Magnesium—A More Important Role in CKD–MBD than We Thought

Peride, Ileana; Ţigliş, Mirela; Neagu, Tiberiu Paul; Niculae, Andrei; Checherita, Ionel Alexandru

doi:10.3390/diagnostics12040880

Cited by 4 publications

(7 citation statements)

References 127 publications

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“…Therefore, it is important to manage the mineral metabolism to prevent VC [10]. Recent studies have reported that Mg plays an important role in VC pathogenesis and VC [21]. Hence, we focused on Mg, i-Ca, and VC levels in our cohort.…”

Section: Discussionmentioning

confidence: 99%

Understanding the Korean Dialysis Cohort for Mineral, Vascular Calcification, and Fracture (ORCHESTRA) Study: Design, Method, and Baseline Characteristics

Ahn,

Ko,

Hwang

et al. 2024

Kidney Blood Press Res

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Introduction: End-stage renal disease (ESRD) is a growing disease in Korea and worldwide and is an important condition that affects patient outcomes. In order to provide optimal management for mineral disturbance, vascular calcification, and bone disease of ESRD patients, the ORCHESTRA study (Korean dialysis cohort for mineral, vascular calcification, and fracture) was conducted and enrolled Korean dialysis patients. Methods: Sixteen university-affiliated hospitals and one Veterans Health Service Medical Center participated in this study. This prospective cohort study enrolled approximately 900 consecutive dialysis patients between May 2019 and January 2021. Enrolled subjects were evaluated at baseline for demographic information, laboratory tests, radiologic imaging, and bone mineral densitometry (BMD) scans. After enrollment, regular assessments of patients were performed and their biospecimens were collected according to the study protocol. Primary outcomes were occurrence of major adverse cardiovascular events (MACE), invasive treatment for peripheral artery disease (PAD), and osteoporotic fractures. Secondary outcomes were hospitalization for cerebro-cardiovascular disease or progression of abdominal aortic calcification (AAC). Participants will be assessed for up to three years to determine whether primary or secondary outcomes occur. Results: From May 2019 to January 2021, all participating centers recruited 900 consecutive dialysis patients, including 786 undergoing hemodialysis (HD) and 114 undergoing peritoneal dialysis (PD). The mean age of subjects was 60.4 ± 12.3 years. Males accounted for 57.7%. The mean dialysis vintage was 6.1 ± 6.0 years. The HD group was significantly older, had a longer dialysis vintage, and more comorbidities. Overall, the severity of vascular calcification was higher and the level of BMD was lower in the HD group than in the PD group. Conclusion: This is a nationwide, multicenter, prospective cohort study that focuses on CKD-mineral and bone disorder (CKD-MBD) and aims to provide clinical evidence to establish optimal treatment guidelines for Asian dialysis patients.

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Section: Discussionmentioning

confidence: 99%

Understanding the Korean Dialysis Cohort for Mineral, Vascular Calcification, and Fracture (ORCHESTRA) Study: Design, Method, and Baseline Characteristics

Ahn,

Ko,

Hwang

et al. 2024

Kidney Blood Press Res

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“…Apart from its impacts on hydroxyapatite and CPP formation, studies have shown that Mg also affects vascular calcification at the intracellular level [121,134]. As previously discussed, the transformation of VSMCs into an osteogenic phenotype is recognized as a significant contributor to the development and advancement of vascular calcification [135].…”

Section: Inhibitory Effects Of Mg On the Osteogenic Differentiation O...mentioning

