The Association Between Exposure to Low Magnesium Blood Levels After Renal Transplantation and Cardiovascular Morbidity and Mortality

Abstract

Background: Serum magnesium levels are associated with cardiovascular disease and all-cause mortality in the general population and chronic kidney disease patients, but the association between serum magnesium levels and cardiovascular risk after kidney transplantation is not established. We sought to evaluate whether exposure to low serum magnesium levels after renal transplantation is related to cardiovascular morbidity and mortality.Methods: We conducted a single center retrospective study that included all transplanted patients who had a functioning graft for at least 6 months after transplantation between January 2001 and December 2013. We calculated exposure to magnesium using time weighted average for serum magnesium levels, using all values available during the follow-up. Several statistical methods were used, including liner regression analysis, χ2 test, and multivariate Cox proportional hazard model.Results: Four hundred ninety-eight patients were included. Median follow-up was 5.26 years. High time weighted average of serum magnesium was associated with a hazard ratio of 1.94 for all-cause mortality and major cardiovascular outcome compared to low levels (95% CI 1.18–3.19, p = 0.009). The high quartile of time weighted average of serum magnesium was associated with death censored major cardiovascular outcome (hazard ratio 2.13, 95% CI 1.17–3.86, p = 0.013) in multivariate analysis.Conclusions: Exposure to low serum magnesium levels in renal transplant recipients was associated with a lower risk for all-cause mortality and major cardiovascular outcome. These findings contrast the higher risk found in the general population.

The interaction between estimated glomerular filtration rate and dietary magnesium intake and its effect on stroke prevalence: a cross-sectional study spanning 2003–2018

“…In addition, given that the reabsorption of magnesium in the kidneys plays a key role in its homeostasis, a reduced GFR may lead to magnesium deficiency ( 50 ). Experimental evidence suggests that increased dietary magnesium intake and supplementation can improve renal function, reverse vascular calcification, and lower serum phosphate and parathyroid hormone levels ( 25 , 51 ). Thus, magnesium deficiency may impair kidney function and reduce magnesium absorption from the urine, consequently heightening stroke risk.…”

Magnesium matters: unveiling hidden risks in kidney transplant patients through total and ionized magnesium profiling

“…Dysmagnesemia has also been linked to unfavorable outcomes in individuals undergoing dialysis and those with chronic kidney disease (CKD), acting as a potential predictor for both mortality and the deterioration of renal function in CKD patients ( 1 , 7 ). In kidney transplant (KT) patients, hypomagnesemia is widespread, often encountered in the first weeks after KT, and frequently promoted by calcineurin inhibitors (CNIs), other concomitant medications (i.e., thiazide-type and loop diuretics and pump proton inhibitors), and tubular leakage ( 1 ).…”

“…Mg 2+ deficit, often overlooked compared to other electrolyte disorders, raises substantial health concerns and is frequently encountered in clinical settings, affecting as much as 30% of the elderly population ( 2 ). Hypomagnesemia has been linked to cardiovascular risk and is commonly associated with unfavorable clinical outcomes and higher mortality ( 3 – 7 ).…”

“…KT patients experiencing hypomagnesemia may also be prone to impaired glucose metabolism, increasing their susceptibility to the development of diabetes mellitus ( 6 , 10 ). Moreover, associations between low Mg 2+ levels and a more rapid decline in renal function, increased risk of graft loss ( 1 , 6 , 11 ), and major cardiovascular outcomes have been reported ( 7 ). This underscores the importance of paying more attention to abnormal Mg 2+ values in clinical practice within this patient population.…”