Consequences of Supraphysiological Dialysate Magnesium on Arterial Stiffness, Hemodynamic Profile, and Endothelial Function in Hemodialysis: A Randomized Crossover Study Followed by a Non-Controlled Follow-Up Phase

Abstract

Introduction: Increasing dialysate magnesium (D-Mg 2?) appears to be an intriguing strategy to obtain cardiovascular benefits in subjects with end-stage kidney disease (ESKD) on hemodialysis. To date, however, hemodialysis guidelines do not suggest to increase D-Mg 2? routinely set at 0.50 mmol/L. Methods: A randomized 4-week crossover study aimed at investigating the consequences of increasing D-Mg 2? from 0.50 to 0.75 mmol/L on arterial stiffness, hemodynamic profile, and endothelial function in subjects undergoing hemodialysis. The long-term effect of higher D-Mg 2? on mineral metabolism markers was investigated in a 6-month follow-up. Data were analyzed by linear mixed models for repeated measures. Results: Data of 39 patients were analyzed. Pulse wave velocity and pulse pressure significantly decreased on the higher D-Mg 2? compared with the standard one by-0.91 m/s (95% confidence interval-1.52 to-0.29; p = 0.01) and-9.61 mmHg (-18.89 to-0.33, p = 0.04), respectively. A significant reduction in systolic blood pressure of-12.96 mmHg (-24.71 to-1.22, p = 0.03) was also observed. No period or carryover effects were observed. During the long-term follow-up phase the higher D-Mg 2? significantly increased ionized and total serum Mg (respectively from 0.54 to 0.64 and from 0.84 to 1.07 mmol/L; mean percentage change from baseline to follow-up ? 21% and ? 27%; p B 0.001), while parathormone (PTH) decreased significantly (from 36.6 to 34.4 pmol/ L; % change-11%, p = 0.03). Conclusions: Increasing dialysate magnesium improves vascular stiffness in subjects undergoing maintenance hemodialysis. The present findings merit a larger trial to evaluate the Rosaria Del Giorno and Soraya Lavorato Hadjeres are joint first authors.

Does Ionized Magnesium Offer a Different Perspective Exploring the Association between Magnesemia and Targeted Cardiovascular Risk Factors?

“…The literature has so far suggested the presence of a correlation between serum magnesium levels in the upper part of the distribution and lower arterial stiffness parameters [ 44 ], an inverse relationship between magnesium intake and blood pressure [ 9 ], and a higher risk of magnesium deficiency in overweight conditions [ 15 ]. Nonetheless, evidence regarding the role of Mg in cardiovascular diseases, including hypertension [ 29 , 30 , 31 , 32 , 33 ] and arterial aging parameters [ 34 , 35 , 36 , 37 ], and its correlation with body composition, on the one hand remains inconclusive, and on the other, derives mostly from total serum magnesium analyses.…”

The impact of magnesium on psycho-emotional stress and functional activity of the cardiovascular system in students from African countries

“…В ходе исследования также было выявлено снижение жесткости сосудистого русла у обследуемых при приеме магния. Данное наблюдение согласуется с результатами исследования, свидетельствующими о достоверном снижении жесткости артерий и, как следствие, артериального давления при увеличении уровня магния в диализате у пациентов, находящихся на гемодиализе [14]. Также отмечено снижение толщины комплекса интима-медиа сонных артерий при длительном приеме магния у пациентов с сахарным диабетом 2 типа [15], что может обусловливать изменение жесткости артерий.…”

Magnesium in chronic haemodialysis (MAGIC-HD): a study protocol for a randomised controlled trial to determine feasibility and safety of using increased dialysate magnesium concentrations to increase plasma magnesium concentrations in people treated with haemodialysis

“… 8 9 Moreover, serum magnesium was inversely associated with pulse wave velocity (PWV) in people treated with maintenance haemodialysis, 10 and in a short randomised cross-over study in people treated with haemodialysis, higher dialysate magnesium concentration compared with standard dialysate magnesium concentration decreased PWV. 11 PWV is a marker of vascular stiffness and a strong predictor of cardiovascular outcome in people with CKD stage 4-5D. 12 In most studies that included multiple categories of plasma magnesium concentration in people with CKD including those treated with dialysis, there was a monotonic inverse association between magnesium and all-cause mortality.…”