Hypomagnesemia is a significant predictor of cardiovascular and non-cardiovascular mortality in patients undergoing hemodialysis

Abstract

Although previous studies in the general population showed that hypomagnesemia is a risk for cardiovascular diseases (CVD), the impact of magnesium on the prognosis of patients on hemodialysis has been poorly investigated. To gain information on this we conducted a nationwide registry-based cohort study of 142,555 hemodialysis patients to determine whether hypomagnesemia is an independent risk for increased mortality in this population. Study outcomes were 1-year all-cause and cause-specific mortality with baseline serum magnesium levels categorized into sextiles. During follow-up, a total of 11,454 deaths occurred, of which 4774 had a CVD cause. In a fully adjusted model, there was a J-shaped association between serum magnesium and the odds ratio of all-cause mortality from the lowest to highest sextile, with significantly higher mortality in sextiles 1-3 and 6. Similar associations were found between magnesium and both CVD and non-CVD mortality. The proportion of patients with a baseline intact parathyroid hormone level under 50 pg/ml was significantly higher in the highest sextile; however, after excluding these patients, the CVD mortality risk in the highest sextile was attenuated. Thus, hypomagnesemia was significantly associated with an increased risk of mortality in hemodialysis patients. Interventional studies are needed to clarify whether magnesium supplementation is beneficial for improving patient prognosis.

The Effect of Increasing Dialysate Magnesium on Serum Calcification Propensity in Subjects with End Stage Kidney Disease

“…Similarly, secondary calciprotein particles induce calcification in vitro, and Mg prolongs the time until formation of secondary calciprotein particles in serum (4). This suggests that the inverse association between serum Mg and cardiovascular events (16) and the in vivo inhibitory effect of Mg supplementation on vascular calcification (17) might be due to the inhibitory effect of Mg on amorphous Ca/PO 4 transformation (12) and thus, inhibition of hydroxyapatite and calciprotein particle formation, which in turn, might prevent the formation of calcification. More studies are needed to further examine this association in humans.…”

Arrhythmia and Sudden Death in Hemodialysis Patients

“…Similarly, low serum magnesium levels were associated with higher all-cause mortality in Japanese dialysis patients (20), but few data exist on SCD risk and magnesium dialysate levels.…”

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

“…In our study, we found that hypermagnesemia (42.5 mg/dL) occurs in up to 44% of cases. Although the previous studies were largely concerned about the role of hypomagnesaemia and suggested that hypomagnesaemia was a predictor of mortality in patients undergoing hemodialysis, 26 it was also worthy to note that the association between serum magnesium level and mortality is potentially J-shaped. Thus, hypermagnesemia and its effect on prognosis in hemodialysis patients could not be ignored either.…”

“…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.…”