Oral Magnesium Supplementation in Chronic Kidney Disease Stages 3 and 4: Efficacy, Safety, and Effect on Serum Calcification Propensity—A Prospective Randomized Double-Blinded Placebo-Controlled Clinical Trial

Bressendorff, Iain; Hansen, Ditte; Schou, Morten; Silver, Burton B.; Pasch, Andreas; Bouchelouche, Pierre; Pedersen, Lise; Rasmussen, Lars Melholt; Brandi, Lisbet

doi:10.1016/j.ekir.2016.12.008

Cited by 78 publications

(66 citation statements)

References 35 publications

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“…In vitro experiments suggested that other serum electrolytes than serum bicarbonate influence the T 50 -time: recently, Bressendorff et al demonstrated that magnesium supplementation compared to placebo in 36 patients with CKD 3 and 4 over 8 weeks changed the T 50 -time on average by 40 min [29]. Although the clinical relevance of the observed effect is still unclear, it is worth mentioning that the result reached statistical significance with a similar sample size and standard deviation of T 50 -time to the here presented study.…”

Section: Discussionmentioning

confidence: 99%

Oral Sodium Bicarbonate Supplementation Does Not Affect Serum Calcification Propensity in Patients with Chronic Kidney Disease and Chronic Metabolic Acidosis

Aigner¹,

Cejka²,

Sliber³

et al. 2019

Kidney Blood Press Res

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Background: Cardiovascular disease is the leading cause of death in patients with chronic kidney disease (CKD) and metabolic acidosis might accelerate vascular calcification. The T₅₀ calcification inhibition test (T₅₀-test) is a global functional test analyzing the overall propensity of calcification in serum, and low T₅₀-time is associated with progressive aortic stiffening and with all-cause mortality in non-dialysis CKD, dialysis, and transplant patients. Low serum bicarbonate is associated with a short T₅₀-time and alkali supplementation could be a simple modifier of calcification propensity. The aim of this study was to investigate the short-term effect of oral sodium bicarbonate supplementation on T₅₀-time in CKD patients. Material and Methods: The SoBic-study is an ongoing randomized-controlled trial in CKD-G3 and G4 patients with chronic metabolic acidosis (serum HCO₃^– ≤21 mmol/L), in which patients are randomized to either achieve serum HCO₃^– levels of 24 ± 1 mmol/L (intervention group) or 20 ± 1 mmol/L (rescue group). The effect of bicarbonate treatment on T₅₀-time was assessed. Results: The study cohort consisted of 35 (14 female) patients aged 57 (±15) years, and 18 were randomized to the intervention group. The mean T₅₀-time was 275 (± 64) min. After 4 weeks, the mean change of T₅₀-time was 4 (±69) min in the intervention group and 18 min (±56) in the rescue group (β = –25; 95% CI: –71 to 22; p = 0.298). Moreover, change of serum bicarbonate in individual patients was not associated with change in T₅₀-time, analyzed by regression analysis. Change of serum phosphate had a significant impact on change of T₅₀-time (β = –145; 95% CI: –237 to –52). Conclusion: Oral sodium bicarbonate supplementation showed no effect on T₅₀-time in acidotic CKD patients.

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Section: Discussionmentioning

confidence: 99%

Oral Sodium Bicarbonate Supplementation Does Not Affect Serum Calcification Propensity in Patients with Chronic Kidney Disease and Chronic Metabolic Acidosis

Aigner¹,

Cejka²,

Sliber³

et al. 2019

Kidney Blood Press Res

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“…Specifically, interventions such as hemodialysis [67][68][69] , increasing bicarbonate and magnesium, and lowering phosphate serum concentrations improve the T 50 value [56,68] . Uniform interventions, even of moderate intensity, have been shown to improve the T 50 value by approximately 40 min in hemodialysis and CKD patients [69] .…”

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confidence: 99%

Hope for CKD-MBD Patients: New Diagnostic Approaches for Better Treatment of CKD-MBD

Hocher¹

2017

Kidney Dis

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Background: Chronic kidney disease-mineral and bone disorder (CKD-MBD) patients have a huge morbidity and mortality. Only relatively minor progress in therapeutic strategies has been made in the past decades. This is at least partially due to a lack of predictive diagnostic tools allowing personalized treatment of CKD-MBD patients. Summary: In this review we describe recent progress in the diagnosis of disturbances of calcium and phosphate metabolism in patients with CKD-MBD, measuring biological active nonoxidized parathyroid hormone as well as the overall likelihood of a patient to get calcified. Key Message: There is hope. The new tools have the potential of allowing personalized therapy for the treatment of CKD-MBD and hence improving outcome.

