Ionized and total magnesium levels in patients with chronic kidney disease: associated factors and outcomes
ABSTRACT Background The association between hypo- and/or hypermagnesaemia and cardiovascular (CV) outcomes or mortality has shown conflicting results in chronic kidney disease (CKD) and has been conducted on total magnesium (tMg) levels. Thus, the objectives of the present study were to (i) describe...
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| Veröffentlicht in: | Clinical kidney journal 2024-04, Vol.17 (4), p.sfae046-sfae046 |
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| creator | Pluquet, Maxime Kamel, Said Alencar de Pinho, Natalia Mansencal, Nicolas Combe, Christian Metzger, Marie Massy, Ziad A Liabeuf, Sophie Laville, Solène M |
| description | ABSTRACT
Background
The association between hypo- and/or hypermagnesaemia and cardiovascular (CV) outcomes or mortality has shown conflicting results in chronic kidney disease (CKD) and has been conducted on total magnesium (tMg) levels. Thus, the objectives of the present study were to (i) describe the serum ionized Mg (iMg) concentration in patients at various CKD stages, (ii) measure the correlation between iMg and tMg concentrations, (iii) identify their associated factors and (iv) determine whether serum tMg and/or iMg concentrations are associated with major adverse cardiovascular events (MACE) and mortality before kidney replacement therapy in CKD patients.
Methods
Chronic Kidney Disease–Renal Epidemiology and Information Network (CKD-REIN) is a prospective cohort of CKD patients with an estimated glomerular filtration rate (eGFR) |
| doi_str_mv | 10.1093/ckj/sfae046 |
| format | Article |
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Background
The association between hypo- and/or hypermagnesaemia and cardiovascular (CV) outcomes or mortality has shown conflicting results in chronic kidney disease (CKD) and has been conducted on total magnesium (tMg) levels. Thus, the objectives of the present study were to (i) describe the serum ionized Mg (iMg) concentration in patients at various CKD stages, (ii) measure the correlation between iMg and tMg concentrations, (iii) identify their associated factors and (iv) determine whether serum tMg and/or iMg concentrations are associated with major adverse cardiovascular events (MACE) and mortality before kidney replacement therapy in CKD patients.
Methods
Chronic Kidney Disease–Renal Epidemiology and Information Network (CKD-REIN) is a prospective cohort of CKD patients with an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2. Baseline iMg and tMg serum concentrations were centrally measured. Adjusted cause-specific Cox proportional hazard models were used to estimate hazard ratios (HRs) for first MACE and for mortality.
Results
Of the 2419 included patients, median age was 68 years, and the mean eGFR was 34.8 mL/min/1.73 m2. Concentrations of serum iMg and tMg were strongly correlated (r = 0.89, P < .001) and were independently associated with eGFR. The adjusted HR [95% confidence interval (CI)] for MACE associated with the baseline serum tMg level was 1.27 (0.95; 1.69) for patients in Tertile 1 and 1.56 (1.18; 2.06) for patients in Tertile 3, relative to patients in Tertile 2. The HR (95% CI) of death according to serum tMg concentration was increased in Tertile 3 [1.48 (1.11; 1.97)]. The adjusted risk for MACE and mortality (all-cause or CV) associated with the baseline serum iMg level was not significantly different between tertiles.
Conclusions
Our analysis of a large cohort of patients with moderate-to-advanced CKD demonstrated that individuals with higher serum tMg concentrations, although still within the normal range, had a greater likelihood of MACE and mortality. However, serum iMg levels were not associated with these outcomes.
