Magnesium and the risk of all-cause and cardiac mortality in hemodialysis patients: agent provocateur or innocent bystander?

Courivaud, Cécile; Davenport, Andrew

doi:10.1038/ki.2013.301

Cited by 19 publications

(11 citation statements)

References 10 publications

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“…In our study, MHD patients with Mg < 2.4 mg/dl had worse nutritional status, which comprised lower values of serum albumin, nPNA, GNRI, phosphate, and uric acid, compared with patients with Mg ≥ 2.4 mg/dl. Taken together with the results of the previous reports [ 9 , 16 , 20 – 22 ], our findings indicate that nutritional factors greatly influence hypomagnesemia, and that such factors might partly contribute to the poor outcomes described by Courivaud et al [ 11 ]. Thus, hypomagnesemia appears to be correlated with mortality; whether Mg plays a causal role in this relationship remains unclear [ 4 , 11 ].…”

Section: Discussionsupporting

confidence: 88%

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Hypomagnesemia is not an independent risk factor for mortality in Japanese maintenance hemodialysis patients

Mizuiri¹,

Nishizawa²,

Yamashita³

et al. 2019

Int Urol Nephrol

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Purpose It is unclear whether hypomagnesemia is an independent risk factor or innocent bystander for mortality in maintenance hemodialysis (MHD) patients. Thus, we studied associations between hypomagnesemia and all-cause as well as cardiovascular (CV) mortality in MHD patients. Methods Baseline clinical characteristics and coronary artery calcium score (CACS) of 353 Japanese MHD patients were reviewed. Three-year survival rate and mortality risk factors were assessed. Results Median (interquartile range) age, dialysis vintage, serum magnesium (Mg), serum albumin and CACS of the subjects were 68 (60–78) years, 75 (32–151) months, 2.4 (2.2–2.7) mg/dl, 3.6 (3.3–3.8) g/dl, and 1181 (278–3190), respectively. During the 3-year period, 91 patients died. Kaplan–Meier overall 3-year survival rates were 59.0% in in patients with Mg < 2.4 mg/dl ( n = 136) and 82.3% in patients with Mg ≥ 2.4 mg/dl ( n = 217), ( P < 0.0001). In Cox regression models not incorporating serum albumin, Mg < 2.4 mg/dl was significantly associated with 3-year all-cause death, independent of age, dialysis vintage, average ultrafiltration, Log (CACS + 1), warfarin use, serum potassium, high-sensitivity C-reactive protein (hsCRP), phosphate, uric acid, and intact parathyroid hormone [Hazard ratio (HR) 95% confidence interval (CI): 2.82 (1.31–6.29), P = 0.0078], and CV death, independent of age, dialysis vintage, Log (CACS + 1), warfarin use, serum hsCRP, and uric acid [HR (95% CI): 4.47 (1.45–16.76), P = 0.0086]. Nevertheless, associations of Mg < 2.4 mg/dl with all-cause and CV mortality were all absent in models that included serum albumin. Conclusions Hypomagnesemia is not an independent risk factor for mortality but is associated with malnutrition in MHD patients.

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Section: Discussionsupporting

confidence: 88%

“…Clinical studies have produced inconsistent results regarding the association between Mg levels and mortality, partly because hypomagnesemia is linked to an increased frequency of co-morbidities. It is unclear whether hypomagnesemia causes increased mortality as an independent risk factor or as an “innocent bystander” [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Hypomagnesemia is not an independent risk factor for mortality in Japanese maintenance hemodialysis patients

Mizuiri¹,

Nishizawa²,

Yamashita³

et al. 2019

Int Urol Nephrol

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“…When examined as a continuous variable, we found that there was a trend towards higher death risk with Mg levels > 3 mg/dl, although not statistically significant. Prior data suggest that hypermagnesemia may inhibit PTH secretion, leading to low bone turnover and vascular calcification 51,52 as potential risk factors for CVD and death. However, our study did not show a significant correlation between baseline serum Mg and iPTH.…”

Section: Discussionmentioning

confidence: 99%

Hypomagnesemia and Mortality in Incident Hemodialysis Patients

Streja

Rhee

et al. 2015

American Journal of Kidney Diseases

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Background In the general population, low serum magnesium (Mg) levels are associated with poor outcomes and death. While limited data suggest that low baseline Mg levels may be associated with higher mortality in hemodialysis (HD) patients, the impact of changes in Mg over time is unknown. Study Design We examined the association of time-varying serum Mg levels with all-cause mortality using multivariable time-dependent survival models adjusted for clinical characteristics and other time-varying laboratory measures. Setting & Participants 9,359 maintenance HD patients treated in a large dialysis organization between 2007 and 2011. Predictor Time-varying serum Mg levels across 5 Mg increments (<1.8, 1.8–<2.0, 2.0–<2.2, 2.2–<2.4, ≥2.4 mg/dl). Outcomes All-Cause Mortality Results 2,636 individuals died over 5 years. Time-varying serum Mg <2.0 mg/dl was associated with higher mortality after adjustment for demographics and co-morbidities including hypertension, diabetes, and malignancies (reference: Mg 2.2–<2.4 mg/dL): adjusted HRs for serum Mg <1.8 and 1.8–<2.0 mg/dl were 1.39 (95% CI, 1.23–1.58; p<0.001) and 1.20 (95% CI, 1.06–1.36; p=0.004), respectively. Some associations were attenuated to the null after incremental adjustment for laboratory tests, particularly serum albumin. However among patients with serum albumin measurements, low albumin levels (<3.5 g/dl) and Mg <2.0 mg/dl was associated with an additional death risk (adjusted HR, 1.17; 95% CI, 1.05–1.31; p=0.004), while patients with high serum albumin levels (≥3.5 g/dl) exhibited low death risk (adjusted HRs of 0.53 and 0.53 [p≤0.001] for Mg <2.0 mg/dl and ≥2.0 mg/dl, respectively; reference: albumin <3.5 g/dl and Mg ≥2.0 mg/dl). Limitations Causality cannot be determined, and residual confounding cannot be excluded given the observational study design. Conclusions Lower serum Mg levels are associated with higher mortality in HD patients including in those with hypoalbuminemia. Interventional studies are warranted to examine whether correction of hypomagnesemia ameliorates adverse outcomes in this population.

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“…Furthermore, population-based studies of patients with chronic renal disease and congestive heart failure found that both lowest and highest magnesium ranges were independently associated with greater mortality, after adjusting for other comorbidities. 7,8 Although the effects of serum magnesium on clinical outcomes remain controversial, surveillance of serum magnesium levels is a common practice considering that it is a modifiable factor. 2,[9][10][11] Consensus among various experts recommends maintaining serum magnesium levels >2 mg/dL among patients at risk for arrhythmias.…”

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confidence: 99%

Association of Serum Magnesium on Mortality in Patients Admitted to the Intensive Cardiac Care Unit

Naksuk

Krittanawong

et al. 2017

The American Journal of Medicine

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Magnesium and the risk of all-cause and cardiac mortality in hemodialysis patients: agent provocateur or innocent bystander?

Cited by 19 publications

References 10 publications

Hypomagnesemia is not an independent risk factor for mortality in Japanese maintenance hemodialysis patients

Hypomagnesemia is not an independent risk factor for mortality in Japanese maintenance hemodialysis patients

Hypomagnesemia and Mortality in Incident Hemodialysis Patients

Association of Serum Magnesium on Mortality in Patients Admitted to the Intensive Cardiac Care Unit

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