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Serum magnesium and cardiovascular mortality in peritoneal dialysis patients: a 5-year prospective cohort study

  • Hongjian Ye (a1) (a2), Peiyi Cao (a1) (a2), Xiaodan Zhang (a1) (a2), Jianxiong Lin (a1) (a2), Qunying Guo (a1) (a2), Haiping Mao (a1) (a2), Xueqing Yu (a1) (a3) and Xiao Yang (a1) (a2)...

Abstract

The aim of this study was to explore the association between serum Mg and cardiovascular mortality in the peritoneal dialysis (PD) population. This prospective cohort study included prevalent PD patients from a single centre. The primary outcome of this study was cardiovascular mortality. Serum Mg was assessed at baseline. A total of 402 patients (57 % male; mean age 49·3±14·9 years) were included. After a median of 49·9 months (interquartile range: 25·9–68·3) of follow-up, sixty-two patients (25·4 %) died of CVD. After adjustment for conventional confounders in multivariate Cox regression models, being in the lower quartile for serum Mg level was independently associated with a higher risk of cardiovascular mortality, with hazards ratios of 2·28 (95 % CI 1·04, 5·01), 1·41 (95 % CI 0·63, 3·16) and 1·62 (95 % CI 0·75, 3·51) for the lowest, second and third quartiles, respectively. A similar trend was observed when all-cause mortality was used as the study endpoint. Further analysis showed that the relationships between lower serum Mg and higher risk of cardiovascular and all-cause mortality were present only in the female subgroup, and not among male patients. The test for interaction indicated that the associations between lower serum Mg and cardiovascular and all-cause mortality differed by sex (P=0·008 and P=0·011, respectively). In conclusion, lower serum Mg was associated with a higher risk of cardiovascular and all-cause mortality in the PD population, especially among female patients.

