Association between serum magnesium levels and abdominal aorta calcification in patients with pre-dialysis chronic kidney disease stage 5

Abstract

Background Several studies have revealed the relationship between serum magnesium levels and vascular calcification in chronic kidney disease patients. Despite excellent predictability of abdominal aorta calcification for cardiovascular disease events, the relationship between serum magnesium levels and abdominal aorta calcification, as evaluated by quantitative methods, in pre-dialysis patients remains unclear. This study aimed to determine the abdominal aorta calcification volume using computerized tomography and its association with serum magnesium levels in pre-dialysis chronic kidney disease stage 5 patients. Methods This single-center cross-sectional study included 100 consecutive patients with pre-dialysis chronic kidney disease stage 5 between January 2016 and May 2020 at Aichi Medical University Hospital, Japan. The relationships between serum magnesium levels and the abdominal aorta calcification volume were assessed using multiple linear regression models after adjusting for clinically relevant factors. We also assessed clinical factors that affect serum magnesium levels. Results The mean serum magnesium level was 2.0 mg/dL (interquartile range, 1.8 to 2.3). Multivariate analyses revealed that a higher serum magnesium level (stand. β = -0.245, p = 0.010) was significantly associated with a reduced abdominal aorta calcification volume, and that a history of cardiovascular disease (stand. β = 0.3792, p < 0.001) and older age (stand. β = 0.278, p = 0.007) were significantly associated with an increased abdominal aorta calcification volume. Moreover, multivariate analysis showed that the use of proton pump inhibitor or potassium-competitive acid blocker was significantly associated with lower serum magnesium levels (stand. β = -0.246, p = 0.019). Conclusions The present study revealed that the higher Mg level was significantly associated with lower volume of abdominal aorta calcification in pre-dialysis chronic kidney disease stage 5 patients. Further studies should be undertaken to determine the appropriate magnesium level to suppress vascular calcification.

Magnesium Administration in Chronic Kidney Disease

“…Within hemodialysis populations, three RCTs studied the effect of 2 to 6 months of oral Mg supplementation on IMT [ 26 , 29 , 30 ]. A recent systematic review and meta-analysis combining these studies demonstrated a significant improvement of IMT for those treated with oral Mg supplements compared to placebo (weighted mean difference (WMD) −0.18; 95% CI −0.34, −0.01) [ 67 ]. Of note, no studies addressing IMT as outcome parameter investigated the effect of increasing dialysate Mg concentration for those on dialysis or oral Mg supplementation for people with CKD stage 1 to 4.…”

“…These studies demonstrated that solely Mg carbonate or a combination tablet of Mg/calcium carbonate/acetate is equally effective in controlling phosphate levels compared to a calcium-only-containing phosphate binder and sevelamer [ 23 , 24 , 69 ]. However, a recent systematic review and meta-analysis of oral Mg intervention studies in people treated with hemodialysis did not reveal a significant phosphate-lowering effect of these compounds (WMD −0.36 [95% CI −0.89,0.16]) [ 67 ]. Most likely, the small phosphate-lowering effect through intestinal chelation of dietary phosphate by oral Mg supplementation is negligible compared to the phosphate clearance during hemodialysis.…”

“…The effect of Mg administration on serum calcium and PTH levels have been debated due to conflicting results [ 24 , 26 , 30 , 44 , 96 , 97 ]. A recent meta-analysis with subgroup analysis for the effect of oral Mg administration demonstrated a significant reduction of both serum calcium levels (WMD −0.50 [95% CI −0.77, −0.23]) and serum PTH levels (WMD −237 [95% CI −350, −123]) [ 67 ]. Subgroup analyses for the effect of increased dialysate suggested a comparable yet non-significant effect on serum calcium levels (WMD −2.40 (95% CI −6.91, 2.11)) with no data on PTH levels.…”

“…Guo et al [ 67 ], systematic review and meta-analysis, hemodialysis patients, Mg administration improves IMT…”

Hypomagnesemia as a Risk Factor and Accelerator for Vascular Aging in Diabetes Mellitus and Chronic Kidney Disease

“…Notwithstanding all these risk factors created in the context of CKD, hypomagnesemia is yet another interesting and underappreciated risk factor for cardiovascular mortality. Observational data have shown an association between low serum magnesium concentrations or magnesium intake and the increased risk of atherosclerosis, coronary artery disease, arrhythmias, aortic valve calcification [ 47 , 48 , 49 , 50 ], and heart failure [ 51 ]. Furthermore, low serum magnesium levels were associated with an increased risk of end-stage renal disease associated with high serum phosphate levels in a cohort study, suggesting a strong relationship between magnesium deficiency and the adverse effects of high phosphate levels.…”