Kurita Noriaki, Akizawa Tadao, Fukagawa Masafumi, Onishi Yoshihiro, Kurokawa Kiyoshi, Fukuhara Shunichi
Department of Innovative Research and Education for Clinicians and Trainees (DiRECT) , Fukushima Medical University Hospital , Fukushima , Japan ; Institute for Health Outcomes and Process Evaluation Research (iHope International) , Kyoto , Japan ; Department of Healthcare Epidemiology , School of Public Health in the Graduate School of Medicine, Kyoto University , Kyoto , Japan.
Division of Nephrology, Department of Medicine , Showa University School of Medicine , Tokyo , Japan.
Clin Kidney J. 2015 Dec;8(6):744-52. doi: 10.1093/ckj/sfv097. Epub 2015 Nov 20.
The extent of contribution of disturbed magnesium balance to mortality remains unclear among hemodialysis patients.
This was a cohort study involving 3276 patients on maintenance hemodialysis at 86 facilities in Japan from 2008 to 2010 who had secondary hyperparathyroidism (SHPT). Baseline serum magnesium (sMg) values were categorized into quintiles (≤2.3, >2.3-2.5, >2.5-2.7, >2.7-3.0 and >3.0 mg/dL), and the middle quintile was set as the reference. Outcome was all-cause death. Independent contribution to all-cause death was assessed via Cox regression to generate population-attributable fractions (PAFs).
A total of 2165 patients from 68 facilities were analyzed. The lowest quintile of sMg was positively associated with lower serum potassium and albumin levels, higher C-reactive protein (CRP) levels and prevalence of atrial fibrillation and cerebrovascular disease than the other quintiles. The highest sMg quintile was positively associated with higher potassium levels, and negatively associated with lower serum albumin levels and higher intact parathyroid hormone and CRP levels and prevalence of cerebrovascular disease than the other quintiles. During a median follow-up of 3 years, the lowest and the second lowest quintiles of sMg were associated with all-cause death [adjusted hazard ratio (HR) 1.737, 95% confidence interval (95% CI) 1.200-2.512 and HR 1.675, 95% CI 1.254-2.238, respectively). Point estimates of adjusted HRs of the highest and the second highest sMg quintiles were higher than those of the middle quintile for all-cause death. Adjusted PAFs of lower sMg and of higher and lower sMg for all-cause death were 24.0% (95% CI 13.0-35.0%) and 30.7% (95% CI 14.5-46.8%), respectively.
In hemodialysis patients with SHPT, dysregulated sMg is an important contributor to all-cause death. Further studies are warranted to examine whether or not correction of sMg improves survival.
在血液透析患者中，镁平衡紊乱对死亡率的影响程度尚不清楚。
这是一项队列研究，纳入了2008年至2010年期间日本86家医疗机构的3276例维持性血液透析且患有继发性甲状旁腺功能亢进（SHPT）的患者。将基线血清镁（sMg）值分为五分位数（≤2.3、>2.3 - 2.5、>2.5 - 2.7、>2.7 - 3.0和>3.0mg/dL），并将中间五分位数设为参照。结局为全因死亡。通过Cox回归评估对全因死亡的独立影响，以生成人群归因分数（PAFs）。
共分析了来自68家医疗机构的2165例患者。与其他五分位数相比，sMg最低的五分位数与较低的血清钾和白蛋白水平、较高的C反应蛋白（CRP）水平以及房颤和脑血管疾病的患病率呈正相关。sMg最高的五分位数与较高的钾水平呈正相关，与较低的血清白蛋白水平、较高的完整甲状旁腺激素和CRP水平以及脑血管疾病的患病率呈负相关。在中位随访3年期间，sMg最低和第二低的五分位数与全因死亡相关[调整后风险比（HR）分别为1.737，95%置信区间（95%CI）1.200 - 2.512和HR 1.675，95%CI 1.254 - 2.238]。sMg最高和第二高的五分位数的调整后HR的点估计值高于全因死亡的中间五分位数。sMg较低以及较高和较低sMg对全因死亡的调整后PAFs分别为24.0%（95%CI 13.0 - 35.0%）和30.7%（95%CI 14.5 - 46.8%）。
在患有SHPT的血液透析患者中，sMg失调是全因死亡的重要因素。有必要进一步研究校正sMg是否能改善生存率。
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