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“…T50, although strongly influenced by fetuin-A concentrations [1,3], is additionally a dynamic functional serum measure, more broadly affected by other determinantsserum phosphorus, magnesium, and bicarbonate [1,3,36], which are modifiable in CKD [37][38][39]. Thus CKD patients, including KTRs, with shorter duration T50, could be targeted for interventions already familiar to clinicians, which may improve (i.e., prolong) this index of serum calcification propensity [1,3,36].…”

Section: Resultsmentioning

confidence: 99%

“…Thus CKD patients, including KTRs, with shorter duration T50, could be targeted for interventions already familiar to clinicians, which may improve (i.e., prolong) this index of serum calcification propensity [1,3,36]. Phosphoruslowering treatments [37], and magnesium [38] or alkali [39] supplementation are examples of such individual therapies whose experimental capacity to prolong T50 might be considerably enhanced if administered in combination [1,3,36].…”

Section: Resultsmentioning

confidence: 99%

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Serum Calcification Propensity and Fetuin-A: Biomarkers of Cardiovascular Disease in Kidney Transplant Recipients

et al. 2018

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Background: “T50,” shortened transformation time from primary to secondary calciprotein particles may reflect deranged mineral metabolism predisposing to vascular calcification and cardiovascular disease (CVD). The glycoprotein fetuin-A is a major T50 determinant. Methods: The Folic Acid For Vascular Outcome Prevention In Transplantation (FAVORIT) cohort is a completed, large, multiethnic controlled clinical trial cohort of chronic, stable kidney transplant recipients (KTRs). We conducted a longitudinal case-cohort analysis using a randomly selected subcohort of patients, and all individual cases who developed CVD. Serum T50 and fetuin-A were determined in this total of n = 685 FAVORIT trial participants at randomization. Results: During a median surveillance of 2.18-years, 311 incident or recurrent CVD events occurred. Shorter T50 (minutes) or reduced fetuin-A concentrations (g/L) were associated with CVD after adjustment for treatment assignment, systolic blood pressure, age, sex, race, preexisting CVD and diabetes, smoking, body mass index, total cholesterol/HDL cholesterol, kidney allograft vintage and type, calcineurin inhibitor, or lipid-lowering drug use, estimated glomerular filtration rate, and urinary albumin/creatinine: tertile 1 (lowest) to tertile 3 (highest) comparisons, T50, (hazard ratio [HR] 1.86; 95% CI 1.20–2.89); fetuin-A, (HR 2.25; 95% CI 1.38–3.69). Elevated high sensitivity c-reactive protein (hsCRP) was an effect modifier of both these associations. Conclusions: Shortened T50, as well as reduced fetuin-A levels, ostensible promoters of vascular calcification, remained associated with greater risk for CVD outcomes, after adjustment for major CVD risk factors, measures of kidney function and damage, and KTR clinical characteristics and demographics, in a large, multiethnic cohort of long-term KTRs. Increased hsCRP was an effect modifier of these CVD risk associations.

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Oral Magnesium Supplementation in Chronic Kidney Disease Stages 3 and 4: Efficacy, Safety, and Effect on Serum Calcification Propensity—A Prospective Randomized Double-Blinded Placebo-Controlled Clinical Trial

Cited by 78 publications

References 35 publications

Oral Sodium Bicarbonate Supplementation Does Not Affect Serum Calcification Propensity in Patients with Chronic Kidney Disease and Chronic Metabolic Acidosis

Oral Sodium Bicarbonate Supplementation Does Not Affect Serum Calcification Propensity in Patients with Chronic Kidney Disease and Chronic Metabolic Acidosis

Hope for CKD-MBD Patients: New Diagnostic Approaches for Better Treatment of CKD-MBD

Serum Calcification Propensity and Fetuin-A: Biomarkers of Cardiovascular Disease in Kidney Transplant Recipients

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