Skip to main content
SpringerLink
Log in

Association between serum magnesium and anemia in patients with chronic kidney disease

  • Nephrology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Purpose

An inverse association was shown between serum magnesium levels and anemia in the general population. However, limited information is available about the association between serum magnesium level and anemia in the patient population with chronic kidney disease. We aimed to investigate the relationship between hypomagnesemia and anemia in pre-dialysis patients with chronic kidney disease stage 3–5.

Methods

This cross-sectional retrospective study included 213 chronic kidney disease patients with an estimated glomerular filtration rate of 60 mL/min and below. Laboratory and demographic data of outpatients were collected in January 2018—January 2019. Patients with a magnesium level below 1.9 mg/dL were accepted as the hypomagnesemia group.

Results

Serum magnesium level of 62 (29.1%) of these patients were below 1.9 mg/dL. Compared with normomagnesemic patients, hypomagnesemic patients had lower mean hemoglobin values (11.3 g/dL vs. 12.7 g/dL, P < 0.001), proton-pump inhibitor usage rates were significantly higher (33.9% vs. 17.2%, P = 0.008) and the median urine protein/creatinine ratio was found to be significantly higher (1017.5 mg/gCr vs. 536 mg/gCr, P = 0.045). In the multivariate analysis, the use of hemoglobin (OR 0.634; 95% CI 0.505–0.795; P < 0.001) and proton-pump inhibitor (OR 2.670; 95% CI 1.113–6.318; P = 0.025) were independent predictors of hypomagnesemia.

Conclusions

Hypomagnesemia is a common electrolyte disorder in pre-dialysis CKD patients. In this patient group, anemia is independently associated with hypomagnesemia.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Stauffer ME, Fan T (2014) Prevalence of anemia in chronic kidney disease in the United States. PLoS ONE 9(1):e84943

    Article  PubMed  PubMed Central  Google Scholar 

  2. Babitt JL, Lin HY (2012) Mechanisms of anemia in CKD. J Am Soc Nephrol 23(10):1631–1634

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Zadrazil J, Horak P (2015) Pathophysiology of anemia in chronic kidney diseases: a review. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 159(2):197–202

    Article  PubMed  Google Scholar 

  4. Gafter-Gvili A, Schechter A, Rozen-Zvi B (2019) Iron deficiency anemia in chronic kidney disease. Acta Haematol 142(1):44–50

    Article  CAS  PubMed  Google Scholar 

  5. van de Wal-Visscher ER, Kooman JP, van der Sande FM (2018) Magnesium in chronic kidney disease: should we care? Blood Purif 45(1–3):173–178

    Article  PubMed  Google Scholar 

  6. Ahmed F, Mohammed A (2019) Magnesium: the forgotten electrolyte—a review on hypomagnesemia. Med Sci (Basel). 7(4):10

    Google Scholar 

  7. Ferre S, Li X, Adams-Huet B, Maalouf NM, Sakhaee K, Toto RD et al (2019) Low serum magnesium is associated with faster decline in kidney function: the Dallas Heart Study experience. J Investig Med 67(6):987–994

    Article  PubMed  PubMed Central  Google Scholar 

  8. Tao SH, Fry BE, Fox MRS (1983) Magnesium stores and anemia in young Japanese Quail. J Nutr 113(6):1195–1203

    Article  CAS  PubMed  Google Scholar 

  9. Piomelli S, Jansen V, Dancis J (1973) The hemolytic anemia of magnesium deficiency in adult rats. Blood 41(3):451–459

    Article  CAS  PubMed  Google Scholar 

  10. Cinar V, Nizamlioglu M, Mogulkoc R, Baltaci AK (2007) Effects of magnesium supplementation on blood parameters of athletes at rest and after exercise. Biol Trace Elem Res 115(3):205–212

    Article  CAS  PubMed  Google Scholar 

  11. Zhan Y, Chen R, Zheng W, Guo C, Lu L, Ji X et al (2014) Association between serum magnesium and anemia: China health and nutrition survey. Biol Trace Elem Res 159(1–3):39–45

    Article  CAS  PubMed  Google Scholar 

  12. Xu X, Hall J, Byles J, Shi Z (2017) Dietary pattern, serum magnesium, ferritin, C-reactive protein and anaemia among older people. Clin Nutr 36(2):444–451

    Article  CAS  PubMed  Google Scholar 

  13. Kim IY, Kim JH, Kim MJ, Lee DW, Hwang CG, Han M et al (2018) Low 1,25-dihydroxyvitamin D level is associated with erythropoietin deficiency and endogenous erythropoietin resistance in patients with chronic kidney disease. Int Urol Nephrol 50(12):2255–2260

    Article  CAS  PubMed  Google Scholar 

  14. Yu L, Song J, Lu X, Zu Y, Li H, Wang S (2019) Association between serum magnesium and erythropoietin responsiveness in hemodialysis patients: a cross-sectional study. Kidney Blood Press Res 44(3):354–361

    Article  CAS  PubMed  Google Scholar 

  15. Kdoqi (2007) KDOQI Clinical Practice Guideline and Clinical Practice Recommendations for anemia in chronic kidney disease: 2007 update of hemoglobin target. Am J Kidney Dis 50(3):471–530

    Article  Google Scholar 

  16. Kdoqi, National Kidney F (2006) KDOQI clinical practice guidelines and clinical practice recommendations for anemia in chronic kidney disease. Am J Kidney Dis 47(5):11–145

