الفهرس 
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Abstract
ESRD is associated with many comorbidities and cardiovascular disease which is the most common cause of death. ESRD is treated by renal replacement therapies. The gold standard for renal replacement therapy is kidney transplantation. Calcineurin inhibitors (CNIs) are very crucial for renal graft survival but they have numerous toxicities despite a significant reduction in the rejection rate.
CNIs are associated with hypertension, dyslipidemia, new-onset diabetes mellitus and multiple electrolytes disturbances like hypomagnesemia which has been associated with many metabolic effects in renal transplant recipients affecting both graft and patient survival.
Our work included 80 living renal transplant recipients. Cases who were with serum creatinine more than 2.5 mg/dL, diabetic, alcoholic, less than one-year post-transplant duration and patients on diuretics, magnesium supplements and proton pump inhibitors were excluded. All cases were subjected to detailed history taking, physical examination and laboratory investigation including serum magnesium, urea, creatinine, calcium, phosphorus, fasting blood sugar, sodium, potassium, chloride, cholesterol, triglycerides, complete blood count, uric acid, albumin, trough level of cyclosporine or tacrolimus, intact PTH, 25-OH vitamin D, 24-hour urinary(Mg, Ca, Ph, Cl and protein) and measurement of FEMg.
Fifty cases were on Tacrolimus, 26 cases were on Cyclosporine, other 2 cases were on Everolimus and another 2 cases on Sirolimus with mean age (39.65 ± 12.14) years and with a mean duration of transplantation (6.33 ± 4.66) years.
By comparing normomagnesemic cases with hypomagnesemic, there was a significant difference according to tacrolimus (p = 0.014) and cyclosporine (p = 0.040) use.
Cases on Cyclosporine were significantly older in age than tacrolimus group (p = 0.019) and had a significant longer post-transplant duration (p = 0.001).
The prevalence rate of hypomagnesemia in our study was 21.3% and the serum magnesium level ranged from 1.3 to 2.6 mg/dl with a mean of (1.83 ± 0.26)mg/dl.
The Prevalence of hypomagnesemia is significantly higher among the tacrolimus-treated group than the cyclosporine-treated group 30% versus 7.7% (p = 0.027).
There was a significant inverse correlation between serum magnesium and tacrolimus trough level (p = 0.038).
By using serum magnesium as a dependent variable, univariate and multivariate linear regression analysis for the parameters affecting serum magnesium in cases of tacrolimus showed that the tacrolimus trough level (p=0.008), (p=0.010) and fractional excretion of magnesium(p=0.019), (p=0.025) are the best predictors of serum magnesium.
There was a slight negative correlation between serum magnesium and Cyclosporine trough level but it was not statistically significant.
Our cases had FEMg ranging from (0.9 to 10.8 )% and with a median of (3.08) % suggesting inappropriate renal wasting and we found a significant inverse correlation between serum Mg and FEMg ( p = 0.001) but we did not find a significant correlation between FEMg and 24 hour protein