Mortality, Magnesium Imbalance Linked in Dialysis Patients with SHPT

Lowest magnesium level was associated with a 74% increased risk of early death compared with mid-range levels.
Lowest magnesium level was associated with a 74% increased risk of early death compared with mid-range levels.

Disturbed magnesium balance may contribute to early death in hemodialysis (HD) patients with secondary hyperparathyroidism (SHPT), according to researchers.

Shunichi Fukuhara, MD, DMSc, professor of Healthcare Epidemiology at Kyoto University in Japan, and colleagues, examined serum magnesium levels and all-cause mortality in 2,165 SHPT patients from 68 HD centers in Japan. They divided patients into 5 groups based on baseline magnesium levels for analysis.

Having the lowest serum magnesium levels (2.3 mg/dL or less) was associated with lower serum potassium and albumin levels, higher C-reactive protein (CRP) levels, atrial fibrillation, and cerebrovascular disease.  The highest magnesium levels (more than 3.0 mg/dL) were linked to higher potassium levels and negatively associated with cerebrovascular disease, lower serum albumin, and higher intact parathyroid hormone, and CRP levels.

During a median of 3 years, the lowest and second lowest (2.3-2.5 mg/dL) magnesium groups had a 74% and 68% increased risk of early death from any cause, respectively, compared with the group with magnesium levels in the mid-range (2.5-2.7 mg/dL). The higher magnesium groups also appeared to have increased risks.

The investigators determined that dysregulated magnesium contributed substantially to early mortality by 24%–31%, after adjusting for confounding factors, such as malnutrition and inflammation markers, potassium levels, and cardiovascular diseases.

“These findings may encourage health policy makers and physicians to pay more attention to dysregulated [serum magnesium] than they do at present in an effort to reduce the number of preventable deaths among dialysis patients with SHPT,” Dr. Fukuhara and colleagues wrote in Clinical Kidney Journal.

If future research confirms serum magnesium as a risk factor, it can be managed in part by customizing dialysate magnesium levels. Future guidelines can discuss management of magnesium.

Among the study limitations, the investigators noted that they were unable to account for use of magnesium-containing medications.

Source

  1. Kurita N, Akizawa T, Fukagawa M, et al. Contribution of Dysregulated Serum Magnesium to Mortality in Hemodialysis Patients With Secondary Hyperparathyroidism: A 3-Year Cohort Study. Clin Kidney J. doi:10.1093/ckj/sfv097.
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