Department of Nephrology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
Department of Nephrology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
Clin Nutr. 2021 May;40(5):3133-3147. doi: 10.1016/j.clnu.2020.12.015. Epub 2020 Dec 26.
BACKGROUND & AIMS: Despite modern treatment, risk for cardiovascular disease and mortality in patients with chronic kidney disease (CKD) is unacceptably high. Observational studies have shown associations of magnesium with risk for several clinical outcomes in CKD of variable magnitude. The aim of this review is to provide a systematic overview and meta-analysis of longitudinal studies assessing the association of plasma magnesium concentration with clinically relevant outcomes in adult patients with chronic kidney disease, with a minimal follow-up of 6 months. Primary outcomes of interest were all-cause mortality, cardiovascular mortality, cardiovascular events, sudden death and hospitalisation.
The electronic databases PubMed, Embase and The Cochrane Library were searched using terms relating to plasma magnesium and CKD patients, and two authors independently selected eligible studies. Study quality was assessed according to the Newcastle-Ottawa Scale. Results of studies with a comparable magnesium exposure and outcome measure, were pooled using a random-effects meta-regression analysis.
The search yielded 6156 records of which 33 studies, involving 348,059 patients, met the eligibility criteria. Finally, 22 studies could be included in the meta-analysis. Higher magnesium was associated with a lower risk for all-cause mortality (HR 0.90 [0.87-0.94] per 0.1 mmol/L increase of magnesium) and cardiovascular mortality and events (HR 0.85 [0.77-0.94] per 0.1 mmol/L).
Magnesium concentration is inversely associated with all-cause mortality and cardiovascular mortality and events. Therefore, increasing magnesium may improve risk in patients with chronic kidney disease. This meta-analysis forms a firm base for future prospective trials to test whether increasing plasma magnesium, indeed has beneficial effects on clinical outcomes.
尽管采用了现代治疗方法，慢性肾脏病（CKD）患者发生心血管疾病和死亡的风险仍然高得令人无法接受。观察性研究表明，镁与 CKD 患者多种临床结局的风险之间存在关联，且这种关联的程度不一。本综述的目的是对评估成人慢性肾脏病患者血浆镁浓度与临床相关结局之间相关性的前瞻性研究进行系统评价和荟萃分析，这些研究的随访时间至少为 6 个月。主要研究终点为全因死亡率、心血管死亡率、心血管事件、猝死和住院。
使用与血浆镁和 CKD 患者相关的术语，对 PubMed、Embase 和 The Cochrane Library 这三个电子数据库进行检索，两位作者独立筛选合格的研究。根据 Newcastle-Ottawa 量表评估研究质量。使用随机效应荟萃回归分析，对具有可比性的镁暴露和结局测量的研究结果进行汇总。
检索结果得到 6156 条记录，其中 33 项研究，涉及 348059 名患者，符合入选标准。最终，有 22 项研究纳入荟萃分析。镁浓度每升高 0.1mmol/L，全因死亡率（HR 0.90[0.87-0.94]）和心血管死亡率及事件（HR 0.85[0.77-0.94]）的风险降低。
镁浓度与全因死亡率和心血管死亡率及事件呈负相关。因此，增加镁的含量可能会改善慢性肾脏病患者的风险。本荟萃分析为未来的前瞻性试验提供了坚实的基础，以检验增加血浆镁是否确实对临床结局有有益的影响。
