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Increase in Serum Magnesium Level in Haemodialysis Patients Receiving Sevelamer Hydrochloride

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Abstract

Background: Clinical studies have shown that sevelamer hydrochloride improves lipid profiles and attenuates the progression of the cardiovascular calcifications in haemodialysis patients. It is known that both of these properties are associated with increased magnesium levels. The effect of sevelamer on serum magnesium level is not well documented. The aim of this study was to determine the effects of sevelamer treatment on serum magnesium in haemodialysis patients and to assess the association of magnesium levels with lipid profiles and intact parathyroid hormone (iPTH). Methods: Phosphate binders were discontinued during a two week washout period. Forty-seven patients, whose serum phosphate was greater than 6.0 mg/dl at the end of washout, received sevelamer hydrochloride for eight weeks. The patients were then washed off sevelamer for another two weeks. Results: Mean serum phosphorus concentration declined from 7.5 ± 1.3 to 6.4 ± 1.2 mg/dl (P < 0.001), mean serum magnesium levels increased from 2.75 ± 0.35 to 2.90 ± 0.41 mg/dl (P < 0.001) and median serum iPTH levels decreased from 297 to 213 pg/ml (P=0.001) during the eight weeks of sevelamer treatment. After the two week post-treatment washout phosphorus levels increased to 7.3 ± 1.3 mg/dl (P < 0.001), magnesium levels were reduced to 2.77 ± 0.39 mg/dl (P < 0.001) and iPTH levels increased to 240 pg/ml (P=0.012). No change was observed in serum calcium levels during the sevelamer treatment period and the subsequent washout period. The mean decline in total and low density lipoprotein (LDL) cholesterol during sevelamer treatment was 16.3 and 28.3 (P < 0.001), respectively. The mean increase in high density lipoprotein (HDL) cholesterol and in apolipoprotein A1 was 2.9 ± 5.8 mg/dl (P=0.004) and 6.8 ± 11.1 mg/dl (P=0.001), respectively. Multivariate analysis showed that the rise in serum magnesium concentration significantly correlated with reductions in iPTH levels (r=−0.40, P=0.016), but did not have any significant correlation with the changes in lipid profiles. Conclusions: Our findings indicate that patients on haemodialysis receiving sevelamer have a significant increase in serum magnesium concentrations. This increase in serum magnesium is associated with reduction in iPTH levels. The changes in lipid profiles of these patients however are not related to changes in serum magnesium levels.

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References

  1. EA Slatopolsky SK Burke MA Dillon (1999) ArticleTitleThe Renagel Study Group Renagel, a nonabsorbed calcium- and aluminum-free phosphate binder, lowers serum phosphorus and parathyroid hormone Kidney Int 55 299–307 Occurrence Handle10.1046/j.1523-1755.1999.00240.x Occurrence Handle9893140

    Article  PubMed  Google Scholar 

  2. GM Chertow SK Burke MA Dillon E Slatopolsky (1999) ArticleTitleFor the Renagel Study Group. Long term effects of sevelamer hydrochloride on the calcium × phosphate product and lipid profile of haemodialysis patients Nephrol Dial Transplant 14 2907–2914 Occurrence Handle10.1093/ndt/14.12.2907 Occurrence Handle10570096

    Article  PubMed  Google Scholar 

  3. GM Chertow SK Burke P Raggi (2002) ArticleTitleFor the Treat to Goal Working Group. Sevelamer attenuates the progression of coronary and aortic calcification in haemodialysis patients Kidney Int 62 245–252 Occurrence Handle10.1046/j.1523-1755.2002.00434.x Occurrence Handle12081584

    Article  PubMed  Google Scholar 

  4. HS Rasmussen P Aurup K Goldstein et al. (1989) ArticleTitleInfluence of magnesium substitution therapy on blood lipid composition in patients with ischemic heart disease: a double-blind, placebo controlled study Arch Intern Med 149 1050–1053 Occurrence Handle10.1001/archinte.149.5.1050 Occurrence Handle2719498

