Inverse correlation between serum magnesium and parathyroid hormone in peritoneal dialysis patients: a contributing factor to adynamic bone disease?

Wei, Mingxin; Esbaei, Khaled; Bargman, Joanne M.; Oreopoulos, Dimitrios G.

doi:10.1007/s11255-006-0082-6

Cited by 36 publications

(28 citation statements)

References 46 publications

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“…Therefore, these experiments show for the first time on the molecular level how Mg 2ϩ influences renal P i excretion. Moreover, these data also confirm previous findings that Mg 2ϩ influences PTH secretion not only in vitro but also in vivo (2,5,10,16,23,26,33).…”

Section: F1131supporting

confidence: 90%

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Magnesium stimulates renal phosphate reabsorption

Thumfart¹,

Jung²,

Amasheh³

et al. 2008

American Journal of Physiology-Renal Physiology

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In the kidney, ϳ80% of the filtered phosphate (Pi) is reabsorbed along the proximal tubule. Changes in renal Pi reabsorption are associated with modulation of the sodium-dependent Pi cotransporter type IIa (NaPi-IIa) and type IIc (NaPi-IIc) protein abundance in the brush-border membrane (BBM) of proximal tubule cells. NaPi-IIa is mainly regulated by dietary Pi intake and parathyroid hormone (PTH). The purpose of the present study was to elucidate the effect of alteration in dietary magnesium (Mg 2ϩ ) intake on renal Pi handling. Urinary Pi excretion and renal expression of NaPi-IIa and NaPi-IIc were analyzed in rats fed a normal (0.2%) or high-Mg 2ϩ (2.5%) diet. A high-Mg 2ϩ diet resulted in decreased renal Pi excretion and increased protein expression of NaPi-IIa and NaPi-IIc. Serum FGF-23 (fibroblast growth factor 23) levels were unchanged under a high-Mg 2ϩ diet. Serum PTH levels were slightly decreased under a high-Mg 2ϩ diet. To examine whether the observed changes in renal Pi reabsorption are PTH dependent, expression of NaPi-IIa and NaPi-IIc was also analyzed in parathyroidectomized (PTX) rats fed a normal or high-Mg 2ϩ diet. In PTX rats, Mg 2ϩ had no significant effect on renal Pi excretion or NaPi-IIa protein expression. Mg 2ϩ increased NaPi-IIc protein expression in PTX rats. This experiment shows for the first time on the molecular level how Mg 2ϩ stimulates renal Pi reabsorption. Under a high-Mg 2ϩ diet, NaPi-IIa expression is dependent on PTH levels, whereas NaPiIIc expression seems to be independent of PTH levels. in renal P i handling. Overall P i homeostasis is mainly regulated by intestinal absorption and renal excretion of P i . Approximately 80% of the filtered P i is reabsorbed along the proximal tubule. Transport of P i across the proximal tubular cell membrane is mainly initiated by the sodium dependent P i cotransporter NaPi type IIa (NaPi-IIa) (21). Less is reabsorbed by NaPi-IIc. The abundance of NaPi-IIa protein in the brush border membrane (BBM) reflects the capacity of the kidney to reabsorb P i . Acute phosphaturic stimuli like PTH decrease the amount of NaPi-IIa protein in the BBM by inducing the endocytosis and lysosomal degradation of NaPi-IIa (3).In this study, the effect of Mg 2ϩ on renal P i excretion and expression of NaPi-IIa and NaPi-IIc was analyzed in rats fed a normal (0.2%) or high-Mg 2ϩ (2.5%) diet for 4 wk. Mg 2ϩ increased renal P i reabsorption by enhancing protein expression of NaPi-IIa and NaPi-IIc. Slightly decreased serum PTH levels were measured under a high-Mg 2ϩ diet. In a second set of experiments, renal P i excretion and NaPi-IIa and NaPi-IIc expression were analyzed in parathyroidectomized (PTX) rats fed a normal or high-Mg 2ϩ diet. In PTX rats, Mg 2ϩ did not significantly change renal P i excretion or NaPi-IIa expression. NaPi-IIc expression was increased. These data indicate that Mg 2ϩ stimulates renal P i reabsorption via NaPi-IIa in a PTHdependent manner, whereas NaPi-IIc expression seems to be influenced independently by Mg 2ϩ and PTH levels. MATERIALS ...

