Effect of parathyroid hormone on serum magnesium levels: the neglected relationship in hemodialysis patients with secondary hyperparathyroidism

Abstract

disturbance plays an important role in CKD-MBD and cardiovascular mortality, the interest on magnesium has grown recently. Although much concern focused on the effect of Mg on parathyroid hormone (PTH) levels, however, the influence of PTH on serum Mg levels is nearly unexplored. To evaluate the effect of PTH on serum Mg levels, we first described the relationship between serum Mg and PTH in secondary hyperparathyroidism. Besides, we also monitored the changes of serum Mg concentration after parathyroidectomy (PTX) in 23 patients. In our study, we found that hypermagnesemia (42.5 mg/dL) occurred in up to 44% of cases and hypomagnesemia did not present. No statistically signiEcant correlations were found between serum Mg levels and PTH (r ¼ À0.143, p ¼ 0.134). Correlation analysis and regression analysis suggested that the derangement of magnesium homeostasis was consistent with the derangement of calcium/phosphorus homeostasis. However, after PTX, serum magnesium levels dropped immediately after the surgery, minimally at the first day and gradually restored from the third day. The changes of serum Mg after surgery was positive correlated with the changes of serum phosphate (r ¼ 0.558, p ¼ 0.003). Taken altogether, our data suggested that the therapeutic strategies to achieve optimum serum magnesium levels in CKD-MBD should take into account the varying stages of disease development since PTH could also influence magnesium metabolism and this problem might be important in severe secondary hyperparathyroidism. KeywordsSerum magnesium, parathyroid hormone, secondary hyperparathyroidism, chronic kidney disease-mineral and bone disorder, parathyroidectomy History

Impact of Subtotal Parathyroidectomy on Clinical Parameters and Quality of Life in Hemodialysis Patients with Secondary Hyperparathyroidism

“…However, Sanda et al [12] stated that PTH could elevate serum magnesium levels by enhancing its gastrointestinal absorption and bone resorption. In 2015, Fang et al [13] documented a case of preoperative hypermagnesemia. They suggested that magnesium liberated by PTH induced excessive osteoclastic bone resorption.…”

“…They suggested that magnesium liberated by PTH induced excessive osteoclastic bone resorption. PTX could stimulate hungry bone syndrome, causing a postoperative reduction of serum magnesium, which might be due to the movement of magnesium out of the extracellular space into the cells or to be deposited in the bones [13]. It was suggested that patients on dialysis are largely dependent on the magnesium concentration in the dialysate to maintain their serum magnesium levels.…”

Magnesium disorders can cause calcium pyrophosphate deposition disease: A case report and literature review

“…However, extreme hypomagnesemia immediately after parathyroidectomy and precipitation of acute CPP arthritis in this setting have also been described (21). It has been proposed that hypomagnesemia in the period after parathyroidectomy for hyperparathyroidism is related to the hungry bone syndrome and Mg being driven from the extracellular to the intracellular space (22).…”

“…In patients with diuretic-induced hypomagnesemia, apart from replacing Mg, switching to a different form of therapy or diuretic should be considered. In patients with hyperparathyroidism, undergoing parathyroidectomy treatment with parenteral Mg replacements to prevent acute CPP arthritis in the post-surgery period should be attempted (22,25).…”

Serum Magnesium Abnormality and Influencing Factors of Serum Magnesium Level in Peritoneal Dialysis Patients: A Single-Center Study in Northern China

“…p  < 0.05 was considered to be statistically significant. The basis of calculation of sample size is following, according to previous publications [5], age, and serum Mg-related coefficient β = 0.295. Linear regression module of PASS analysis software was used to calculate the sample size required in this study.…”