    Article  PubMed  Google Scholar 

  5. F Corica A Allegra A Di Benedetto et al. (1994) ArticleTitleEffects of oral magnesium supplementation on plasma lipid concentrations in patients with non-insulin-dependent diabetes mellitus Magnes Res 7 43–47 Occurrence Handle8054260

    PubMed  Google Scholar 

  6. R Kirsten B Heintz K Nelson et al. (1988) ArticleTitleMagnesium pyridoxal 5-phosphate glutamate reduces hyperlipidaemia in patients with chronic renal insufficiency Eur J Clin Pharmacol 34 133–137 Occurrence Handle10.1007/BF00614549 Occurrence Handle3383985

    Article  PubMed  Google Scholar 

  7. BK Gupta D Glicklich VA. Tellis (1999) ArticleTitleMagnesium repletion therapy improves lipid metabolism in hypomagnesemic renal transplant recipients Transplantation 67 1485–1487 Occurrence Handle10.1097/00007890-199906150-00017 Occurrence Handle10385091

    Article  PubMed  Google Scholar 

  8. IN Cholst SF Steinberg PJ Tropper et al. (1984) ArticleTitleThe influence of hypermagnesemia on serum calcium and parathyroid hormone levels in human subjects N Engl J Med 310 1221–1225 Occurrence Handle6709029

    PubMed  Google Scholar 

  9. H Meema D Oreopoulos A. Rapoport (1987) ArticleTitleSerum magnesium level and arterial calcification in end-stage renal disease Kidney Int 32 388–394 Occurrence Handle3669498

    PubMed  Google Scholar 

  10. BS Levine JW. Coburn (2001) Magnesium metabolism SG Massry RJ Glassock (Eds) Massry and Glassock’s Textbook of Nephrology. EditionNumber4 Lippincott Williams and Wilkins Philadelphia PA 341–344

    Google Scholar 

  11. MB Andon JZ Ilich MA Tzagournis V. Matkovic (1996) ArticleTitleMagnesium balance in adolescent females consuming a low- or high-calcium diet Am J Clin Nutr 63 950–953 Occurrence Handle8644692

    PubMed  Google Scholar 

  12. DI Goldberg MA Dillon EA Slatopolsky et al. (1998) ArticleTitleEffect of Renagel, a non-absorbed, calcium- and aluminium-free phosphate binder, on serum phosphorus, calcium, and intact parathyroid hormone in end stage renal disease patients Nephrol Dial Transplant 13 2303–2310 Occurrence Handle10.1093/ndt/13.9.2303 Occurrence Handle9761513

    Article  PubMed  Google Scholar 

  13. GA. Quamme (1997) ArticleTitleRenal magnesium handling: new insights in understanding old problems Kidney Int 52 1180–1195 Occurrence Handle9350641

    PubMed  Google Scholar 

  14. D Blumberg A Bonetti V Jacomella et al. (1998) ArticleTitleFree circulating magnesium and renal magnesium handling during acute metabolic acidosis in humans Am J Nephrol 18 233–236 Occurrence Handle10.1159/000013342 Occurrence Handle9627040

    Article  PubMed  Google Scholar 

  15. CC Marone RA. Sutton (1983) ArticleTitleEffects of acute metabolic acid–base changes and furosemide on magnesium excretion in rats Metabolism 32 1033–1037 Occurrence Handle10.1016/0026-0495(83)90073-2 Occurrence Handle6621362

    Article  PubMed  Google Scholar 

  16. NL Wong GA Quamme JH. Dirks (1986) ArticleTitleEffects of acid–base disturbances on renal handling of magnesium in the dog Clin Sci 70 277–284 Occurrence Handle3948477

