Dr. Lin Li (LL), from UC Irvine, Orange, CA, discusses his abstract for the National Kidney Foundation’s 2015 Spring Clinical Meetings (SCM15), Hypomagnesemia and Risk of All-Cause Mortality In USA Maintenance Hemodialysis Patients, with Dr. Kenar Jhaveri, AJKD Blog Editor.
AJKDblog: Why don’t you tell us a little about your research and abstract being presented at the NKF 2015 Spring Meetings?
LL: Low serum magnesium (Mg) levels have been associated with higher risk of type 2 diabetes mellitus, hypertension, cardiovascular disease, and mortality. In ESRD patients, serum Mg levels are largely dependent upon dietary intake and dialysate Mg concentrations. Limited data suggested that hypomagnesemia is associated with increased all-cause and cardiovascular mortality in ESRD population. Our study is the first to examine the association between time-varying serum Mg and mortality risk among a large US hemodialysis cohort. We observed that lower serum Mg was significantly associated with increased all-cause mortality. We also found that there was a differential association between serum Mg and mortality across serum albumin levels such that hypomagnesemia had a particularly stronger association with death among patients with low albumin levels.
AJKDblog: Diabetes has been associated with low magnesium as well. Did you notice that the diabetic patients with low magnesium had the biggest impact?
LL: Mg deficiency is associated with insulin resistance and metabolic syndrome in both human and animal studies. In the general population, hypomagnesemia was associated with higher risk of type 2 diabetes mellitus and poorer glycemic control. In our dialysis cohort, hypomagnesemia was associated with higher mortality risk among diabetic patients. The association was similar to that in the entire cohort, and was not modified by the presence of diabetic mellitus.
AJKDblog: Where do you and your group go from here?
LL: Hypomagnesemia may lead to adverse outcomes via several mechanistic pathways. Mg deficiency has been shown to induce endothelial dysfunction and promote atherosclerosis. Low Mg level also promotes vascular calcification and vascular stiffness. Therefore, it is import to further explore the cause-specific mortality risk with low serum Mg in dialysis patients, in particular the cardiovascular disease associated mortality risk. Secondly, we have observed that hemodialyis patients with lower serum Mg levels tended to have lower hemoglobin in this study. A similar finding was previously reported in a Japanese dialysis cohort. Lower serum Mg has been found to be associated with increased inflammation dialyzed subjects, which may explain the difficulty in anemia control. Future studies are needed to clarify the association between serum Mg level and anemic management in hemodialysis patients. Finally, randomized studies are in great need to evaluate the safety and impact of correcting low Mg levels with Mg supplementation or increase dialysate Mg concentration upon survival among hypomagnesemic dialysis patients.
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