Moyano-Peregrin Cayetana, Rodelo-Haad Cristian, Martín-Malo Alejandro, Muñoz-Castañeda Juan Rafael, Ojeda Raquel, Lopez-Lopez Isabel, Rodríguez Mariano, Pendon-Ruiz de Mier Mª Victoria, Santamaría Rafael, Soriano Sagrario
Maimónides Biomedical Research Institute of Cordoba (IMIBIC-GC13 Calcium Metabolism and Vascular Calcification), Cordoba, Spain.
University of Cordoba, Cordoba, Spain.
Clin Kidney J. 2024 Dec 2;18(2):sfae390. doi: 10.1093/ckj/sfae390. eCollection 2025 Feb.
Serum magnesium disturbances are common in patients with cardiovascular disease (CVD). However, the well-established link between low serum magnesium and nutritional or inflammatory disorders has limited its consideration as a non-traditional risk factor for mortality. This study aims to elucidate the relationship between serum magnesium concentrations and mortality due to fatal heart failure (HF), coronary heart disease (CHD) and stroke in non-dialysis patients with chronic kidney disease (CKD) stages 4 and 5.
A cohort of 1271 non-dialysis patients with CKD stages 4 and 5 was followed from 2008 to 2018. Patients with prior major adverse cardiovascular events (MACE) were excluded. Serum magnesium levels were stratified into tertiles and the primary outcomes were incidence rates of fatal HF, CHD and stroke. Secondary outcomes included composite MACE and all-cause mortality. Hazard ratios (HRs) were calculated using multivariate Cox regression, adjusting for demographics, comorbidities and biochemical parameters. E-values were used to assess the robustness of the results.
Over the 10-year follow-up, 186 patients died. Higher serum magnesium levels were significantly associated with reduced mortality risk from HF [HR 0.49 (95% CI 0.27-0.89) for T2; HR 0.31 (95% CI 0.16-0.60) for T3] compared with the lowest tertile. Similar trends were observed for CHD and stroke mortality. The incidence rate of MACE per 1000 person-years was reduced from 68.2 in tertile 1 to 26.2 in tertile 2 and 16.8 in tertile 3. Secondary endpoints, including all-cause mortality and composite MACE, followed trends similar to the primary outcomes.
Higher serum magnesium concentrations were associated with lower risks of death from fatal HF, CHD and stroke in non-dialysis patients with CKD stages 4 and 5.
血清镁紊乱在心血管疾病（CVD）患者中很常见。然而，低血清镁与营养或炎症性疾病之间已确立的联系限制了其作为死亡率的非传统风险因素的考量。本研究旨在阐明慢性肾脏病（CKD）4期和5期非透析患者的血清镁浓度与因致命性心力衰竭（HF）、冠心病（CHD）和中风导致的死亡率之间的关系。
对1271例CKD 4期和5期的非透析患者进行了2008年至2018年的随访。排除既往有重大不良心血管事件（MACE）的患者。血清镁水平分为三分位数，主要结局是致命性HF、CHD和中风的发生率。次要结局包括复合MACE和全因死亡率。使用多变量Cox回归计算风险比（HRs），并对人口统计学、合并症和生化参数进行调整。E值用于评估结果的稳健性。
在10年的随访中，186例患者死亡。与最低三分位数相比，较高的血清镁水平与HF死亡率风险降低显著相关[T2的HR为0.49（95%CI 0.27-0.89）；T3的HR为0.31（95%CI 0.16-0.60）]。CHD和中风死亡率也观察到类似趋势。每1000人年的MACE发生率从三分位数1的68.2降至三分位数2的26.2和三分位数3的16.8。次要终点，包括全因死亡率和复合MACE，遵循与主要结局相似的趋势。
较高的血清镁浓度与CKD 4期和5期非透析患者因致命性HF、CHD和中风导致的死亡风险较低相关。
