Most of chronic kidney disease (CKD) patients are elder adults. Elderly patients are usually having gastrointestinal motility disorder, especially, chronic constipation. Magnesium oxide (MgO) is used for main treatment of the constipation as a laxative without habit-forming and is often prescribed for a long term in Japan. When MgO is administrated to renal function decline patients, the caution about hypermagnesemia is raised in not only Japan, but also Europe and USA.The warning about “hypermagnesemia” in the long-term dosage of MgO is issued safety information by pharmaceuticals and medical devices agency in November, 2008. We have very few evidence about the dose of the MgO for the renal function decline patients. Therefore, we examined correlation between renal function decline and the risk of hypermagnesemia, influence of doses of MgO and serum Mg levels.The serum Mg levels and the serum creatinine (Cr) levels are extracted from laboratory data of the patients receiving MgO during the period of from April 1, 2010 to February 29, 2012. In extracted laboratory data, there were 87 cases with estimated glomerular filtration rate (eGFR) <60 mL/min/1.73m2 classified more than CKD stage 3 in CKD medical treatment guide 2009. These laboratory data of 87 cases were performed statistical analysis.These results indicate a significant correlation between eGFR and serum Mg levels. In the patients of 45 ≦ eGFR<60, a significant correlation was not revealed between MgO dose and a serum Mg level. On the other hand, in the patients with eGFR<45, MgO dose correlated with a serum Mg level significantly. In the patients with eGFR<15, a mean serum Mg level was over the normal upper limit.The part of patients with CKD stage 5 (eGFR<15) receiving MgO dose of >1000mg/day was elevated serum Mg concentration over 6 mg/dL. It was thought that attention to hypermagnesaemia was necessary for more than 1000mg/day dose in patients with eGFR<15. It was suggested that MgO laxative is administrated more safely in the patients with eGFR ≧ 45 than that with eGFR < 45 in this study. Furthermore, it is suggested that the patients with eGFR<45 are received MgO laxative safely by measuring the serum Mg level, and setting a dose depending on renal function decline.

Appearance of hypokalemia is a problem associated with the use of liposomal amphotericin B (L-AMB).In this study, we aimed to clarify whether the relative frequency of hypokalemia attributed to the use of liposomal amphotericin B medication changes with the grade of renal function. The study focused on 46 adult patients in the Osaka National Hospital, who had been administered L-AMB for 3 or more days.In this study, we found that the appearance of hypokalemia did not depend on the level of renal function. Further, hypokalemia developed in one patient for whom renal replacement therapy had been performed. However, there was no significant difference in the frequency of hypokalemia according to renal function. Therefore, when using L-AMB, it is desirable to monitor serum potassium levels from an early stage, regardless of the grade of renal function.

A 57-year-old woman presented with fever, elevated β-D-glucan, and Aspergillus antigen in the blood. She had been diagnosed as having refractory Still’s disease and was being treated with cyclosporine A (CyA) and cyclophosphamide. She was administered liposomal amphotericin B (L-AMPH-B) because it was felt that she could have a fungal infection; after that, her levels of serum creatinine and blood urea nitrogen rapidly increased. Deteriorated renal function was observed thereafter. It was concluded that the combination of L-AMPH-B and CyA induced the acute renal failure, and that the subsequent deterioration in renal function was triggered by CyA. Thus, if amphotericin B is administered together with CyA, there is the need to repeatedly measure renal function and reduce the dosage of CyA if necessary.