confidence: 96%

Magnesium and Vascular Calcification in Chronic Kidney Disease: Current Insights

Zaslow,

Oliveira-Paula,

Chen

2024

IJMS

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Magnesium (Mg) plays crucial roles in multiple essential biological processes. As the kidneys are the primary organ responsible for maintaining the blood concentration of Mg, people with chronic kidney disease (CKD) may develop disturbances in Mg. While both hyper- and hypomagnesemia may lead to adverse effects, the consequences associated with hypomagnesemia are often more severe and lasting. Importantly, observational studies have shown that CKD patients with hypomagnesemia have greater vascular calcification. Vascular calcification is accelerated and contributes to a high mortality rate in the CKD population. Both in vitro and animal studies have demonstrated that Mg protects against vascular calcification via several potential mechanisms, such as inhibiting the formation of both hydroxyapatite and pathogenic calciprotein particles as well as limiting osteogenic differentiation, a process in which vascular smooth muscle cells in the media layer of the arteries transform into bone-like cells. These preclinical findings have led to several important clinical trials that have investigated the effects of Mg supplementation on vascular calcification in people with CKD. Interestingly, two major clinical studies produced contradictory findings, resulting in a state of equipoise. This narrative review provides an overview of our current knowledge in the renal handling of Mg in health and CKD and the underlying mechanisms by which Mg may protect against vascular calcification. Lastly, we evaluate the strength of evidence from clinical studies on the efficacy of Mg supplementation and discuss future research directions.

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“…Magnesium (Mg), the second most prevalent cation in cells after potassium, is involved in more than 300 enzymatic reactions and significantly impacts neurotransmitter release, oxidative stress prevention, bone metabolism, regulation of heart rhythm, and vascular tone ( 1 ). Mg ranges from 21 to 28 g in the human body.…”

Section: Introductionmentioning

confidence: 99%

“…In CKD patients, serum Mg abnormalities have been found ( 1 ). CKD patients may have hypomagnesemia or hypermagnesemia ( 1 ).…”

Section: Introductionmentioning

confidence: 99%

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Influencing factors of serum magnesium in CKD5 patients: A multicenter study in southern China

Wang

Lin²,

Li³

et al. 2022

Front. Public Health

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IntroductionMagnesium (Mg) disturbances are related to cardiac, bone, and renal patient mortality. In this study, we compared biochemical markers in hemodialysis (HD) and peritoneal dialysis (PD) patients and explored the influencing factors of serum Mg in stage 5 chronic kidney disease (CKD5) patients.Material and methodsAll 598 patients with CKD5 from three medical centers in South China were recruited into this prospective cohort study from March 1, 2018, to January 31, 2021. Our study recorded the clinical characteristics and laboratory data of the patients.ResultsHemodialysis patients (0.99 ± 0.19 mmol/L) had a higher mean serum Mg level than PD patients (0.86 ± 0.20 mmol/L; p < 0.01). Regression analysis showed that only corrected calcium (Ca), phosphate (P), Ca/Mg, Ca × P, albumin (Alb), total protein and creatine (Cr) predicted Mg levels in CKD5 patients (p < 0.01). Ca/Mg predicts hypomagnesemia with 78% sensitivity and 85% specificity in CKD5 patients. The AUC value corresponding to Ca/Mg was 0.88.ConclusionsThis multicenter study in southern China showed that for all CKD5 patients, corrected Ca and Alb had a significant positive effect on serum Mg, while Ca/Mg had a significant negative effect on serum Mg. In 123 HD patients, Ca × P was positively associated with Mg while Ca/Mg and P were negatively associated with Mg. In 398 PD patients, Ca × P, Alb, and total protein were positively associated with Mg while Ca/Mg and P were negatively associated with Mg. In 77 non-dialysis patients, corrected Ca, Cr, and total protein were positively associated with Mg while Ca/Mg was negatively associated with Mg. Furthermore, Ca/Mg might be another useful technique to monitor blood Mg levels in CKD5 patients.Clinical trial registrationChiCTR1800014557.

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Magnesium—A More Important Role in CKD–MBD than We Thought

Cited by 4 publications

References 127 publications

Understanding the Korean Dialysis Cohort for Mineral, Vascular Calcification, and Fracture (ORCHESTRA) Study: Design, Method, and Baseline Characteristics

Understanding the Korean Dialysis Cohort for Mineral, Vascular Calcification, and Fracture (ORCHESTRA) Study: Design, Method, and Baseline Characteristics

Magnesium and Vascular Calcification in Chronic Kidney Disease: Current Insights

Influencing factors of serum magnesium in CKD5 patients: A multicenter study in southern China

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