Low serum magnesium levels are associated with an increased risk of death among hemodialysis (HD) patients, especially among patients with low serum albumin levels, according to study findings reported at the National Kidney Foundation’s 2015 Spring Clinical Meetings in Dallas.

The study, led by Kamyar Kalantar-Zadeh, MD, MPH, PhD, of the University of California Irvine, and presented by Lin Li, MD, of the same institution, included 9,359 HD patients who initiated dialysis at DaVita facilities. The cohort had a median follow-up of 19 months, during which 2,636 deaths occurred. 

Compared with patients who had a serum magnesium level of at least 2.2 but less than 2.4 mg/dL (reference), patients with a level below 2.0 mg/dL had a significantly increased risk of all-cause mortality over time after adjusting for baseline characteristics and co-morbidities. The risk was increased by about 20% for patients with a magnesium level of at least 1.8 but less than 2.0 mg/dL and 40% for those with a level below 1.8 mg/dL. 

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The association between magnesium level and mortality, however, was not statistically significant after additional adjustment for other laboratory analytes, especially serum albumin, Dr. Kalantar-Zadeh’s group reported.

Among patients with low serum albumin (less than 3.5 g/dL), patients with a magnesium level below 2.0 mg/dL had a significant 17% increased risk of death compared with those who had a magnesium level of 2.0 mg/dL or higher.

“These findings may help identify HD patients with higher mortality risk for potential interventions,” the investigators concluded.