Magnesium Studies in Hemodialysis Patients before and after Treatment with Low Dialysate Magnesium

Nilsson, Per; Johansson, S. G. O.; Danielson, Bo G.

doi:10.1159/000183202

Cited by 49 publications

(47 citation statements)

References 10 publications

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“…Using a similarly low (0.5 mEq/l) dialysate [Mg], Gonella et al [13] reported predialysis [Mg] of 1.57 ± 0.05 mEq/l (range 1.16-1.82) with 4/12 (33%) of patients having a predialysis [Mg] of <1.5 mEq/l. Using an even lower (0.4 mEq/l) dialysate [Mg] for a duration of 4 months, Nilsson et al [14] reported a mean predialysis [Mg] of 1.86 ± 0.48 mEq/l. The range of values was not given, but based on the reported variance in their data, probably no more than 20% had plasma [Mg] <1.5 mEq/l.…”

Section: Discussionmentioning

confidence: 99%

“…Lower dialysate [Mg] (i.e. 0.4-0.5 mEq/l) has generally not resulted in hypomagnesemia in previous studies [1,13,14,16,18]. …”

Section: Introductionmentioning

confidence: 96%

“…More recently, use of magnesium as an inexpensive phosphate binder [7,8,9,10,11] and the possible role of high magnesium in adynamic bone disease [12] have led to use of a lower dialysate [Mg]. Whereas mild hypermagnesemia is expected with use of a dialysate [Mg] of 1.5 mEq/l [13,14,15,16], a dialysate [Mg] of 1.0 mEq/l has generally been associated with either normal plasma [Mg] or mild hypermagnesemia [17,18]. Lower dialysate [Mg] (i.e.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

“…Lower dialysate [Mg] (i.e. 0.4-0.5 mEq/l) has generally not resulted in hypomagnesemia in previous studies [1,13,14,16,18]. …”

Section: Introductionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Hypomagnesemia in Hemodialysis Patients: Role of Proton Pump Inhibitors

Alhosaini¹,

Walter

Singh

et al. 2014

Am J Nephrol

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“…Serum Mg levels showed an independent inverse relationship with intact PTH levels in pre-dialysis ESRD patients [55] and dialysis patients [56,57]. Interventional studies showed that dialysate Mg concentration and Mg-containing phosphate binders affected intact PTH levels [58,59]. Mg suppresses PTH secretion via the activation of Ca sensing receptor, although Mg is 2-to 3-fold less potent than Ca.…”

Section: Mg and Dialysis Therapymentioning

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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“…Other factors, such as xerosis, increases in skin mast cells, hyperparathyroidism, high serum magnesium, and increased vitamin A, may lead to onset or may aggravate uremic pruritus (7)(8)(9)(10)(11). Not only is the treatment of uremic pruritus complex (12), but dialysis also has a mild effect on it (13), as the severity of pruritus can increase on the day of dialysis therapy or on the following day (14).…”

Section: Introductionmentioning

confidence: 99%