    PubMed  Google Scholar 

  17. RJ Shapiro CK Yong GA. Quamme (1987) ArticleTitleInfluence of chronic dietary acid on renal tubular handling of magnesium Pflugers Arch 409 492–498 Occurrence Handle10.1007/BF00583806 Occurrence Handle3627965

    Article  PubMed  Google Scholar 

  18. EJ Brink AC. Beynen (1992) ArticleTitleNutrition and magnesium absorption: a review Prog Food Nutr Sci 16 125–162 Occurrence Handle1496118

    PubMed  Google Scholar 

  19. JF Navarro C Mora A Jimenez et al. (1999) ArticleTitleRelationship between serum magnesium and parathyroid hormone levels in haemodialysis patients Am J Kidney Dis 34 43–48 Occurrence Handle10401014

    PubMed  Google Scholar 

  20. MS Djurhuus NAH Klitgaard KK Pedersen et al. (2001) ArticleTitleMagnesium reduces insulin-stimulated glucose uptake and serum lipid concentrations in type 1 diabetes Metabolism 50 1409–1417 Occurrence Handle10.1053/meta.2001.28072 Occurrence Handle11735085

    Article  PubMed  Google Scholar 

  21. Y Rayssiguier L Noe J Etienne et al. (1991) ArticleTitleEffect of magnesium deficiency on post-heparin lipase activity and tissue lipoprotein lipase in the rat Lipids 26 182–186 Occurrence Handle2046484

    PubMed  Google Scholar 

  22. P Jaya PA. Kurup (1987) ArticleTitleMagnesium deficiency and metabolism of lipids in rats fed cholesterol-free and cholesterol-containing diet Indian J Biochem Biophys 24 92–95 Occurrence Handle3666782

    PubMed  Google Scholar 

  23. S Humphries H Kushner B. Falkner (1999) ArticleTitleLow dietary magnesium is associated with insulin resistance in a sample of young, nondiabetic Black Americans Am J Hypertens 12 747–756 Occurrence Handle10.1016/S0895-7061(99)00041-2 Occurrence Handle10480466

    Article  PubMed  Google Scholar 

  24. PO Attman O Samuelsson P. Alaupovic (1993) ArticleTitleLipoprotein metabolism and renal failure Am J Kidney Dis 21 573–592 Occurrence Handle8503411

    PubMed  Google Scholar 

  25. RM. Mclean (1994) ArticleTitleMagnesium and its therapeutic uses: a␣review Am J Med 96 63–76 Occurrence Handle10.1016/0002-9343(94)90117-1 Occurrence Handle8304365

    Article  PubMed  Google Scholar 

  26. AL Boskey AS. Poshner (1980) ArticleTitleEffect of magnesium on lipid-induced calcification: an in vitro model of bone mineralization Calcif Tissue Int 32 139–143 Occurrence Handle6773631

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Nephrology, “Papageorgiou” General Hospital, Thessaloniki Ring Road, 56403, Thessaloniki, Greece

    Efstathios Mitsopoulos, Ioannis Griveas, Stavros Zanos & Georgios Sakellariou

  2. Laboratory of Biochemistry, “Papageorgiou” General Hospital, Thessaloniki, Greece

    Konstantinos Anagnostopoulos

  3. Laboratory of Immunology, “Papageorgiou” General Hospital, Thessaloniki, Greece

    Anastasia Giannakou & Aikaterini Pavlitou

Authors
  1. Efstathios Mitsopoulos
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  2. Ioannis Griveas
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  3. Stavros Zanos
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  4. Konstantinos Anagnostopoulos
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  5. Anastasia Giannakou
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  6. Aikaterini Pavlitou
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  7. Georgios Sakellariou
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Correspondence to Efstathios Mitsopoulos.

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Mitsopoulos, E., Griveas, I., Zanos, S. et al. Increase in Serum Magnesium Level in Haemodialysis Patients Receiving Sevelamer Hydrochloride. Int Urol Nephrol 37, 321–328 (2005). https://doi.org/10.1007/s11255-004-7135-5

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