Effect of Magnesium Supplementation on Carotid Intima-Media Thickness and Flow-Mediated Dilatation among Hemodialysis Patients: A Double-Blind, Randomized, Placebo-Controlled Trial

Abstract

Objectives: The aim of the present study was to determine the efficacy of oral magnesium (Mg) supplementation on endothelial function through evaluation of carotid intima-media thickness (cIMT), brachial artery flow-mediated dilatation (FMD), and C-reactive protein (CRP) among hemodialysis (HD) patients. Methods: This randomized, controlled, double-blind clinical trial consisted of 54 patients on HD. One group was treated orally with 440 mg of Mg oxide 3 times per week for 6 months (n = 29). The control group (n = 25) was given placebo using the same administration protocol. cIMT, FMD, serum calcium levels, phosphorus, lipid, CRP, and bicarbonate were measured at baseline and at 6 months in both groups. Results: At 6 months, cIMT was significantly decreased in the Mg group (0.84 ± 0.13 mm at baseline and 0.76 ± 0.13 mm at 6 months, p = 0.001). However, in the placebo group, cIMT was significantly increased (0.73 ± 0.13 and 0.79 ± 0.12 mm, respectively, p = 0.003). When hypertension, diabetes mellitus, smoking, hyperlipidemia, and systemic lupus erythematosus were controlled for in the analysis, the effect of Mg remained significant in both groups (p = 0.000). Conclusion: Our results indicate that Mg might not improve endothelial function (CRP level and FMD) and that a decreased cIMT as a marker of atherosclerosis may be due to the inhibition of calcification through the regulation parathormone, calcium, and phosphorus.

Oral magnesium supplementation improves endothelial function and attenuates subclinical atherosclerosis in thiazide-treated hypertensive women

“…In accordance with these findings, a recent study in hemodialysis patients showed that magnesium oxide for 6 months was able to decrease carotid IMT with an increase in the placebo group [57]. Indeed, the role of magnesium in attenuating the progression of atherosclerosis has been previously demonstrated in hemodialysis patients [58].…”

Magnesium Replacement Improves the Metabolic Profile in Obese and Pre-Diabetic Patients with Mild-to-Moderate Chronic Kidney Disease: A 3-Month, Randomised, Double-Blind, Placebo-Controlled Study

“…In a trial in hypomagnesemic patients, magnesium improved glycemia after kidney transplantation [48]. In another study, carotid intima-media thickness was decreased after magnesium treatment in patients on hemodialysis [49]. Other studies have shown that magnesium reduces blood pressure [15, 50].…”

Calcium Acetate/Magnesium Carbonate and Cardiovascular Risk Factors in Chronic Hemodialysis Patients

“…In a small interventional study with 47 HD patients, Mg supplementation was associated with a significant improvement of bilateral carotid intima-media thickness [24]. In a recent randomized double-blinded, placebo-controlled study, Mg supplementation over 6 months also resulted in a decrease of carotid intima thickness, which is possibly due to an inhibition of calcification [25]. Mg seems to influence molecular processes associated with the inhibition of vascular calcification such as a decrease of the calcium entry into the cells of the media, prevention of cell damage (apoptosis) [31] and inhibition of Wnt/β-catenin signaling pathway [32].…”

“…In a recent double-blind, randomized, placebo-controlled trial with 54 HD patients, Mg supplementation over 6 months resulted in a decrease of carotid intima-media thickness possibly due to an inhibition of calcification [25]. …”