Graphical Abstract
Graphical Abstract</description><identifier>ISSN: 2048-8505</identifier><identifier>EISSN: 2048-8513</identifier><identifier>DOI: 10.1093/ckj/sfae046</identifier><identifier>PMID: 38572502</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Chronic kidney failure ; Epidemiology ; France ; Germany ; Health care industry ; Life Sciences ; Medical research ; Medicine, Experimental ; Mortality ; Original ; Patient outcomes</subject><ispartof>Clinical kidney journal, 2024-04, Vol.17 (4), p.sfae046-sfae046</ispartof><rights>The Author(s) 2024. Published by Oxford University Press on behalf of the ERA. 2024</rights><rights>The Author(s) 2024. Published by Oxford University Press on behalf of the ERA.</rights><rights>COPYRIGHT 2024 Oxford University Press</rights><rights>Attribution - NonCommercial</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c472t-4fd0afa162a53d3aafbccd6058a72360899fb4626a32024162e6f7c074f3e5793</cites><orcidid>0000-0002-0360-573X ; 0000-0002-0214-5567 ; 0000-0001-5771-5996 ; 0000-0001-5384-9006 ; 0000-0001-5500-1535 ; 0000-0002-0438-6487 ; 0009-0008-4801-4846</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10986257/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10986257/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,1598,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38572502$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://hal.science/hal-04626802$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Pluquet, Maxime</creatorcontrib><creatorcontrib>Kamel, Said</creatorcontrib><creatorcontrib>Alencar de Pinho, Natalia</creatorcontrib><creatorcontrib>Mansencal, Nicolas</creatorcontrib><creatorcontrib>Combe, Christian</creatorcontrib><creatorcontrib>Metzger, Marie</creatorcontrib><creatorcontrib>Massy, Ziad A</creatorcontrib><creatorcontrib>Liabeuf, Sophie</creatorcontrib><creatorcontrib>Laville, Solène M</creatorcontrib><title>Ionized and total magnesium levels in patients with chronic kidney disease: associated factors and outcomes</title><title>Clinical kidney journal</title><addtitle>Clin Kidney J</addtitle><description>ABSTRACT
Background
The association between hypo- and/or hypermagnesaemia and cardiovascular (CV) outcomes or mortality has shown conflicting results in chronic kidney disease (CKD) and has been conducted on total magnesium (tMg) levels. Thus, the objectives of the present study were to (i) describe the serum ionized Mg (iMg) concentration in patients at various CKD stages, (ii) measure the correlation between iMg and tMg concentrations, (iii) identify their associated factors and (iv) determine whether serum tMg and/or iMg concentrations are associated with major adverse cardiovascular events (MACE) and mortality before kidney replacement therapy in CKD patients.
Methods
Chronic Kidney Disease–Renal Epidemiology and Information Network (CKD-REIN) is a prospective cohort of CKD patients with an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2. Baseline iMg and tMg serum concentrations were centrally measured. Adjusted cause-specific Cox proportional hazard models were used to estimate hazard ratios (HRs) for first MACE and for mortality.
Results
Of the 2419 included patients, median age was 68 years, and the mean eGFR was 34.8 mL/min/1.73 m2. Concentrations of serum iMg and tMg were strongly correlated (r = 0.89, P < .001) and were independently associated with eGFR. The adjusted HR [95% confidence interval (CI)] for MACE associated with the baseline serum tMg level was 1.27 (0.95; 1.69) for patients in Tertile 1 and 1.56 (1.18; 2.06) for patients in Tertile 3, relative to patients in Tertile 2. The HR (95% CI) of death according to serum tMg concentration was increased in Tertile 3 [1.48 (1.11; 1.97)]. The adjusted risk for MACE and mortality (all-cause or CV) associated with the baseline serum iMg level was not significantly different between tertiles.
Conclusions
Our analysis of a large cohort of patients with moderate-to-advanced CKD demonstrated that individuals with higher serum tMg concentrations, although still within the normal range, had a greater likelihood of MACE and mortality. However, serum iMg levels were not associated with these outcomes.
