1.19, 95% CI 1.05–1.35), with no strong evidence of nonlinearity (p = 0.21).

Conclusions

In older kidney transplant recipients, a higher persistent low‑magnesium during days 0–90 was associated with later PTDM. Because magnesium is routinely monitored after transplantation, sustained early hypomagnesemia may serve as a pragmatic risk marker to support targeted, guideline-consistent glycemic assessment within routine follow-up.