Association between hypomagnesemia and mortality among dialysis patients: a systematic review and meta-analysis

Abstract

Background Malnutrition-inflammation-atherosclerosis (MIA) syndrome is caused by the inflammatory cytokines in end stage renal disease (ESRD) patients, and MIA complex-related factors may be associated with hypomagnesemia and mortality. However, the association between serum magnesium level and mortality for dialysis patients is still not clear. Additionally, no meta-analysis has investigated the impact of serum magnesium on peritoneal dialysis and hemodialysis, separately. Methods We searched published studies in PubMed, Embase, Cochrane, Collaboration Central Register of Controlled Clinical Trials, and Cochrane Systematic Reviews through April 2022. Studies associated with serum magnesium and all-cause mortality or cardiovascular (CV) mortality in ESRD on kidney replacement therapy (KRT) patients were included. A hazard ratio (HR) with 95% confidence intervals (CI) was used to report the outcomes. Results Twenty-one studies involving 55,232 patients were included. Overall, there was a significant association between hypomagnesemia and all-cause mortality for dialysis patients (HR: 1.67, 95% CI [1.412–2.00], p < 0.001; certainty of evidence: moderate) using a mixed unadjusted and adjusted HR for analysis. There was also a significantly increased risk of CV mortality for individuals with hypomagnesemia compared with the non-hypomagnesemia group (HR 1.56, 95% CI [1.08–2.25], p < 0.001; certainty of evidence: moderate). In addition, a subgroup analysis demonstrated that hypomagnesemia was associated with a high risk of both all-cause mortality and CV mortality (all-cause mortality, HR:1.80, 95% CI [1.48–2.19]; CV mortality, HR:1.84, 95% CI [1.10–3.07]) in hemodialysis (HD) patients, but not in participants receiving peritoneal dialysis (PD; all-cause mortality, HR:1.26, 95% CI [0.84–1.91]; CV mortality, HR:0.66, 95% CI [0.22–2.00]). The systematic review protocol was prespecified and registered in PROSPERO [CRD42021256187]. Conclusions Hypomagnesemia may be a significant risk factor for all-cause mortality and CV mortality in KRT patients, especially in those receiving hemodialysis. However, because of the limited certainty of evidence, more studies are required to investigate this association.

Lower product of magnesium × potassium is associated with higher mortality in chronic hemodialysis patients: a cohort study

“…Lower serum albumin and higher hs-CRP levels in group 1 patients were evidence of ongoing subclinical inflammation and/or infection status. Hypomagnesaemic dialysis patients had a strong association with mortality risk 20 , especially those with hypoalbuminemia, which infers the link between hypomagnesaemia and the severity of underlying comorbidities.…”

Association between magnesium, erythropoietin resistance and mortality: the Japanese Dialysis Outcomes and Practice Patterns Study (J-DOPPS)

“…In a cohort study that compared patients with CKD with persons without CKD, an inverse association was found between s-Mg levels and mortality in both groups, while the CKD patients with hypomagnesemia (under 1.9 mg/dL) had an independently increased mortality risk [ 25 ]. Although much evidence of CVD and mortality risks due to hypomagnesemia in dialysis patients has accumulated [ 14 , 15 ], the low-s-Mg level threshold at the start of a hemodialysis session that is likely to cause harm is still unknown. In our study, there was no consistent association between Mg and the incidence of CVD deaths and all-cause mortality, although patients with hypermagnesemia (>2.8 mg/dL) showed the lowest incidence rate of deaths.…”

“…Many studies have reported that hypomagnesemia is associated with increased mortality in dialysis patients [ 14 , 15 ]. Magnesium (Mg) plays a key role in mineral and bone disorders in CKD (CKD-MBD) in conjunction with phosphate and calcium, and its deficiency is associated with accelerated vascular calcification and increased CVD [ 16 ].…”

Comparison of Patient Survival According to Erythropoiesis-Stimulating Agent Type of Treatment in Maintenance Hemodialysis Patients

“…Other studies that have evaluated the association between magnesium and mortality in dialysis patients and a meta-analysis using 21 studies revealed a positive association between the level of magnesium and all-cause and cardiovascular mortality in dialysis patients [ 22 ]. Yu et al also showed an association between magnesium levels and HD patients’ responses to ESAs [ 23 ].…”