Differences in Serum Ionized and Total Magnesium Values During Chronic Renal Failure Between Nondiabetic and Diabetic Patients

Dewitte, Katy; Dhondt, Annemieke; Giri, Mimi; Stöckl, Dietmar; Rottiers, R; Lameire, Norbert; Thienpont, Linda M.

doi:10.2337/diacare.27.10.2503

Cited by 29 publications

(26 citation statements)

References 18 publications

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“…Dewitte et al (20) reported a significant negative correlation between CCr and serum total and ionized Mg levels in patients without diabetes but no significant correlation in those with diabetes, which is in agreement with our findings. Although the reason for this difference is uncertain, insulin enhances Mg reabsorption at the thick ascending limb of the loop of Henle, where ∼55% of the filtered Mg is reabsorbed (32).…”

Section: Discussionsupporting

confidence: 93%

“…Because the relationship between Mg and renal function may vary with the presence of diabetes (20), we tested the correlation between serum Mg level and CCr after stratifying the subjects by the presence or absence of type 2 diabetes. A significant negative correlation between serum Mg level and CCr was noted in patients with non–type 2 diabetes (Spearman ρ = −0.22; P = 0.004) but not in those with type 2 diabetes (Spearman ρ = −0.006; P = 0.91).…”

Section: Resultsmentioning

confidence: 99%

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Hypomagnesemia in Type 2 Diabetic Nephropathy

et al. 2012

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OBJECTIVE There is now growing evidence that magnesium (Mg) deficiency is implicated in type 2 diabetes and its complications. However, it has not been fully elucidated whether hypomagnesemia is a predictor of end-stage renal disease (ESRD) in type 2 diabetic nephropathy. RESEARCH DESIGN AND METHODS This retrospective cohort study included 455 chronic kidney disease (CKD) patients (144 with type 2 diabetic nephropathy and 311 with nondiabetic CKD) who were hospitalized at Osaka General Medical Center for a CKD educational program between April 2001 and December 2007. The primary outcome was progression to renal replacement therapy. Participants were categorized based on serum Mg level into Low-Mg (serum Mg level ≤1.8 mg/dL) and High-Mg (serum Mg level >1.8 mg/dL) groups with the previously published normal lower limit chosen as the cutoff point. RESULTS Of the subjects with type 2 diabetic nephropathy, 102 progressed to ESRD during follow-up (median, 23 months). A multivariate Cox proportional hazards model showed that after adjustment for various demographic factors and laboratory data, the Low-Mg group had a 2.12-fold higher risk of ESRD than the High-Mg group (95% CI 1.28–3.51; P = 0.004). In contrast, 135 of the nondiabetic CKD subjects progressed to ESRD during follow-up (median, 44 months). No significant difference in outcome was found between the Low- and High-Mg groups of this population (adjusted hazard ratio, 1.15; 95% CI 0.70–1.90; P = 0.57). CONCLUSIONS Hypomagnesemia is a novel predictor of ESRD in patients with type 2 diabetic nephropathy.

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Section: Discussionsupporting

confidence: 93%

Section: Resultsmentioning

confidence: 99%

Hypomagnesemia in Type 2 Diabetic Nephropathy

et al. 2012

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“…According to other studies [23], serum magnesium levels were lower in our diabetic patients. Surprisingly, we did not find any relationship between serum magnesium and bone and mineral metabolism parameters.…”

Section: Discussionsupporting

confidence: 70%

Lack of Influence of Serum Magnesium Levels on Overall Mortality and Cardiovascular Outcomes in Patients with Advanced Chronic Kidney Disease

et al. 2013

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Background. Low serum magnesium has been associated with an increased cardiovascular risk in the general population and in dialysis patients. Our aim was to analyze the influence of serum magnesium on overall mortality and cardiovascular outcomes in patients with advanced CKD not yet on dialysis. Methods. Seventy patients with CKD stages 4 and 5 were included. After a single measurement of s-magnesium, patients were followed a mean of 11 months. Primary end-point was death of any cause, and secondary end-point was the occurrence of fatal or nonfatal CV events. Results. Basal s-magnesium was within normal range (2.1 ± 0.3 mg/dL), was lower in men (P = 0.008) and in diabetic patients (P = 0.02), and was not different (P = 0.2) between patients with and without cardiopathy. Magnesium did not correlate with PTH, calcium, phosphate, albumin, inflammatory parameters (CRP), and cardiac (NT-proBNP) biomarkers but correlated inversely (r = −0.23; P = 0.052) with the daily dose of loop diuretics. In univariate and multivariate Cox proportional hazard models, magnesium was not an independent predictor for overall mortality or CV events. Conclusions. Our results do not support that serum magnesium can be an independent predictor for overall mortality or future cardiovascular events among patients with advanced CKD not yet on dialysis.

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“…Previous studies reported an inverse correlation between renal function and serum Mg levels in non-diabetic CKD [11,22]. However, this correlation was not observed in diabetic CKD [11,22], which would be attributable to an insulin-induced increase in renal Mg excretion leading to hypomagnesemia in diabetic patients [5,23].…”

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confidence: 73%

Cardiovascular disease, mortality, and magnesium in chronic kidney disease: growing interest in magnesium-related interventions

Ikee¹

2018

Ren Replace Ther

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Magnesium (Mg) is an essential element that plays pivotal roles in a number of biological processes in the human body. Hypomagnesemia is involved in the pathophysiology of hypertension, vascular calcification, and metabolic derangements including diabetes mellitus and dyslipidemia, which are all risk factors for cardiovascular disease, the leading cause of mortality and morbidity in patients with chronic kidney disease (CKD). Hypomagnesemia is also associated with the development and progression of CKD. As CKD advances, renal Mg excretion decreases and hypermagnesemia emerges in end-stage renal disease (ESRD). In addition, dialysates with high Mg concentrations, which were used in the early era of dialysis therapy, increased the risk of hypermagnesemia, and thus, the dialysate Mg composition has since been reduced. Accordingly, dialysis patients in the modern era commonly have normomagnesemia or even hypomagnesemia. The relationships between hypomagnesemia and cardiovascular disease and mortality have been increasingly reported in observational studies in CKD/ESRD. However, these relationships may be attenuated by a patient's race or region. Although dialysates with higher Mg concentrations or Mg-containing phosphate binders appear to be promising in this setting, only a few interventional studies have examined the effects of Mg supplementation on cardiovascular lesions. Furthermore, the effects of Mg supplementation on mortality have not yet been investigated as a primary end-point in randomized controlled trials. Further studies are required in order to establish the efficacy and safety of Mg in CKD patients.

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Differences in Serum Ionized and Total Magnesium Values During Chronic Renal Failure Between Nondiabetic and Diabetic Patients

Cited by 29 publications

References 18 publications

Hypomagnesemia in Type 2 Diabetic Nephropathy

Hypomagnesemia in Type 2 Diabetic Nephropathy

Lack of Influence of Serum Magnesium Levels on Overall Mortality and Cardiovascular Outcomes in Patients with Advanced Chronic Kidney Disease

Cardiovascular disease, mortality, and magnesium in chronic kidney disease: growing interest in magnesium-related interventions

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