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

Abstract

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.

Relationship between sex and cardiovascular mortality in chronic kidney disease: A systematic review and meta-analysis

“…The majority of the studies reported results for end-stage renal disease (ESRD) patients on dialysis: 30 studies included subjects exclusively on HD [ 15 , 16 , 19 , 20 , 22 – 47 ], eight studies included subjects on PD [ 48 – 55 ], three studies included both HD and PD [ 17 , 18 , 56 ], and six studies reported their subjects were not on dialysis [ 21 , 57 – 61 ]. Six studies defined their subjects as having CKD stages 3 to 5, [ 18 , 21 , 58 , 59 , 61 , 62 ], while only one study described their subjects as CKD stages 3 and 4 [ 60 ].…”

Cardiovascular Calcification in Chronic Kidney Disease—Therapeutic Opportunities

“…Lower serum magnesium levels were associated with higher all-cause and CV mortality [93][94][95][96]. However, hypomagnesemia was not an independent predictor for mortality in end-stage renal disease [93,96]. CAC and vessel stiffness occurred in patients with high magnesium serum levels [97].…”

The Role of Disturbed Mg Homeostasis in Chronic Kidney Disease Comorbidities

“…Kaplan–Meier analysis showed a significantly higher incidence of death in patients with serum Mg levels lower than 2.5 mg/dL ( Shimohata et al, 2019 ). Furthermore, in a prospective study in Japanese hemodialysis patients, hypomagnesemia showed significantly worse 3-year cumulative survival for all-cause mortality; however, hypomagnesemia was not an independent risk factor for mortality, and it was associated with malnutrition ( Mizuiri et al, 2019 ). In recent systematic review and meta-analysis of 20 publications, there was a strong association between hypomagnesemia and the risk of all-cause mortality in patients with CKD and ESKD ( Xiong et al, 2019 ).…”