Hypomagnesemia, chronic kidney disease and cardiovascular mortality: Pronounced association but unproven causation

Dousdampanis, Periklis; Trigka, Konstantina; Fourtounas, Costas

doi:10.1111/hdi.12159

Cited by 24 publications

(28 citation statements)

References 110 publications

(236 reference statements)

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“…Among 311 non-diabetic CKD patients, those in the lower Mg and higher P group were at a 2.07-fold risk for incident ESRD compared with those in the higher Mg and higher P group. The mechanisms contributing to the relationship between hypomagnesemia and renal function loss have not yet been elucidated in detail, but endothelial dysfunction, inflammation, vascular calcification, DM, insulin resistance, hyperaldosteronism, and pro-thrombotic effects may be involved [13,15]. Lower dietary Mg intake may also induce renal function loss [16].…”

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confidence: 99%

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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confidence: 99%

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

Ikee¹

2018

Ren Replace Ther

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“…22,23 Recently, since numerous studies suggested an association between hypomagnesaemia and risk factors of cardiovascular disease, such as diabetes mellitus, metabolic syndrome, coronary artery disease and atherosclerosis risk in the general population, 24,25 the impact of magnesium disorders on the prognosis of patients with chronic kidney disease has received a great deal of interest. Although clinical and epidemiological studies have consistently suggested that lower serum magnesium levels were associated with vascular calcification and cardiovascular mortality among patients with end-stage renal disease (ESRD), 19,[26][27][28] the pathophysiology and the role of magnesium disturbances in chronic kidney disease still need further studies.…”

Section: Discussionmentioning

confidence: 99%

“…However, actually the role and mechanism of magnesium in secondary hyperparathyroidism were largely unknown. 19 Magnesium could influence PTH levels, and vise versa. When researchers were most concerned about the effect of serum magnesium on PTH levels, the influence of PTH on serum magnesium levels in ESRD patients was nearly unexplored.…”

Section: Introductionmentioning

confidence: 99%

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

Teng

Hou

et al. 2015

Renal Failure

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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

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“…When a 1.5 mEq/L dialysate Mg is prescribed, most patients will have normal or a slightly higher serum Mg [56,57]. When using a 1.0 mEq/L dialysate Mg concentration, a small number of patients will have pre-dialysis hypomagnesaemia [58,59]. Moreover, hypomagnesaemia is even more common (5-33%) when a 0.5 mEq/L dialysate Mg is used.…”

Section: Clinical Effects Of Dialysate Magnesium Prescriptionmentioning

confidence: 99%

Magnesium in Chronic Kidney Disease: Should We Care?

Wal-Visscher

Kooman

Sande³

2018

Blood Purif

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Background: Magnesium (Mg) is an essential cation for multiple processes in the body. The kidney plays a major role in regulating the Mg balance. In a healthy individual, totalbody Mg content is kept constant by interactions among intestine, bones and the kidneys. Summary: In case of chronic kidney disease (CKD), renal regulatory mechanisms may be insufficient to balance intestinal Mg absorption. Usually Mg remains normal; however, when glomerular filtration rate declines, changes in serum Mg are observed. Patients with end-stage renal disease on dialysis are largely dependent on the dialysate Mg concentration for maintaining serum Mg and Mg homeostasis. A low Mg is associated with several complications such as hypertension, and vascular calcification, and also associated with an increased risk for both cardiovascular disease (CVD) and non-CVD mortality. Severe hypermagnesaemia is known to cause cardiac conduction defects, neuromuscular effects and muscle weakness; a slightly elevated Mg has been suggested to be beneficial in patients with end-stage renal disease. Key Messages: The role of both low and high Mg, in general, but especially in relation to CKD and dialysis patients is discussed.

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Hypomagnesemia, chronic kidney disease and cardiovascular mortality: Pronounced association but unproven causation

Cited by 24 publications

References 110 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

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

Magnesium in Chronic Kidney Disease: Should We Care?

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