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Association of serum magnesium levels with renal prognosis in patients with chronic kidney disease

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Abstract

Background

Magnesium deficiency is associated with various health conditions, but its impact on the progression of chronic kidney disease (CKD) remains unclear. This study aimed to investigate the association between serum magnesium levels and prognosis of renal function in CKD patients.

Methods

This is an analysis of the Japan Chronic Kidney Disease Database Ex　(J-CKD-DB-Ex), which is a multicenter prospective cohort including CKD patients enrolled from January 1, 2014 to December 31, 2020. We included adult outpatients with CKD stage G3 and G4 at the time of initial magnesium measurement. Patients were classified by magnesium levels as low (<1.7 mg/dl), normal (1.7–2.6 mg/dl), or high (>2.6 mg/dl). The primary outcomes were the composite of an eGFR < 15 ml/min/1.73 m2 or a ≥30% reduction in eGFR from the initial measurement, which was defined as CKD progression. We applied the Kaplan–Meier analysis and Cox regression hazard model to examine the association between magnesium levels and CKD progression.

Results

The analysis included 9868 outpatients during the follow-up period. The low magnesium group was significantly more likely to reach CKD progression. Cox regression, adjusting for covariates and using the normal magnesium group as the reference, showed that the hazard ratio for the low magnesium group was 1.20 (1.08–1.34). High magnesium was not significantly associated with poor renal outcomes compared with normal magnesium.

Conclusion

Based on large real-world data, this study demonstrated that low magnesium levels are associated with poorer renal outcomes.

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Data availability

J-CKD-DB-Ex, which was analyzed in this study, is a real-world database established under the initiative of the Japanese Society of Nephrology. For data analysis, the steering committee will review the submitted research plan. Data sharing is not possible at this time, as we plan to proceed with the analysis by providing the necessary data to the research plans that are approved after the review.

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Acknowledgements

We would like to thank Kaori Ikemoto, Department of Nephrology and Hypertension, for her assistance in data management.

Funding

This work was supported by grants from Research Project Grant from Kawasaki Medical School (R05B111) to SK and Japan Agency for Medical Research and Development, Practical Research Project for Life-Style related Diseases including Cardiovascular Diseases and Diabetes Mellitus to N.K. (22ek0210135h0001).

Author information

Author notes

  1. Seiji Kishi and Takaya Nakashima have contributed equally to this work.

Authors and Affiliations

  1. Department of Nephrology and Hypertension, Kawasaki Medical School, Kurashiki, 7010192, Japan

    Seiji Kishi, Hajime Nagasu & Naoki Kashihara

  2. TXP Medical Co. Ltd, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan

    Takaya Nakashima & Tadahiro Goto

  3. Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan

    Tadahiro Goto

  4. Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN, USA

    Craig R. Brooks

  5. Department of Nephrology, Faculty of Medicine, Saitama Medical University, Saitama, Japan

    Hirokazu Okada

  6. Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Kanagawa, Japan

    Kouichi Tamura

  7. Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Toshiaki Nakano

  8. Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan

    Ichiei Narita

  9. Department of Nephrology, Nagoya University Graduate School of Medicine, Aichi, Japan

    Shoichi Maruyama

  10. Department of Advanced Epidemiology, NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan

    Yuichiro Yano

  11. Division of Kidney and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan

    Takashi Yokoo

  12. Department of Nephrology and Laboratory Medicine, Kanazawa University, Kanazawa, Japan

    Takashi Wada

  13. Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan

    Jun Wada

  14. Division of Nephrology and Endocrinology, University of Tokyo Graduate School of Medicine, Tokyo, Japan

    Masaomi Nangaku

Authors
  1. Seiji Kishi
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  2. Takaya Nakashima
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  3. Tadahiro Goto
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  4. Hajime Nagasu
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  15. Masaomi Nangaku
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  16. Naoki Kashihara
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Contributions

SK, TN, and TG, contributed to the study conception and design, analysis and interpretation of data, wrote the first draft of the manuscript, and final approval of the submitted manuscript. CRB contributed to the interpretation of the data, scientific and grammatical editing of the English text, and final approval of the submitted manuscript. HN and NK contributed to study conception and design, interpretation of data, and final approval of the submitted manuscript. HO, KT, TN, IN, SM, YY, TY, TW, JW, and MN contributed to the interpretation of data and final approval of the submitted manuscript.

Corresponding authors

Correspondence to Seiji Kishi or Tadahiro Goto.

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The authors declare no conflicts of interest associated with this study.

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Kishi, S., Nakashima, T., Goto, T. et al. Association of serum magnesium levels with renal prognosis in patients with chronic kidney disease. Clin Exp Nephrol (2024). https://doi.org/10.1007/s10157-024-02486-7

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  • DOI: https://doi.org/10.1007/s10157-024-02486-7

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