Calcium and Magnesium Flux in Automated Peritoneal Dialysis

Eddington, Helen; Hurst, Helen; Ramli, Marlina T.; Speake, Mary; Hutchison, Alastair J.

doi:10.1177/089686080902900511

Cited by 10 publications

(4 citation statements)

References 13 publications

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“…Patients using these solutions are slightly hypermagnesaemic [ 37 , 39 , 40 ] (see Table 1 ). This is because the transfer of magnesium is, if diffusive, mostly into the patient and thus positive [ 39 , 41 ].…”

Section: Magnesium In Dialysis Patientsmentioning

confidence: 99%

Magnesium in chronic kidney disease Stages 3 and 4 and in dialysis patients

Cunningham

Rodríguez

Messa³

2012

Clinical Kidney Journal

144

117

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The kidney has a vital role in magnesium homeostasis and, although the renal handling of magnesium is highly adaptable, this ability deteriorates when renal function declines significantly. In moderate chronic kidney disease (CKD), increases in the fractional excretion of magnesium largely compensate for the loss of glomerular filtration rate to maintain normal serum magnesium levels. However, in more advanced CKD (as creatinine clearance falls <30 mL/min), this compensatory mechanism becomes inadequate such that overt hypermagnesaemia develops frequently in patients with creatinine clearances <10 mL/min. Dietary calcium and magnesium may affect the intestinal uptake of each other, though results are conflicting, and likewise the role of vitamin D on intestinal magnesium absorption is somewhat uncertain. In patients undergoing dialysis, the effect of various magnesium and calcium dialysate concentrations has been investigated in haemodialysis (HD) and peritoneal dialysis (PD). Results generally show that dialysate magnesium, at 0.75 mmol/L, is likely to cause mild hypermagnesaemia, results for a magnesium dialysate concentration of 0.5 mmol/L were less consistent, whereas serum magnesium levels were mostly normal to hypomagnesaemic when 0.2 and 0.25 mmol/L were used. While dialysate magnesium concentration is a major determinant of HD or PD patients’ magnesium balance, other factors such as nutrition and medications (e.g. laxatives or antacids) also play an important role. Also examined in this review is the role of magnesium on parathyroid hormone (PTH) levels in dialysis patients. Although various studies have shown that patients with higher serum magnesium tend to have lower PTH levels, many of these suffer from methodological limitations. Finally, we examine the complex and often conflicting results concerning the interplay between magnesium and bone in uraemic patients. Although the exact role of magnesium in bone metabolism is unclear, it may have both positive and negative effects, and it is uncertain what the optimal magnesium levels are in uraemic patients.

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Section: Magnesium In Dialysis Patientsmentioning

confidence: 99%

Magnesium in chronic kidney disease Stages 3 and 4 and in dialysis patients

Cunningham

Rodríguez

Messa³

2012

Clinical Kidney Journal

144

117

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“…This can be attributed to the difference in dialysate Mg concentrations as well as dietary restrictions between PD and HD patients. Still, the laboratory results do not reveal the exact state of Mg in the body, and serum Mg levels can be normal even as cellular Mg is depleted 22 . Therefore, Mg deficiency in the dialysis population might be more widespread than is commonly realized.…”

Section: Discussionmentioning

confidence: 98%

Why are serum magnesium levels lower in Saudi dialysis patients?

Mitwalli

2017

Journal of Taibah University Medical Sciences

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Objectives Serum magnesium (Mg) levels are often altered in dialysis patients. This study was conducted to ascertain the trends in Mg levels in patients on dialysis treatment. Methods A retrospective study was performed in the Dialysis Unit of King Khalid University Hospital, King Saud University, Riyadh, on patients undergoing regular dialysis. Patient demographic data, including body mass index (BMI), serum calcium (Ca), Mg, parathyroid hormone (PTH), cholesterol, and triglycerides were documented. Results Of a total of 115 patients, 70 (60.9%) were on haemodialysis (HD), and 45 (39.1%) were on peritoneal dialysis (PD). Of these, 10 patients (8.7%) had Mg levels of <0.7 mmol/L, 13 (11.3%) had 0.7 mmol/L, 24 (20.9%) had 0.8 mmol/L, 26 (22.6%) had 0.9 mmol/L, 16 (13.9%) 1.0 mmol/L, and 26 (23.9%) showed levels of ≥1.1 mmol/L. Approximately 93.0% had increased PTH levels, 43 (37.4%) had decreased serum Ca, 24 (20.9%) had low serum cholesterol, and 60 (52.2%) had low serum triglyceride. PD patients had significantly lower Mg and higher PTH levels compared to HD patients. Conclusion Patients with chronic kidney disease are generally considered at risk of developing hypermagnesaemia due to reduced renal excretion. However, a considerable number of dialysis patients in our unit had hypomagnesaemia (or low levels) instead. In addition to other factors, PTH secretion is affected by serum Mg levels. We found a significant correlation between serum Mg and Ca as well as PTH levels. Consequently, optimizing Mg concentration in patients on dialysate is essential to reduce risk of dyslipidaemia, arrhythmias, hyperparathyroidism, or adynamic bone disease.

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“…Notably, the Mg concentration in clinical peritoneal dialysate is relatively low (0.25–0.75 mEq/L) for the purpose of Mg elimination 42 , 47 , 48 . One cohort study showed mean serum Mg levels of 0.84 mEq/L in PD patients, and > 32% of this cohort had low serum Mg levels (defined as < 0.74 mEq/L).…”

Section: Discussionmentioning

confidence: 99%

Magnesium inhibits peritoneal calcification as a late-stage characteristic of encapsulating peritoneal sclerosis

Aihara,

Yamada,

Matsueda

et al. 2023

Sci Rep

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Peritoneal calcification is a prominent feature of the later stage of encapsulating peritoneal sclerosis (EPS) in patients undergoing long-term peritoneal dialysis (PD). However, the pathogenesis and preventive strategy for peritoneal calcification remain unclear. Peritoneum samples from EPS patients were examined histologically. Peritoneal calcification was induced in mice by feeding with an adenine-containing diet combined with intraperitoneal administration of lipopolysaccharide and a calcifying solution containing high calcium and phosphate. Excised mouse peritoneum, human mesothelial cells (MeT5A), and mouse embryonic fibroblasts (MEFs) were cultured in calcifying medium. Immunohistochemistry confirmed the appearance of osteoblastic differentiation-marker-positive cells in the visceral peritoneum from EPS patients. Intraperitoneal administration of magnesium suppressed peritoneal fibrosis and calcification in mice. Calcifying medium increased the calcification of cultured mouse peritoneum, which was prevented by magnesium. Calcification of the extracellular matrix was accelerated in Met5A cells and MEFs treated with calcification medium. Calcifying medium also upregulated osteoblastic differentiation markers in MeT5A cells and induced apoptosis in MEFs. Conversely, magnesium supplementation mitigated extracellular matrix calcification and phenotypic transdifferentiation and apoptosis caused by calcifying conditions in cultured MeT5A cells and MEFs. Phosphate loading contributes to the progression of EPS through peritoneal calcification and fibrosis, which can be prevented by magnesium supplementation.

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Calcium and Magnesium Flux in Automated Peritoneal Dialysis

Cited by 10 publications

References 13 publications

Magnesium in chronic kidney disease Stages 3 and 4 and in dialysis patients

Magnesium in chronic kidney disease Stages 3 and 4 and in dialysis patients

Why are serum magnesium levels lower in Saudi dialysis patients?

Magnesium inhibits peritoneal calcification as a late-stage characteristic of encapsulating peritoneal sclerosis

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