Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Division of Mineral Metabolism, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Nephrol Dial Transplant. 2018 Aug 1;33(8):1389-1396. doi: 10.1093/ndt/gfx275.
Low serum magnesium (SMg) has been linked to increased mortality and cardiovascular disease (CVD) in the general population. We examined whether this association is similar in participants with versus without prevalent chronic kidney disease (CKD) in the multiethnic Dallas Heart Study (DHS) cohort.
SMg was analyzed as a continuous variable and divided into tertiles. Study outcomes were all-cause death, cardiovascular (CV) death or event, and CVD surrogate markers, evaluated using multivariable Cox regression models adjusted for demographics, comorbidity, anthropometric and biochemical parameters including albumin, phosphorus and parathyroid hormone, and diuretic use. Median follow-up was 12.3 years (11.9-12.8, 25th percentile-75th percentile).
Among 3551 participants, 306 (8.6%) had prevalent CKD. Mean SMg was 2.08 ± 0.19 mg/dL (0.85 ± 0.08 mM, mean ± SD) in the CKD and 2.07 ± 0.18 mg/dL (0.85 ± 0.07 mM) in the non-CKD subgroups. During the follow-up period, 329 all-cause deaths and 306 CV deaths or events occurred. In a fully adjusted model, every 0.2 mg/dL decrease in SMg was associated with ∼20-40% increased hazard for all-cause death in both CKD and non-CKD subgroups. In CKD participants, the lowest SMg tertile was also independently associated with all-cause death (adjusted hazard ratio 2.31; 95% confidence interval 1.23-4.36 versus 1.15; 0.55-2.41; for low versus high tertile, respectively).
Low SMg levels (1.4-1.9 mg/dL; 0.58-0.78 mM) were independently associated with all-cause death in patients with prevalent CKD in the DHS cohort. Randomized clinical trials are important to determine whether Mg supplementation affects survival in CKD patients.
低血清镁（SMg）与普通人群的死亡率和心血管疾病（CVD）增加有关。我们在多民族达拉斯心脏研究（DHS）队列中检查了这种关联在是否存在普遍慢性肾脏病（CKD）的参与者中是否相似。
SMg 被分析为连续变量并分为三分位。使用多变量 Cox 回归模型评估全因死亡、心血管（CV）死亡或事件以及 CVD 替代标志物，该模型调整了人口统计学、合并症、人体测量和生化参数，包括白蛋白、磷和甲状旁腺激素以及利尿剂的使用。中位随访时间为 12.3 年（11.9-12.8，25 分位-75 分位）。
在 3551 名参与者中，306 名（8.6%）患有普遍 CKD。CKD 组的平均 SMg 为 2.08±0.19mg/dL（0.85±0.08mM，平均值±SD），非 CKD 亚组为 2.07±0.18mg/dL（0.85±0.07mM）。在随访期间，发生了 329 例全因死亡和 306 例 CV 死亡或事件。在完全调整的模型中，SMg 每降低 0.2mg/dL，CKD 和非 CKD 亚组的全因死亡风险均增加约 20-40%。在 CKD 参与者中，最低 SMg 三分位也与全因死亡独立相关（调整后的危险比 2.31；95%置信区间 1.23-4.36 与 1.15；0.55-2.41；低与高三分位相比，分别）。
在 DHS 队列中，普遍存在 CKD 的患者中，低 SMg 水平（1.4-1.9mg/dL；0.58-0.78mM）与全因死亡独立相关。随机临床试验对于确定镁补充剂是否影响 CKD 患者的生存率非常重要。
