Relationship of serum magnesium level with body composition and survival in hemodialysis patients

Abstract

Introduction: A relationship between serum magnesium (Mg) and body composition parameters has not been reported in hemodialysis (HD) patients. We aimed to clarify whether serum Mg has any association with body composition parameters, or survival in HD patients.Methods: This study included 215 consecutive maintenance HD patients. Laboratory data collection and postdialysis body composition analysis were performed at baseline. The patients were divided based on baseline serum Mg level tertiles (low, medium, and high Mg groups). Kaplan-Meier survival, logistic regression analyses and Cox proportional hazard analyses were conducted.Findings: Among all patients, the median age and dialysis vintage were 73 (65-81) years and 44 (8-96) months, respectively. The serum Mg levels were < 2.3, 2.3-2.5, and > 2.5 mg/dL for the low (n = 67), middle (n = 76), and high (n = 72) Mg groups, respectively. Compared to other groups, low Mg group showed significantly higher age and C-reactive protein levels, but lower serum albumin, normalized protein catabolic rates and frequency of on-line hemodiafiltration. The low, middle, and high Mg groups differed significantly regarding body cell mass (fat-free mass without bone mineral mass and extracellular water) index (BCMI): [5.6 (4.2-6.8), 6.0 (4.8-8.1), 6.7 (4.9-7.5) kg/m 2 , respectively] and overhydration/extracellular water ratio (OH/ECW) [11.7 (4.5-21.9), 4.8 (1.0-14.1), 8.5 (−0.5-15.0) %, respectively] but not regarding body mass index, lean tissue index, fat tissue index. Hypomagnesemia was significantly associated with BCMI [odds ratio (OR) [95% confidence interval (CI)]: 0.85 [0.73-1.00] and OH/ECW (OR [95% CI]: 1.03 [1.01-1.05]), respectively. Kaplan-Meyer 3-year survival rates were 53.6%, 69.7%, and 71.7% in low, middle, and high Mg groups, respectively. However, hypomagnesemia was not significantly associated with 3-year allcause mortality independent of age, serum albumin and C-reactive protein.Discussion: Hypomagnesemia was associated with lower BCMI, more pronounced OH/ECW and poorer Kaplan-Meier 3-year cumulative survival, but was not an independent risk factor for mortality in HD patients.

Associations between the serum magnesium and all-cause or cardiovascular mortality in chronic kidney disease and end-stage renal disease patients

“…We then carefully read the full text of each of the remaining 37 studies. Finally, 13 studies involving 205,436 patients met the inclusion criteria [11,13,14,18–45] . As shown in Table 1, the studies that met the inclusion criteria were all conducted between 2007 and 2020, involving 205,436 patients.…”

“…Ishimura et al [18] ★★★★ ★ ★★★ 7 Markaki et al [19] ★★★ ★ ★★★ 6 Ortega et al [20] ★★★ ★ ★★★ 6 Broek et al [21] ★★★★ ★ ★★★ 7 Laecke et al [22] ★★★★ ★ ★★★ 7 Lacson et al [11] ★★★★ ★ ★★★ 7 Fein et al [23] ★★★★ ★ ★★★ 6 Sakaguchi et al [14] ★★★★ ★ ★★ 6 Li et al [24] ★★★★ ★ ★★★ 7 de Roij van Zuijdewijn et al [25] ★★★ ★ ★★★ 7 Matias et al [26] ★★★★ ★ ★★★ 7 Garagarza et al [27] ★★★ ★ ★★★ 6 Kurita et al [28] ★★★ ★ ★★★ 6 Yang et al [13] ★★★ ★ ★★★ 7 Cai et al [29] ★★★ ★ ★★★ 7 Ago et al [30] ★★★★ ★ ★★ 7 Hughes et al [31] ★★★★ ★ ★★★ 7 Lv et al [34] ★★★ ★ ★★★ 6 Ferrè et al [32] ★★★ ★ ★★★ 7 Schmaderer et al [35] ★★★ ★ ★★★ 7 Sato et al [36] ★★★★ ★ ★★★ 6 Selim et al [33] ★★★★ ★ ★★★ 7 de Francisco et al [37] ★★★ ★ ★★★ 7 Zhang et al [38] ★★★ ★ ★★★ 7 Ye et al [39] ★★★ ★ ★★★ 7 Li et al [40] ★★★★ ★ ★★ 6 Lu et al [41] ★★★ ★ ★★★ 6 Mizuiri et al [42] ★★★ ★ ★★★ 6 Wu et al [43] ★★★★ ★ ★★★ 7 Ogawa et al [44] ★★★ ★ ★★★ 7 Guan et al [45] ★★★ ★ ★★★ 7…”

