#SCM16: The Status of Magnesium in Nephrology
Dr. Anawin Sanguankeo (AS), from Bassett Medical Center in Cooperstown, New York, discusses his abstract for the National Kidney Foundation’s 2016 Spring Clinical Meetings (SCM16), Magnesium Level and Mortality in Chronic Kidney Disease and Dialysis Patients: A Systematic Review and Meta-Analysis, 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 2016 Spring Meetings?
AS: Studies in the general population have found that lower serum magnesium has been associated with inflammation, disturbance in endothelial function that leads to progression of atherosclerosis, and coronary heart disease. It also is associated with ventricular arrhythmia and is a risk factor for sudden cardiac death.
We know that chronic kidney disease (CKD) and dialysis patients tend to have abnormal electrolyte homeostasis, as they have difficulty clearing some electrolytes, including magnesium. Conflicting results exist regarding the relationship between serum magnesium and mortality in this population. Therefore, we wanted to do a systematic review and meta-analysis to summarize the current evidence on how serum magnesium affects mortality and also to find what factors relate to this association. We searched the databases MEDLINE and EMBASE to review prospective original articles that evaluated the association of magnesium, hypomagnesemia, and hypermagnesemia with mortality in CKD or dialysis patients. We used a random-effects model meta-analysis to compare risk of mortality among patients with hypomagnesemia, hypermagnesemia, or normal serum magnesium. We found that compared to normal magnesium, hypomagnesemia increases risk of mortality by 42%, but the association between hypermagnesemia and mortality is not statistically significant.
AJKDblog: Why do you think hypomagnesemia is causing increased mortality in our patients?
AS: There is evidence from other population studies that hypomagnesemia impacts neuromuscular and cardiovascular function. It contributes to the development of cardiovascular diseases, ventricular arrhythmias, and sudden death. The mechanism behind this could be from modulating vascular smooth muscle tone, endothelial function, and vascular excitability.
AJKDblog: Where do you and your group go from here?
AS: We plan to study the effect of supplemental magnesium on mortality benefit in patients with CKD and dialysis. We also want to study how magnesium level affects mortality in other settings, such as in critical care patients.
All Spring Clinical Meeting abstracts are available in the May issue of AJKD.
Check out more AJKDblog coverage of the NKF’s 2016 Spring Clinical Meetings (#SCM16)!
Like most of us, Dr. Jhaveri also falls into the the same trap of correlation and causation! His question: Why do you think hypomagnesemia is causing increased mortality in our patients? Who said hypomagnesemia CAUSES increased mortality. What Dr. Sanguankeo has shown is that hypomagnesemia is ASSOCIATED with increased mortality.
Agree with Professor Nephron, I meant association, not causation. Guess I got trapped!