Hospital General Universitario Reina Sofía, Avenida Intendente Jorge Palacios, Murcia, Spain.
Hospital General Universitario Gregorio Marañón, Madrid, Spain.
J Ren Nutr. 2021 Sep;31(5):494-502. doi: 10.1053/j.jrn.2020.09.004. Epub 2020 Dec 9.
In the general population, hypomagnesemia has been associated with cardiovascular events and hypermagnesemia with overall mortality. In chronic kidney disease (CKD) the evidence is not so strong. The objective of our study was to investigate the relationship between serum magnesium (SMg) concentration and cardiovascular morbidity and mortality, all-cause mortality, and the progression to kidney failure in a population with CKD.
Observational study of a cohort of 746 patients with CKD. Baseline characteristics and analytical profile were collected at the first visit, and patients were followed for a mean of 42.6 months.
A cohort of 746 patients were analyzed, age 70 ± 13 years, 62.9% were male, 45.2% had CKD grade 3, and 35.9% grade 4. The mean SMg concentration was 2.09 ± 0.33 mg/dL, with a close correlation between SMg concentration and serum creatinine, phosphorus, and intact parathyroid hormone (iPTH) values. Use of calcitriol was associated with higher SMg (SMgH) concentration, while calcium supplements and proton pump inhibitors (PPIs) were associated with lower SMg concentration. For risk of cardiovascular events, patients with hypermagnesemia had an overall higher risk on a crude analysis (Log Rank 4.83, P = .28) and adjusted analysis (HR = 1.34, CI 1.02-1.77, P = .037). For risk of all-cause mortality, patients with hypermagnesemia had an overall higher risk on crude analysis (Log Rank 13.11, P > .001) and adjusted analysis (HR = 1.5424, IC = 1.002-2.319, P = .049). After performing a propensity score matching for SMg concentration, we achieved two comparable groups of 287 patients, finding again higher all-cause mortality in the hypermagnesemia group (LogRank 15.147, P < .001), that persisted in the Cox model adjusted for calcium, phosphorus, and iPTH. No association was found between SMg concentration and initiation of kidney replacement therapy (KRT).
Magnesium concentration increases with decreasing kidney function. Hypermagnesemia predicts cardiovascular events and all-cause mortality in this same population. Thus, magnesium supplementation should be used with caution in these patients.
在普通人群中，低镁血症与心血管事件有关，而高镁血症与总死亡率有关。在慢性肾脏病（CKD）中，证据并不那么确凿。我们的研究目的是调查血清镁（SMg）浓度与心血管发病率和死亡率、全因死亡率以及 CKD 患者发生肾衰竭的进展之间的关系。
对 746 例 CKD 患者进行观察性研究。在首次就诊时收集基线特征和分析概况，平均随访 42.6 个月。
对 746 例患者进行了分析，年龄 70±13 岁，62.9%为男性，45.2%为 CKD 3 期，35.9%为 CKD 4 期。SMg 浓度的平均值为 2.09±0.33mg/dL，SMg 浓度与血清肌酐、磷和完整甲状旁腺激素（iPTH）值密切相关。使用骨化三醇与较高的 SMg（SMgH）浓度相关，而钙补充剂和质子泵抑制剂（PPIs）与较低的 SMg 浓度相关。在心血管事件风险方面，高镁血症患者的总体风险在未经调整的分析（对数秩检验 4.83，P=0.28）和调整分析（HR=1.34，CI 1.02-1.77，P=0.037）中均较高。在全因死亡率风险方面，高镁血症患者在未经调整的分析（对数秩检验 13.11，P＞0.001）和调整分析（HR=1.5424，IC 1.002-2.319，P=0.049）中均有较高的总体风险。在对 SMg 浓度进行倾向评分匹配后，我们得到了两组具有可比性的 287 例患者，发现高镁血症组的全因死亡率更高（对数秩检验 15.147，P＜0.001），这一结果在调整钙、磷和 iPTH 的 Cox 模型中仍然存在。SMg 浓度与肾脏替代治疗（KRT）的启动之间未发现关联。
镁浓度随肾功能下降而增加。高镁血症预测了同一人群中的心血管事件和全因死亡率。因此，在这些患者中应谨慎使用镁补充剂。