Graphical Abstract
Graphical Abstract</description><subject>Chronic kidney failure</subject><subject>Epidemiology</subject><subject>France</subject><subject>Germany</subject><subject>Health care industry</subject><subject>Life Sciences</subject><subject>Medical research</subject><subject>Medicine, Experimental</subject><subject>Mortality</subject><subject>Original</subject><subject>Patient outcomes</subject><issn>2048-8505</issn><issn>2048-8513</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>TOX</sourceid><recordid>eNp9kt9rFDEQxxdRbKl98l0Cgljk2tlksz98kaNUWzjwRZ_DXHZyl95ucm6yJ_WvN-udhxUxeUiY-Xy_MwmTZS9zuMyhEVd6c38VDBIU5ZPslENRz2qZi6fHO8iT7DyEe0grZaCQz7MTUcuKS-Cn2ebOO_uDWoauZdFH7FiPK0fBjj3raEddYNaxLUZLLgb23cY10-shqTTb2NbRA2ttIAz0nmEIXluMyc6gjn4Iv2z9GLXvKbzInhnsAp0fzrPs68ebL9e3s8XnT3fX88VMFxWPs8K0gAbzkqMUrUA0S63bEmSNFRcl1E1jlkXJSxQceJE4Kk2loSqMIFk14iz7sPfdjsueWp0aH7BT28H2ODwoj1Y9zji7Viu_U-lH65LLKjlc7B3Wf-lu5ws1xWCqXwPf5Yl9e6g2-G8jhah6GzR1HTryY1AChACoRAMJfb1HV9iRss74VF5PuJqnvhvJC5ioy39QabfUW-0dGZvijwTv9gI9-BAGMseWc5jeJFSaEnWYkkS_-vN3juzvmUjAmz3gx-1_nX4ClE3F3Q</recordid><startdate>20240401</startdate><enddate>20240401</enddate><creator>Pluquet, Maxime</creator><creator>Kamel, Said</creator><creator>Alencar de Pinho, Natalia</creator><creator>Mansencal, Nicolas</creator><creator>Combe, Christian</creator><creator>Metzger, Marie</creator><creator>Massy, Ziad A</creator><creator>Liabeuf, Sophie</creator><creator>Laville, Solène M</creator><general>Oxford University Press</general><scope>TOX</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>1XC</scope><scope>VOOES</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-0360-573X</orcidid><orcidid>https://orcid.org/0000-0002-0214-5567</orcidid><orcidid>https://orcid.org/0000-0001-5771-5996</orcidid><orcidid>https://orcid.org/0000-0001-5384-9006</orcidid><orcidid>https://orcid.org/0000-0001-5500-1535</orcidid><orcidid>https://orcid.org/0000-0002-0438-6487</orcidid><orcidid>https://orcid.org/0009-0008-4801-4846</orcidid></search><sort><creationdate>20240401</creationdate><title>Ionized and total magnesium levels in patients with chronic kidney disease: associated factors and outcomes</title><author>Pluquet, Maxime ; Kamel, Said ; Alencar de Pinho, Natalia ; Mansencal, Nicolas ; Combe, Christian ; Metzger, Marie ; Massy, Ziad A ; Liabeuf, Sophie ; Laville, Solène M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c472t-4fd0afa162a53d3aafbccd6058a72360899fb4626a32024162e6f7c074f3e5793</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Chronic kidney failure</topic><topic>Epidemiology</topic><topic>France</topic><topic>Germany</topic><topic>Health care industry</topic><topic>Life Sciences</topic><topic>Medical research</topic><topic>Medicine, Experimental</topic><topic>Mortality</topic><topic>Original</topic><topic>Patient outcomes</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pluquet, Maxime</creatorcontrib><creatorcontrib>Kamel, Said</creatorcontrib><creatorcontrib>Alencar de Pinho, Natalia</creatorcontrib><creatorcontrib>Mansencal, Nicolas</creatorcontrib><creatorcontrib>Combe, Christian</creatorcontrib><creatorcontrib>Metzger, Marie</creatorcontrib><creatorcontrib>Massy, Ziad A</creatorcontrib><creatorcontrib>Liabeuf, Sophie</creatorcontrib><creatorcontrib>Laville, Solène M</creatorcontrib><collection>Oxford Journals Open Access Collection</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Hyper Article en Ligne (HAL)</collection><collection>Hyper Article en Ligne (HAL) (Open Access)</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical kidney journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pluquet, Maxime</au><au>Kamel, Said</au><au>Alencar de