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

Abstract

Background:Some studies have found that hypomagnesemia is associated with vascular calcification, atherosclerosis, and cardiovascular disease, which may lead to increased mortality in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) who need to maintain hemodialysis (HD). However, the conclusion of these studies remain controversial.Methods:Relevant literature was retrieved from the database of Cochrane library, PubMed, EMBASE, and CNKI until December 2020, without any language restrictions. The data was analyzed using the Stata 12.0 software.Results:A total of 31 studies were included, involving 205436 participants. The results showed that after multivariable adjusted, hypomagnesemia was significant associated with the risk of all-cause mortality in patients with CKD and end-stage renal disease (ESRD) (hazard ratios [HR] 1.955; 95% confidence interval (95% CI) 1.511-2.528; P = .000; hypomagnesemia vs normal magnesium or hypermagnesemia). In contrast, in patients with CKD and ESRD, hypermagnesemia was negatively correlated with all-cause mortality (HR 0.873; 95% CI 0.793-0.960; P = .005) (per unit increase). Moreover, in the adjusted model, it was observed that hypermagnesemia was significantly associated with a reduced risk of cardiovascular death (HR 0.598; 95% CI 0.094-1.102, P = .020). In addition, subgroup analysis found that hypomagnesemia was closely related to the increase of all-cause mortality in HD patients (HR 1.799; 95% CI 1.375-2.354; P = .000) (hypomagnesemia vs normal magnesium or hypermagnesemia).Conclusion:Our results show that hypomagnesemia is significantly associated with cardiovascular and all-cause mortality in maintenance HD patients. Further studies should be conducted to evaluate the benefits of magnesium correction in maintenance dialysis patients with hypomagnesemia.

Comparative Efficacy and Acceptability of 12 Phosphorus-Lowering Drugs in Adults with Hyperphosphatemia and Chronic Kidney Disease: A Systematic Review and Network Meta-Analysis

“…However, the preliminary results of the Magical trial suggest magnesium had no effect on coronary artery calcification [37]. The relationship between blood magnesium levels, which may be increased by magnesium carbonate [38], and the risk of all-cause and cardiovascular mortality in CKD patients remains under dispute [39]. Magnesium appears to play a key role in preventing vascular calcification since data suggest that increased serum magnesium levels can reduce the development of vascular calcification [40, 41].…”

“…Magnesium appears to play a key role in preventing vascular calcification since data suggest that increased serum magnesium levels can reduce the development of vascular calcification [40, 41]. Hypomagnesemia was found to be highly linked to cardiovascular and all-cause mortality in patients with CKD and end-stage renal disease in meta-analyses [39, 42]. Furthermore, magnesium supplementation can enhance calcium and parathormone metabolism, which can help in CKD-mineral and bone disorder [43].…”

Cardiovascular Calcification Heterogeneity in Chronic Kidney Disease

“…Interestingly, serum magnesium demonstrates an inverse relationship with vascular calcification. 188 The kidneys help regulate magnesium homeostasis, and although many patients with CKD exhibit hypermagnesemia, a significant subset of patients with proteinuria develop hypomagnesemia. 189 Perhaps as a result, arterial calcification in patients with CKD appears to favor hydroxyapatite over whitlockite, whereas the relative abundance of these minerals is similar in individuals with normal renal function.…”

Hypomagnesemia as a Risk Factor and Accelerator for Vascular Aging in Diabetes Mellitus and Chronic Kidney Disease

“…Their simple equation contains only three variables: (−0.129 + (0.620 × Mgtot) + (0.337 × Caion) + (−0.110 × Catot) (Mgtot: total magnesium, Catot total calcium, and Caion: ionized calcium)) [ 84 ]. Knowing the exact serum magnesium level cannot be neglected because this might be a way to reduce the risk of cardiovascular death [ 85 ]. The cause of the hypomagnesemia and the correlation with CVD in PD are unclear.…”