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Corresponding author

*Corresponding author: X. Yang, fax +86 20 87769673, email yangxsysu@126.com

References

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1. Xu, T, Sun, Y, Xu, T, et al. (2013) Magnesium intake and cardiovascular disease mortality: a meta-analysis of prospective cohort studies. Int J Cardiol 167, 30443047.
2. Molnar, AO, Biyani, M, Hammond, I, et al. (2017) Lower serum magnesium is associated with vascular calcification in peritoneal dialysis patients: a cross sectional study. BMC Nephrol 18, 129.
3. Kanbay, M, Yilmaz, MI, Apetrii, M, et al. (2012) Relationship between serum magnesium levels and cardiovascular events in chronic kidney disease patients. Am J Nephrol 36, 228237.
4. Sakaguchi, Y, Fujii, N, Shoji, T, et al. (2014) Hypomagnesemia is a significant predictor of cardiovascular and non-cardiovascular mortality in patients undergoing hemodialysis. Kidney Int 85, 174181.
5. Joao Matias, P, Azevedo, A, Laranjinha, I, et al. (2014) Lower serum magnesium is associated with cardiovascular risk factors and mortality in haemodialysis patients. Blood Purif 38, 244252.
6. Lacson, E Jr, Wang, W, Ma, L, et al. (2015) Serum magnesium and mortality in hemodialysis patients in the United States: a cohort study. Am J Kidney Dis 66, 10561066.
7. Markaki, A, Kyriazis, J, Stylianou, K, et al. (2012) The role of serum magnesium and calcium on the association between adiponectin levels and all-cause mortality in end-stage renal disease patients. PLOS ONE 7, e52350.
8. Ye, H, Zhang, X, Guo, Q, et al. (2013) Prevalence and factors associated with hypomagnesemia in Southern Chinese continuous ambulatory peritoneal dialysis patients. Perit Dial Int 33, 450454.
9. Ejaz, AA, McShane, AP, Gandhi, VC, et al. (1995) Hypomagnesemia in continuous ambulatory peritoneal dialysis patients dialyzed with a low-magnesium peritoneal dialysis solution. Perit Dial Int 15, 6164.
10. Yang, X, Soohoo, M, Streja, E, et al. (2016) Serum magnesium levels and hospitalization and mortality in incident peritoneal dialysis patients: a cohort study. Am J Kidney Dis 68, 619627.
11. Cai, K, Luo, Q, Dai, Z, et al. (2016) Hypomagnesemia is associated with increased mortality among peritoneal dialysis patients. PLOS ONE 11, e0152488.
12. Wenger, NK (2012) Cardiovascular disease: the female heart is vulnerable: a call to action from the 10Q report. Clin Cardiol 35, 134135.
13. Xuereb, R, Magri, CJ, Xuereb, S, et al. (2016) Female gender and cardiovascular disease. Br J Hosp Med (Lond) 77, 454459.
14. Chiuve, SE, Korngold, EC, Januzzi, JL Jr., et al. (2011) Plasma and dietary magnesium and risk of sudden cardiac death in women. Am J Clin Nutr 93, 253260.
15. Nolph, KD, Moore, HL, Twardowski, ZJ, et al. (1992) Cross-sectional assessment of weekly urea and creatinine clearances in patients on continuous ambulatory peritoneal dialysis. ASAIO J 38, M139M142.
16. van Olden, RW, Krediet, RT, Struijk, DG, et al. (1996) Measurement of residual renal function in patients treated with continuous ambulatory peritoneal dialysis. J Am Soc Nephrol 7, 745750.
17. Bergstrom, J, Furst, P, Alvestrand, A, et al. (1993) Protein and energy intake, nitrogen balance and nitrogen losses in patients treated with continuous ambulatory peritoneal dialysis. Kidney Int 44, 10481057.
18. Cheung, AK, Sarnak, MJ, Yan, G, et al. (2004) Cardiac diseases in maintenance hemodialysis patients: results of the HEMO Study. Kidney Int 65, 23802389.
19. Delmez, JA, Yan, G, Bailey, J, et al. (2006) Cerebrovascular disease in maintenance hemodialysis patients: results of the HEMO Study. Am J Kidney Dis 47, 131138.
20. de Jager, DJ, Grootendorst, DC, Jager, KJ, et al. (2009) Cardiovascular and noncardiovascular mortality among patients starting dialysis. JAMA 302, 17821789.
21. Stenvinkel, P, Carrero, JJ, Axelsson, J, et al. (2008) Emerging biomarkers for evaluating cardiovascular risk in the chronic kidney disease patient: how do new pieces fit into the uremic puzzle? Clin J Am Soc Nephrol 3, 505521.
22. Kupetsky-Rincon, EA, Li, Q & Uitto, J (2012) Magnesium reduces carotid intima-media thickness in a mouse model of pseudoxanthoma elasticum: a novel treatment biomarker. Clin Transl Sci 5, 259264.
23. Kupetsky, EA, Rincon, F & Uitto, J (2013) Rate of change of carotid intima-media thickness with magnesium administration in Abcc6(−)/(−) mice. Clin Transl Sci 6, 485486.
24. Ishimura, E, Okuno, S, Kitatani, K, et al. (2007) Significant association between the presence of peripheral vascular calcification and lower serum magnesium in hemodialysis patients. Clin Nephrol 68, 222227.
25. Maier, JA (2012) Endothelial cells and magnesium: implications in atherosclerosis. Clin Sci (Lond) 122, 397407.
26. Shechter, M, Sharir, M, Labrador, MJ, et al. (2000) Oral magnesium therapy improves endothelial function in patients with coronary artery disease. Circulation 102, 23532358.
27. Sternberg, K, Gratz, M, Koeck, K, et al. (2012) Magnesium used in bioabsorbable stents controls smooth muscle cell proliferation and stimulates endothelial cells in vitro. J Biomed Mater Res B Appl Biomater 100, 4150.
28. Hreiche, R, Morissette, P & Turgeon, J (2008) Drug-induced long QT syndrome in women: review of current evidence and remaining gaps. Gend Med 5, 124135.
29. Whang, W, Julien, HM, Higginbotham, L, et al. (2012) Women, but not men, have prolonged QT interval if depressed after an acute coronary syndrome. Europace 14, 267271.
30. Velat, I & Culic, V (2014) Circulating magnesium and cardiovascular events. Am J Clin Nutr 99, 647648.
31. Straus, SM, Kors, JA, De Bruin, ML, et al. (2006) Prolonged QTc interval and risk of sudden cardiac death in a population of older adults. J Am Coll Cardiol 47, 362367.
32. Martin, KJ, Gonzalez, EA & Slatopolsky, E (2009) Clinical consequences and management of hypomagnesemia. J Am Soc Nephrol 20, 22912295.
33. Agus, ZS (1999) Hypomagnesemia. J Am Soc Nephrol 10, 16161622.
34. Bachman, DM (2003) Oral magnesium ion shortens prolonged QTc interval. J Clin Psychiatry 64, 733734.
35. Shah, GM, Winer, RL, Cutler, RE, et al. (1987) Effects of a magnesium-free dialysate on magnesium metabolism during continuous ambulatory peritoneal dialysis. Am J Kidney Dis 10, 268275.
36. Katopodis, KP, Koliousi, EL, Andrikos, EK, et al. (2003) Magnesium homeostasis in patients undergoing continuous ambulatory peritoneal dialysis: role of the dialysate magnesium concentration. Artif Organs 27, 853857.
37. Wada, T, Hirayama, T, Hibino, Y, et al. (2014) Malnutrition as cause of hypomagnesemia. Kidney Int 86, 856.
38. Alhosaini, M & Leehey, DJ (2015) Magnesium and dialysis: the neglected cation. Am J Kidney Dis 66, 523531.
39. Stenvinkel, P, Heimburger, O, Paultre, F, et al. (1999) Strong association between malnutrition, inflammation, and atherosclerosis in chronic renal failure. Kidney Int 55, 18991911.
40. Suliman, ME, Qureshi, AR, Barany, P, et al. (2000) Hyperhomocysteinemia, nutritional status, and cardiovascular disease in hemodialysis patients. Kidney Int 57, 17271735.
41. Bergstrom, J & Lindholm, B (1998) Malnutrition, cardiac disease, and mortality: an integrated point of view. Am J Kidney Dis 32, 834841.
42. Anonymous (2000) Clinical practice guidelines for nutrition in chronic renal failure. K/DOQI, National Kidney Foundation. Am J Kidney Dis 35, S1S140.
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British Journal of Nutrition
  • ISSN: 0007-1145
  • EISSN: 1475-2662
  • URL: /core/journals/british-journal-of-nutrition
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