Pinho, Natalia</au><au>Mansencal, Nicolas</au><au>Combe, Christian</au><au>Metzger, Marie</au><au>Massy, Ziad A</au><au>Liabeuf, Sophie</au><au>Laville, Solène M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Ionized and total magnesium levels in patients with chronic kidney disease: associated factors and outcomes</atitle><jtitle>Clinical kidney journal</jtitle><addtitle>Clin Kidney J</addtitle><date>2024-04-01</date><risdate>2024</risdate><volume>17</volume><issue>4</issue><spage>sfae046</spage><epage>sfae046</epage><pages>sfae046-sfae046</pages><issn>2048-8505</issn><eissn>2048-8513</eissn><abstract>ABSTRACT
Background
The association between hypo- and/or hypermagnesaemia and cardiovascular (CV) outcomes or mortality has shown conflicting results in chronic kidney disease (CKD) and has been conducted on total magnesium (tMg) levels. Thus, the objectives of the present study were to (i) describe the serum ionized Mg (iMg) concentration in patients at various CKD stages, (ii) measure the correlation between iMg and tMg concentrations, (iii) identify their associated factors and (iv) determine whether serum tMg and/or iMg concentrations are associated with major adverse cardiovascular events (MACE) and mortality before kidney replacement therapy in CKD patients.
Methods
Chronic Kidney Disease–Renal Epidemiology and Information Network (CKD-REIN) is a prospective cohort of CKD patients with an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2. Baseline iMg and tMg serum concentrations were centrally measured. Adjusted cause-specific Cox proportional hazard models were used to estimate hazard ratios (HRs) for first MACE and for mortality.
Results
Of the 2419 included patients, median age was 68 years, and the mean eGFR was 34.8 mL/min/1.73 m2. Concentrations of serum iMg and tMg were strongly correlated (r = 0.89, P < .001) and were independently associated with eGFR. The adjusted HR [95% confidence interval (CI)] for MACE associated with the baseline serum tMg level was 1.27 (0.95; 1.69) for patients in Tertile 1 and 1.56 (1.18; 2.06) for patients in Tertile 3, relative to patients in Tertile 2. The HR (95% CI) of death according to serum tMg concentration was increased in Tertile 3 [1.48 (1.11; 1.97)]. The adjusted risk for MACE and mortality (all-cause or CV) associated with the baseline serum iMg level was not significantly different between tertiles.
Conclusions
Our analysis of a large cohort of patients with moderate-to-advanced CKD demonstrated that individuals with higher serum tMg concentrations, although still within the normal range, had a greater likelihood of MACE and mortality. However, serum iMg levels were not associated with these outcomes.
Graphical Abstract
Graphical Abstract</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>38572502</pmid><doi>10.1093/ckj/sfae046</doi><orcidid>https://orcid.org/0000-0002-0360-573X</orcidid><orcidid>https://orcid.org/0000-0002-0214-5567</orcidid><orcidid>https://orcid.org/0000-0001-5771-5996</orcidid><orcidid>https://orcid.org/0000-0001-5384-9006</orcidid><orcidid>https://orcid.org/0000-0001-5500-1535</orcidid><orcidid>https://orcid.org/0000-0002-0438-6487</orcidid><orcidid>https://orcid.org/0009-0008-4801-4846</orcidid><oa>free_for_read</oa></addata></record> |
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| source | Oxford Journals Open Access Collection; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central |
| subjects | Chronic kidney failure Epidemiology France Germany Health care industry Life Sciences Medical research Medicine, Experimental Mortality Original Patient outcomes |
| title | Ionized and total magnesium levels in patients with chronic kidney disease: associated factors and outcomes |
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