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Section: F1131supporting

confidence: 90%

“…In peritoneal dialysis patients, serum Mg 2ϩ concentration is inversely correlated with PTH levels (23,33). Taken together, these observations point to an influence of Mg 2ϩ on PTH secretion in vivo.…”

mentioning

confidence: 77%

Magnesium stimulates renal phosphate reabsorption

Thumfart¹,

Jung²,

Amasheh³

et al. 2008

American Journal of Physiology-Renal Physiology

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“…The calcium-sensing receptor in the parathyroid glands is affected by magnesium, and both hypermagnesemia and severe hypomagnesemia can suppress PTH [28,29,30,31,32]. In dialysis patients, many studies have shown an association between lower dialysate [14,33,34,35] or serum [17,36,37] magnesium and higher PTH. However, similar to our findings, Cho et al [38] and O'Donovan et al [39] also failed to show any association between dialysate magnesium and PTH.…”

Section: Discussionmentioning

confidence: 99%

Hypomagnesemia in Hemodialysis Patients: Role of Proton Pump Inhibitors

Alhosaini¹,

Walter

Singh

et al. 2014

Am J Nephrol

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Background: Recent observations have associated hypomagnesemia with increased risk of cardiovascular morbidity and mortality in hemodialysis patients. Methods: We did a 3-month chart review of 62 chronic hemodialysis patients at a single US hospital. All were dialyzed using a dialysate [Mg] of 0.75-1.0 mEq/l. Patients were divided into two groups: hypomagnesemic (mean predialysis plasma [Mg] <1.5 mEq/l) and non-hypomagnesemic (mean predialysis plasma [Mg] ≥1.5 mEq/l). Results: All patients were male; mean age was 64.3 ± 8.7 years and the majority (73%) diabetic. 24 patients (39%) had hypomagnesemia and 38 (61%) were not hypomagnesemic. There were no significant differences between the two groups in age, diabetes status, blood pressure, duration of dialysis, plasma calcium, phosphorus, albumin, intact parathyroid hormone (PTH), dialysis adequacy (Kt/V), or dietary protein intake (as estimated by normalized protein catabolic rate, nPCR). However, use of proton pump inhibitors (PPIs) was significantly associated with hypomagnesemia (plasma [Mg] 1.48 ± 0.16 mEq/l in the PPI group vs. 1.65 ± 0.26 mEq/l in the non-PPI group, p = 0.007). Adjustment for age, diabetes status, duration of dialysis, plasma albumin, Kt/V, nPCR, and diuretic use did not affect the association between PPI use and hypomagnesemia. Conclusions: Use of PPIs in patients dialyzed using a dialysate [Mg] of 0.75-1.0 mEq/l is associated with hypomagnesemia. We suggest monitoring plasma [Mg] in patients taking PPIs, with discontinuation of the medication if possible and/or adjustment of dialysate [Mg] to normalize plasma [Mg].

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“…In our study, unlike other reports, we found that there was no inverse relationship between serum Mg and PTH. 18,[39][40][41] One of the reasons for the difference might be sample differentia. The patients who are included had severe secondary hyperparathyroidism with PTH4500 pg/mL and unmanageable parathyroid hyperplasia.…”

Section: Discussionmentioning

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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Inverse correlation between serum magnesium and parathyroid hormone in peritoneal dialysis patients: a contributing factor to adynamic bone disease?

Cited by 36 publications

References 46 publications

Magnesium stimulates renal phosphate reabsorption

Magnesium stimulates renal phosphate reabsorption

Hypomagnesemia in Hemodialysis Patients: Role of Proton Pump Inhibitors

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

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