    Google Scholar 

  17. Levey AS, Stevens LA, Schmid CH, Zhang YL, CastroFeldman AFHI et al (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150(9):604–612

    Article  PubMed  PubMed Central  Google Scholar 

  18. Stevens PE, Levin A, Kidney Disease: Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group M (2013) Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med. 158(11):825–830

    Article  PubMed  Google Scholar 

  19. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group (2013) KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl 3:1–150

    Article  Google Scholar 

  20. Oka T, Hamano T, Sakaguchi Y, Yamaguchi S, Kubota K, Senda M et al (2019) Proteinuria-associated renal magnesium wasting leads to hypomagnesemia: a common electrolyte abnormality in chronic kidney disease. Nephrol Dial Transpl 34(7):1154–1162

    Article  CAS  Google Scholar 

  21. Hughes J, Chiu D, Kalra PA, Green D (2018) Prevalence and outcomes of proton pump inhibitor associated hypomagnesemia in chronic kidney disease. PLoS ONE 13(5):e0197400

    Article  PubMed  PubMed Central  Google Scholar 

  22. Yu L, Li H, Wang S-X (2017) Serum magnesium and mortality in maintenance hemodialysis patients. Blood Purif 43(1–3):31–36

    Article  PubMed  Google Scholar 

  23. Yu L, Song JH, Lu XX, Zu Y, Li H, Wang SX (2019) Association between serum magnesium and erythropoietin responsiveness in hemodialysis patients: a cross-sectional study. Kidney Blood Press R 44(3):354–361

    Article  CAS  Google Scholar 

  24. Sakaguchi Y, Fujii N, Shoji T, Hayashi T, Rakugi H, Isaka Y (2014) Hypomagnesemia is a significant predictor of cardiovascular and non-cardiovascular mortality in patients undergoing hemodialysis. Kidney Int 85(1):174–181

    Article  CAS  PubMed  Google Scholar 

  25. De Franceschi L, Brugnara C, Beuzard Y (1997) Dietary magnesium supplementation ameliorates anemia in a mouse model of beta-thalassemia. Blood 90(3):1283–1290

    Article  PubMed  Google Scholar 

  26. De Franceschi L, Bachir D, Galacteros F, Tchernia G, Cynober T, Alper S et al (1997) Oral magnesium supplements reduce erythrocyte dehydration in patients with sickle cell disease. J Clin Investig 100(7):1847–1852

    Article  PubMed  PubMed Central  Google Scholar 

  27. Al-Faris L, Al-Humood S, Behbehani F, Sallam H (2017) Altered expression pattern of CD55 and CD59 on red blood cells in anemia of chronic kidney disease. Med Princ Pract 26(6):516–522

    Article  PubMed  PubMed Central  Google Scholar 

  28. Maier JA, Malpuech-Brugere C, Zimowska W, Rayssiguier Y, Mazur A (2004) Low magnesium promotes endothelial cell dysfunction: implications for atherosclerosis, inflammation and thrombosis. Biochim Biophys Acta 1689(1):13–21

    Article  CAS  PubMed  Google Scholar 

  29. Kieboom BCT, Kiefte-de Jong JC, Eijgelsheim M, Franco OH, Kuipers EJ, Hofman A et al (2015) Proton pump inhibitors and hypomagnesemia in the general population: a population-based cohort study. Am J Kidney Dis 66(5):775–782

    Article  CAS  PubMed  Google Scholar 

  30. Hughes J, Kalra PA, Green D (2018) Prevalence and outcomes of proton pump inhibitor associated hypomagnesemia in chronic kidney disease. PLoS ONE 13(5):e0197400

    Article  PubMed  PubMed Central  Google Scholar 

  31. Misra PS, Alam A, Lipman ML, Nessim SJ (2015) The relationship between proton pump inhibitor use and serum magnesium concentration among hemodialysis patients: a cross-sectional study. BMC Nephrol 16:136

    Article  PubMed  PubMed Central  Google Scholar 

  32. William JH, Richards K, Danziger J (2018) Magnesium and drugs commonly used in chronic kidney disease. Adv Chron Kidney Dis 25(3):267–273

    Article  Google Scholar 

  33. Freedberg DE, Kim LS, Yang Y-X (2017) The risks and benefits of long-term use of proton pump inhibitors: expert review and best practice advice from the american gastroenterological association. Gastroenterology 152(4):706–715

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Nephrology, Department of Internal Medicine, Selcuk University Faculty of Medicine, Konya, Turkey

    Zeynep Biyik, Yasemin Coskun Yavuz & Lütfullah Altintepe

Authors
  1. Zeynep Biyik
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yasemin Coskun Yavuz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lütfullah Altintepe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zeynep Biyik.

Ethics declarations

Conflict of interest

The authors have declared that no conflict of interest exists.

Ethics standards

The study was approved by the Ethics Advisory Committee of the Selcuk University (approval number: 2019/383). Informed consent was not required due to the retrospective nature of the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Biyik, Z., Yavuz, Y.C. & Altintepe, L. Association between serum magnesium and anemia in patients with chronic kidney disease. Int Urol Nephrol 52, 1935–1941 (2020). https://doi.org/10.1007/s11255-020-02525-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-020-02525-8

Keywords

Search

Navigation