Serum Magnesium and Mortality in Hemodialysis Patients in the United States: A Cohort Study

Lacson, Eduardo; Wang, Weiling; Ma, Lin; Passlick–Deetjen, Jutta

doi:10.1053/j.ajkd.2015.06.014

Cited by 99 publications

(138 citation statements)

References 25 publications

(26 reference statements)

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“…The significant elevations in serum magnesium levels, and the possibility of increased phosphate levels, might be the result of osmotic diuresis caused by SGLT2 inhibitors, but the precise mechanisms involved are unknown. Abnormally high magnesium levels are predictive of total mortality in individuals with heart failure [22], those who are critically ill [23] and those receiving haemodialysis [24]. Therefore, caution must be exercised in patients with impaired renal function, such as in severe CKD.…”

Section: Discussionmentioning

confidence: 99%

“…Search strategy and selection of articles We searched the PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) and ClinicalTrials.gov databases up to 24 May 2016 to identify eligible RCTs using relevant search terms without restrictions on language and year of publication (see ESM Table 1 for a complete list of search terms). We included parallel-design RCTs of at least 24 weeks duration that compared SGLT2 inhibitors to placebo in adults with type 2 diabetes and reported mean (percentage) change from baseline in electrolyte levels for each group or data that enabled calculation of these variables.…”

Section: Methodsmentioning

confidence: 99%

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Elevated serum magnesium associated with SGLT2 inhibitor use in type 2 diabetes patients: a meta-analysis of randomised controlled trials

et al. 2016

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Aims/hypothesis By analysing available evidence from randomised controlled trials (RCTs), we aimed to examine whether and to what extent sodium-glucose cotransporter 2 (SGLT2) inhibitors affect serum electrolyte levels in type 2 diabetes patients. Methods We searched PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) a nd ClinicalTrials.gov up to 24 May 2016 for published RCTs of SGLT2 inhibitors that reported changes in serum electrolyte levels. Weighted mean differences (WMD) between each SGLT2 inhibitor and placebo were calculated using a randomeffects model. Dose-dependent relationships for each SGLT2 inhibitor were evaluated using meta-regression analysis.Results Eighteen eligible RCTs, including 15,309 patients and four SGLT2 inhibitors (canagliflozin, dapagliflozin, empagliflozin and ipragliflozin) were evaluated. In patients without chronic kidney disease, each SGLT2 inhibitor significantly increased serum magnesium levels compared with placebo (canagliflozin: WMD 0.06 mmol/l for 100 mg and 0.09 mmol/l for 300 mg; dapagliflozin: WMD 0.1 mmol/l for 10 mg; empagliflozin: WMD 0.04 mmol/l for 10 mg and 0.07 mmol/l for 25 mg; and ipragliflozin: WMD 0.05 mmol/l for 50 mg). Canagliflozin increased serum magnesium in a linear dose-dependent manner (p = 0.10). Serum phosphate was significantly increased by dapagliflozin. Serum sodium appeared to significantly differ by SGLT2 inhibitor type. No significant changes in serum calcium and potassium were observed. Findings were robust after including trials involving patients with chronic kidney disease. Conclusions/interpretation SGLT2 inhibitors marginally increased serum magnesium levels in type 2 diabetes patients indicating a drug class effect. Further investigations are required to examine the clinical significance of elevated magnesium levels in individuals with type 2 diabetes.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Elevated serum magnesium associated with SGLT2 inhibitor use in type 2 diabetes patients: a meta-analysis of randomised controlled trials

et al. 2016

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“…Higher level of serum magnesium is mostly associated with better prognoses in MHD patients (Table 3) and it was found to be associated with lower mortality risk in this group of patients in several studies [10] [37]. In Sakaguchi et al's cohort study, it was shown that the mortality risk of HD patients with hyperphosphatemia was greatly reduced with increasing serum magnesium [17].…”

Section: Magnesium Disordersmentioning

confidence: 96%

“…However, in another study of 11,500 patients from the Dialysis Outcomes and Practice Patterns Study (DOPPS), Hecking et al found the prevalence of mean pre-dialysis serum sodium level lower than 137 mmol/L to be 27% and that of mean pre-dialysis serum sodium level higher than or equals to 140 mmol/L to be 31% [6]. Hyponatremia is a frequently seen electrolyte disorder while hypermagnesemia is also highly prevalent in MHD patients and it tends to be in a higher percentage than hypomagnesemia [7] [8] [9] [10]. In a cohort study of 27,544 MHD patients in the United States, 4729 patients (17.2%) had hypomagnesemia and 6133 patients (22.3%) had hypermagnesemia [10].…”

Section: Prevalence Of Serum Electrolytes Abnormalitiesmentioning

confidence: 99%

“…Hyponatremia is a frequently seen electrolyte disorder while hypermagnesemia is also highly prevalent in MHD patients and it tends to be in a higher percentage than hypomagnesemia [7] [8] [9] [10]. In a cohort study of 27,544 MHD patients in the United States, 4729 patients (17.2%) had hypomagnesemia and 6133 patients (22.3%) had hypermagnesemia [10].…”

Section: Prevalence Of Serum Electrolytes Abnormalitiesmentioning

confidence: 99%

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Impact of Abnormal Serum Electrolyte Levels and Acid-Base Disorders on Clinical Outcomes among Maintenance Hemodialysis Patients

Guttee¹,

Nie²,

Wang³

et al. 2017

OALib

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There has been a notable rise in the number of patients diagnosed with chronic kidney disease (CKD) over the years across the world, with most cases subsequently leading to end-stage renal failure. Hemodialysis (HD) remains one of the main treatments for end-stage renal disease (ESRD) worldwide. Despite improvements in dialysis care, the mortality of patients with ESRD on maintenance hemodialysis is persistently high. Abnormal levels of serum electrolytes, pre-and post-dialysis, and acid-base disorders have a crucial influence on clinical outcomes in HD patients. In this review, we aim to discuss the different effects that serum electrolyte levels have on the prognosis of patients on maintenance hemodialysis, particularly sodium, potassium, magnesium, phosphorus and bicarbonate.

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Electrolyte Disorders

Wang

Qian

2022

Evidence‐Based Nephrology

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Serum Magnesium and Mortality in Hemodialysis Patients in the United States: A Cohort Study

Cited by 99 publications

References 25 publications

Elevated serum magnesium associated with SGLT2 inhibitor use in type 2 diabetes patients: a meta-analysis of randomised controlled trials

Elevated serum magnesium associated with SGLT2 inhibitor use in type 2 diabetes patients: a meta-analysis of randomised controlled trials

Impact of Abnormal Serum Electrolyte Levels and Acid-Base Disorders on Clinical Outcomes among Maintenance Hemodialysis Patients

Electrolyte Disorders

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