“…de Francisco et al [37] 2017 Spain 2242 68.1 6 mo Retrospective HD All-cause mortality 7 Zhang et al [38] 2017 China 92 73.92 ± 10.73 5 yrs Retrospective HD All-cause mortality 7 Ye et al [39] 2018 China 402 49.3 ± 14.9 49.9 mo Prospective PD All-cause and cardiovascular mortality 7 Li et al [40] 2019 China 446 53.52 ± 15.21 3 yrs Retrospective HD All-cause and cardiovascular mortality 6 Lu et al [41] 2019 China 413 50.4 ± 14.3 12 mo Retrospective HD All-cause and cardiovascular mortality 6 Mizuiri et al [42] 2019 Japan 215 73 3 yrs Retrospective HD All-cause mortality 6 Wu et al [43] 2019 China 169 60.20 ± 15.64 37 mo Prospective HD All-cause and cardiovascular mortality 7 Ogawa et al [44] 2020 Japan 148 56.4 ± 10.5 6 yrs Prospective HD All-cause mortality 7 Guan et al [45] 2020 China 381 56.1 ± 14.2 6.5 yrs Prospective PD All-cause and cardiovascular mortality 7 CKD = chronic kidney disease, HD = hemodialysis, N = number, NOS = Newcastle-Ottawa Scale, PD = peritoneal dialysis.…”

“…Ishimura et al [18] 2007 0.261 (0.143, 0.477) †,x 0.485 (0.241, 0.975) †,x NR 0.983 (0.313, 3.086) †,x Markaki et al [19] 2012 NR 1.16 (0.34, 3.96) * ,x NR NR Ortega et al [20] 2013 1.5 (0.15, 14.7) †,x NR 0.4 (0.08, 2.5) †,x NR Broek et al [21] 2013 NR NR NR 0.64 (0.39, 1.05) †,x Laecke et al [22] 2013 NR 0.93 (0.89, 0.98) †,x NR NR Lacson et al [11] 2014 1.6 (1.3, 1.96) * ,x NR NR NR Fein et al [23] 2014 0.142 (0.0354, 0.2486) †,x 0.984 (0.9684, 0.9999) †,x NR NR Sakaguchi et al [14] 2014 2.04 (1.9, 2.18) * , ‡ 1.18 (1.07, 1.30) * , ‡ NR NR Li et al [24] 2015 1.28 (1.15, 1.42) * ,x 1.17 (1.05, 1.30) * ,x NR NR de Roij van Zuijdewijn et al [25] 2015 0.85 (0.77, 0.94) †,x 0.88 (0.78, 0.99) †,x 0.73 (0.62, 0.85) †,x 0.73 (0.62, 0.85) †,x Matias et al [26] 2015 NR 0.87 (0.68, 0.99) †,x NR 0.82 (0.72, 0.95) †,x Garagarza et al [27] 2015 NR 0.489 (0.36, 0.76) †,x NR NR Kurita et al [28] 2015 NR NR Yang et al [13] 2016 1.28 (1.09, 1.50) * ,x 1.21 (1.09, 1.50) * ,x NR NR Cai et al [29] 2016 0.041 (0.007, 0.223) †,x 0.075 (0.01, 0.552) †,x 0.007 (0.001, 0.081) †,x 0.003 (0, 0.055) †,x Ago et al [30] 2016 NR NR Hughes et al [31] 2016 NR 1.71 (1.27, 2.30) * ,x NR NR Lv et al [34] 2016 NR NR NR 5.617 (1.628, 19.381) †,x Ferrè et al [32] 2017 Schmaderer et al [35] 2017 0.54 (0.20, 1.46) †,x 0.35 (0.13, 0.97) †,x NR NR Sato et al [36] 2017 de Francisco et al [37] 2017 0.69 (0.54, 0.89) †,x 1.28 (0.97, 1.70) †,x NR NR Zhang et al [38] 2017 0.025 (0.001, 0.528) * , ‡ NR NR NR Ye et al [39] 2018 0.85 (0.71, 1.02) †,x 0.83 (0.68, 1.01) †,x 0.85 (0.67, 1.08) †,x 0.82 (0.64, 1.06) †,x Li et al [40] 2019 0.572 (0.338, 0.797) Lu et al [41] 2019 NR 0.017 (0.002, 0.197) †,x NR 0.011 (0.000, 0.269) †,x Mizuiri et al [42] 2019 1.88 (1.13, 3.08) * ,x 1.72 (1.00, 2.91) * ,x NR NR Wu et al [43] 2019 9.544 (5.372, 16.965)…”