Hypomagnesemia and Mortality in Incident Hemodialysis Patients

Li, Lin; Streja, Elani; Rhee, Connie M.; Mehrotra, Rajnish; Soohoo, Melissa; Brunelli, Steven M.; Kövesdy, Csaba P.; Kalantar-Zadeh, Kamyar

doi:10.1053/j.ajkd.2015.05.024

Cited by 70 publications

(102 citation statements)

References 50 publications

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“…This study included 515 patients, and the mortality risk decreased by 52% with a 1-mg/dL increase in serum Mg levels. Recently, similar findings have been increasingly reported in large-scale studies [33,34,[69][70][71]. Sakaguchi et al examined this relationship using the Japanese National Registry data [69].…”

Section: Mg and Dialysis Therapysupporting

confidence: 54%

“…In these three studies [69][70][71], the relationship between hypomagnesemia and the mortality risk remained significant after the full adjustments. However, the findings from the USA [33,34] were different. In Lacson's study [33], a linear decline was observed in the risk of all-cause death adjusted for case-mix variables (see Table 2) from the lowest to the highest serum Mg category, with the best survival in the category with the highest serum Mg levels (> 3.04 mg/dL [1.25 mmol/L]).…”

Section: Mg and Dialysis Therapymentioning

confidence: 79%

“…However, the relationship between hypomagnesemia and mortality was not significant after additional adjustments for laboratory variables. Similarly, Li et al reported that time-varying serum Mg levels did not predict the death in incident HD patients after adjustment for laboratory variables [34].…”

Section: Mg and Dialysis Therapymentioning

confidence: 95%

“…Therefore, dietary Mg intake may be insufficient, particularly in dialysis patients, as described by Luis et al [31]. Serum Mg levels may be used as nutritional markers in dialysis patients because they correlate with serum albumin levels [24,[32][33][34][35][36], body mass index [24,32], normalized protein catabolic rate [32,34,36], muscle mass [32] and strength [37], and subjective global assessment scores [32]. Of interest, the use of a low Mg PD dialysate induced a decrease in serum albumin levels [38].…”

Section: Mg and Dialysis Therapymentioning

confidence: 99%

“…The relationship between serum Mg levels and mortality in CKD patients is shown in Table 2 [12,[33][34][35][69][70][71][72]. Van Laecke et al found that adjusted HR for all-cause mortality decreased by 7% with a 0.1-mg/dL (0.04 mmol/ L) increase in serum Mg levels in non-dialysis CKD patients [12].…”

Section: Mg and Dialysis Therapymentioning

confidence: 99%

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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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Section: Mg and Dialysis Therapysupporting

confidence: 54%

Section: Mg and Dialysis Therapymentioning

confidence: 79%

Section: Mg and Dialysis Therapymentioning

confidence: 95%

Section: Mg and Dialysis Therapymentioning

confidence: 99%

Section: Mg and Dialysis Therapymentioning

confidence: 99%

See 3 more Smart Citations

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

Ikee¹

2018

Ren Replace Ther

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Clinical features of CKD-MBD in Japan: cohort studies and registry

et al. 2016

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Randomized controlled trials (RCTs) are essential for evidence-based medicine; however, cohort studies and registries provide an important information about risk factors and, hence, shed light on the target of laboratory parameters. The uniqueness of the current Japanese CKD-MBD guidelines lies in the lower target range of intact parathyroid hormone levels than those used in other countries, which is based on analyses of the nationwide Japan Renal Data Registry. Cohort studies were also useful in exploring risk factors of renal outcome in predialysis patients. It was revealed that low vitamin D status (very prevalent in Japan) and high fibroblast growth factor 23 (FGF23) levels predict poor renal outcome. The reported association of FGF23 levels with left ventricular hypertrophy (LVH) and heart failure observed in cohort studies may support the idea of adding the 4th component of CKD-MBD, namely, "LVH" to the three original components. When it is not feasible to conduct RCTs regarding intervention, we have no choice but to rely on observational studies with sophisticated analysis methods, such as facility-level analysis and marginal structural model minimizing indication bias. Observational studies conducted in Japan revealed that the side effects of medications for CKD-MBD, resultant compliance, and effective doses in terms of hard outcome in Japanese patients were found to be different from those in other countries. For example, the MBD-5D study confirmed the benefit of cinacalcet in terms of mortality despite its median dose of only 25 mg/day. These data are very helpful for future guidelines specific to Japanese patients with CKD.

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Hypomagnesemia is not an independent risk factor for mortality in Japanese maintenance hemodialysis patients

Mizuiri¹,

Nishizawa²,

Yamashita³

et al. 2019

Int Urol Nephrol

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Purpose It is unclear whether hypomagnesemia is an independent risk factor or innocent bystander for mortality in maintenance hemodialysis (MHD) patients. Thus, we studied associations between hypomagnesemia and all-cause as well as cardiovascular (CV) mortality in MHD patients. Methods Baseline clinical characteristics and coronary artery calcium score (CACS) of 353 Japanese MHD patients were reviewed. Three-year survival rate and mortality risk factors were assessed. Results Median (interquartile range) age, dialysis vintage, serum magnesium (Mg), serum albumin and CACS of the subjects were 68 (60–78) years, 75 (32–151) months, 2.4 (2.2–2.7) mg/dl, 3.6 (3.3–3.8) g/dl, and 1181 (278–3190), respectively. During the 3-year period, 91 patients died. Kaplan–Meier overall 3-year survival rates were 59.0% in in patients with Mg < 2.4 mg/dl ( n = 136) and 82.3% in patients with Mg ≥ 2.4 mg/dl ( n = 217), ( P < 0.0001). In Cox regression models not incorporating serum albumin, Mg < 2.4 mg/dl was significantly associated with 3-year all-cause death, independent of age, dialysis vintage, average ultrafiltration, Log (CACS + 1), warfarin use, serum potassium, high-sensitivity C-reactive protein (hsCRP), phosphate, uric acid, and intact parathyroid hormone [Hazard ratio (HR) 95% confidence interval (CI): 2.82 (1.31–6.29), P = 0.0078], and CV death, independent of age, dialysis vintage, Log (CACS + 1), warfarin use, serum hsCRP, and uric acid [HR (95% CI): 4.47 (1.45–16.76), P = 0.0086]. Nevertheless, associations of Mg < 2.4 mg/dl with all-cause and CV mortality were all absent in models that included serum albumin. Conclusions Hypomagnesemia is not an independent risk factor for mortality but is associated with malnutrition in MHD patients.

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Hypomagnesemia and Mortality in Incident Hemodialysis Patients

Cited by 70 publications

References 50 publications

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

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

Clinical features of CKD-MBD in Japan: cohort studies and registry

Hypomagnesemia is not an independent risk factor for mortality in Japanese maintenance hemodialysis patients

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