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Serum magnesium, mortality and disease progression in chronic kidney disease

INTRODUCTION: Magnesium disorders are commonly encountered in chronic kidney disease (CKD) and are typically a consequence of decreased kidney function or frequently prescribed medications such as diuretics and proton pump inhibitors. While hypomagnesemia has been linked with increased mortality, th...

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Autores principales: Azem, Rami, Daou, Remy, Bassil, Elias, Anvari, Eva Maria, Taliercio, Jonathan J., Arrigain, Susana, Schold, Jesse D., Vachharajani, Tushar, Nally, Joseph, Na khoul, Georges N.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7017617/
https://www.ncbi.nlm.nih.gov/pubmed/32050924
http://dx.doi.org/10.1186/s12882-020-1713-3
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author Azem, Rami
Daou, Remy
Bassil, Elias
Anvari, Eva Maria
Taliercio, Jonathan J.
Arrigain, Susana
Schold, Jesse D.
Vachharajani, Tushar
Nally, Joseph
Na khoul, Georges N.
author_facet Azem, Rami
Daou, Remy
Bassil, Elias
Anvari, Eva Maria
Taliercio, Jonathan J.
Arrigain, Susana
Schold, Jesse D.
Vachharajani, Tushar
Nally, Joseph
Na khoul, Georges N.
author_sort Azem, Rami
collection PubMed
description INTRODUCTION: Magnesium disorders are commonly encountered in chronic kidney disease (CKD) and are typically a consequence of decreased kidney function or frequently prescribed medications such as diuretics and proton pump inhibitors. While hypomagnesemia has been linked with increased mortality, the association between elevated magnesium levels and mortality is not clearly defined. Additionally, associations between magnesium disorders, type of death, and CKD progression have not been reported. Therefore, we studied the associations between magnesium levels, CKD progression, mortality, and cause specific deaths in patients with CKD. METHODS: Using the Cleveland Clinic CKD registry, we identified 10,568 patients with estimated Glomerular Filtration Rate (eGFR) between 15 and 59 ml/min/1.73 m(2) in this range for a minimum of 3 months with a measured magnesium level. We categorized subjects into 3 groups based on these magnesium levels (≤ 1.7, 1.7–2.6 and > 2.6 mg/dl) and applied cox regression modeling and competing risk models to identify associations with overall and cause-specific mortality. We also evaluated the association between magnesium level and slope of eGFR using mixed models. RESULTS: During a median follow-up of 3.7 years, 4656 (44%) patients died. After adjusting for relevant covariates, a magnesium level < 1.7 mg/dl (vs. 1.7–2.6 mg/dl) was associated with higher overall mortality (HR = 1.14, 95% CI: 1.04, 1.24), and with higher sub-distribution hazards for non-cardiovascular non-malignancy mortality (HR = 1.29, 95% CI: 1.12, 1.49). Magnesium levels > 2.6 mg/dl (vs. 1.7–2.6 mg/dl) was associated with a higher risk of all-cause death only (HR = 1.23, 95% CI: 1.03, 1.48). We found similar results when evaluating magnesium as a continuous measure. There were no significant differences in the slope of eGFR across all three magnesium groups (p = 0.10). CONCLUSIONS: In patients with CKD stage 3 and 4, hypomagnesemia was associated with higher all-cause and non-cardiovascular non-malignancy mortality. Hypermagnesemia was associated with higher all-cause mortality. Neither hypo nor hypermagnesemia were associated with an increased risk of CKD progression.
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spelling pubmed-70176172020-02-20 Serum magnesium, mortality and disease progression in chronic kidney disease Azem, Rami Daou, Remy Bassil, Elias Anvari, Eva Maria Taliercio, Jonathan J. Arrigain, Susana Schold, Jesse D. Vachharajani, Tushar Nally, Joseph Na khoul, Georges N. BMC Nephrol Research Article INTRODUCTION: Magnesium disorders are commonly encountered in chronic kidney disease (CKD) and are typically a consequence of decreased kidney function or frequently prescribed medications such as diuretics and proton pump inhibitors. While hypomagnesemia has been linked with increased mortality, the association between elevated magnesium levels and mortality is not clearly defined. Additionally, associations between magnesium disorders, type of death, and CKD progression have not been reported. Therefore, we studied the associations between magnesium levels, CKD progression, mortality, and cause specific deaths in patients with CKD. METHODS: Using the Cleveland Clinic CKD registry, we identified 10,568 patients with estimated Glomerular Filtration Rate (eGFR) between 15 and 59 ml/min/1.73 m(2) in this range for a minimum of 3 months with a measured magnesium level. We categorized subjects into 3 groups based on these magnesium levels (≤ 1.7, 1.7–2.6 and > 2.6 mg/dl) and applied cox regression modeling and competing risk models to identify associations with overall and cause-specific mortality. We also evaluated the association between magnesium level and slope of eGFR using mixed models. RESULTS: During a median follow-up of 3.7 years, 4656 (44%) patients died. After adjusting for relevant covariates, a magnesium level < 1.7 mg/dl (vs. 1.7–2.6 mg/dl) was associated with higher overall mortality (HR = 1.14, 95% CI: 1.04, 1.24), and with higher sub-distribution hazards for non-cardiovascular non-malignancy mortality (HR = 1.29, 95% CI: 1.12, 1.49). Magnesium levels > 2.6 mg/dl (vs. 1.7–2.6 mg/dl) was associated with a higher risk of all-cause death only (HR = 1.23, 95% CI: 1.03, 1.48). We found similar results when evaluating magnesium as a continuous measure. There were no significant differences in the slope of eGFR across all three magnesium groups (p = 0.10). CONCLUSIONS: In patients with CKD stage 3 and 4, hypomagnesemia was associated with higher all-cause and non-cardiovascular non-malignancy mortality. Hypermagnesemia was associated with higher all-cause mortality. Neither hypo nor hypermagnesemia were associated with an increased risk of CKD progression. BioMed Central 2020-02-12 /pmc/articles/PMC7017617/ /pubmed/32050924 http://dx.doi.org/10.1186/s12882-020-1713-3 Text en © The Author(s). 2020 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Azem, Rami
Daou, Remy
Bassil, Elias
Anvari, Eva Maria
Taliercio, Jonathan J.
Arrigain, Susana
Schold, Jesse D.
Vachharajani, Tushar
Nally, Joseph
Na khoul, Georges N.
Serum magnesium, mortality and disease progression in chronic kidney disease
title Serum magnesium, mortality and disease progression in chronic kidney disease
title_full Serum magnesium, mortality and disease progression in chronic kidney disease
title_fullStr Serum magnesium, mortality and disease progression in chronic kidney disease
title_full_unstemmed Serum magnesium, mortality and disease progression in chronic kidney disease
title_short Serum magnesium, mortality and disease progression in chronic kidney disease
title_sort serum magnesium, mortality and disease progression in chronic kidney disease
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7017617/
https://www.ncbi.nlm.nih.gov/pubmed/32050924
http://dx.doi.org/10.1186/s12882-020-1713-3
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