Skip to main content

Advertisement

SpringerLink
Log in

Association of Serum Magnesium with Gastrointestinal Bleeding in Peritoneal Dialysis Patients: a Multicentre Retrospective Study

  • Published:
Biological Trace Element Research Aims and scope Submit manuscript

Abstract

Serum magnesium is involved in the process of blood coagulation, and low serum magnesium is associated with haemorrhagic diseases. No studies have explored the relationship between serum magnesium and gastrointestinal bleeding (GIB). This study aimed to explore the association between serum magnesium and GIB in peritoneal dialysis (PD) patients. This was a multicentre retrospective cohort study. The primary endpoint was GIB. According to the baseline serum magnesium level of 0.7 mmol/L, patients were divided into two groups: the hypomagnesaemia group and the nonhypomagnesaemia group. A multivariate Cox regression model was used to investigate the association between hypomagnesaemia and GIB. A total of 654 PD patients from four Chinese peritoneal dialysis centres were recruited from February 1, 2010 to January 31, 2020. During the follow-up, 47 patients experienced GIB. Kaplan–Meier curves showed that there was a significant difference in the risk of GIB between the two groups (log-rank = 11.82, P < 0.001). The multivariable Cox regression model showed that the risk of GIB was higher in the hypomagnesaemia group than the nonhypomagnesaemia group after adjustment for demographic variables and laboratory indicators (HR = 3.007, 95% CI 1.488–6.079, P = 0.002). A baseline lower serum magnesium level was associated with a higher risk of GIB in PD patients.

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

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data Availability

The data underlying this article will be shared on reasonable request to the corresponding author.

Abbreviations

ARB:

Angiotensin receptor blocker

BMI:

Body mass index

BUN:

Blood urea nitrogen

CVD:

Cardiovascular disease

CCPBs:

Calcium-containing phosphate binders

GIB:

Gastrointestinal bleeding

CI:

Confidence interval

PPI:

proton pump inhibitors

hsCRP:

Hypersensitive C-reactive protein

RRF:

Residual renal function

RBC:

Red blood cell

References

  1. (2020) Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. LANCET. 395, 709–733

  2. Luo JC, Leu HB, Huang KW, Huang CC, Hou MC, Lin HC, Lee FY, Lee SD (2011) Incidence of bleeding from gastroduodenal ulcers in patients with end-stage renal disease receiving hemodialysis. CMAJ 183:E1345–E1351

    Article  PubMed  PubMed Central  Google Scholar 

  3. Kim M, Kim CS, Bae EH, Ma SK, Kim SW (2019) Risk factors for peptic ulcer disease in patients with end-stage renal disease receiving dialysis. Kidney Res Clin Pract 38:81–89

    Article  PubMed  PubMed Central  Google Scholar 

  4. Trivedi H, Yang J, Szabo A (2015) Gastrointestinal bleeding in patients on long-term dialysis. J NEPHROL 28:235–243

    Article  CAS  PubMed  Google Scholar 

  5. Liang CC, Wang SM, Kuo HL, Chang CT, Liu JH, Lin HH, Wang IK, Yang YF, Lu YJ, Chou CY, Huang CC (2014) Upper gastrointestinal bleeding in patients with CKD. Clin J Am Soc Nephrol 9:1354–1359

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Liang C, Chou C, Chang C, Wang I, Huang C (2016) Upper gastrointestinal bleeding as a risk factor for dialysis and all-cause mortality: a cohort study of chronic kidney disease patients in Taiwan. BMJ Open 6:e10439

    Article  Google Scholar 

  7. Sood P, Kumar G, Nanchal R, Sakhuja A, Ahmad S, Ali M, Kumar N, Ross EA (2012) Chronic kidney disease and end-stage renal disease predict higher risk of mortality in patients with primary upper gastrointestinal bleeding. AM J NEPHROL 35:216–224

    Article  CAS  PubMed  Google Scholar 

  8. Costello R, Wallace TC, Rosanoff A (2016) Magnesium. Adv nutr (Bethesda, Md) 7:199–201

    Article  CAS  Google Scholar 

  9. Grober U, Schmidt J, Kisters K (2015) Magn preve ther NUTRIENTS 7:8199–8226

    Google Scholar 

  10. de Baaij JH, Hoenderop JG, Bindels RJ (2015) Magnesium in man: implications for health and disease. PHYSIOL REV 95:1–46

    Article  PubMed  Google Scholar 

  11. Houillier P (2014) Mechanisms and regulation of renal magnesium transport. ANNU REV PHYSIOL 76:411–430

    Article  PubMed  Google Scholar 

  12. Apetrii M, Covic A, Massy ZA (2018) Magnesium supplementation: a consideration in dialysispatients. Semin Dial 31(1):11–14. https://doi.org/10.1111/sdi.12653

    Article  PubMed  Google Scholar 

  13. Oliveira B, Cunningham J, Walsh SB (2018) Magnesium balance in chronic and end-stage kidney disease. Adv Chronic Kidney Dis 25:291–295

    Article  PubMed  Google Scholar 

  14. Ye H, Zhang X, Guo Q, Huang N, Mao H, Yu X, Yang X (2013) Prevalence and factors associated with hypomagnesemia in Southern Chinese continuous ambulatory peritoneal dialysis patients. Perit Dial Int 33:450–454

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Leenders NHJ, Vervloet MG (2019) Magnesium: a magic bullet for cardiovascular disease in chronic kidney disease? Nutrients 11:455. https://doi.org/10.3390/diagnostics12040880

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Zhang F, Wu X, Wen Y, Zhan X, Peng FF, Wang X, Qian Z, Feng X (2022) Hypomagnesemia is a risk factor for cardiovascular disease- and noncardiovascular disease-related mortality in peritoneal dialysis patients. Blood Purif 51:23–30. https://doi.org/10.1159/000514148

    Article  CAS  PubMed  Google Scholar 

  17. Serebruany VL, Herzog WR, Schlossberg ML, Gurbel PA (1997) Bolus magnesium infusion in humans is associated with predominantly unfavourable changes in platelet aggregation and certain haemostatic factors. PHARMACOL RES 36:17–22

    Article  CAS  PubMed  Google Scholar 

  18. Kamboj AK, Hoversten P, Leggett CL (2019) Upper gastrointestinal bleeding: etiologies and management. MAYO CLIN PROC 94:697–703

    Article  PubMed  Google Scholar 

  19. Maas MB, Jahromi BS, Batra A, Potts MB, Naidech AM, Liotta EM (2020) Magnesium and risk of bleeding complications from ventriculostomy insertion. Stroke 51:2795–2800

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Goyal N, Tsivgoulis G, Malhotra K, Houck AL, Khorchid YM, Pandhi A, Inoa V, Alsherbini K, Alexandrov AV, Arthur AS et al (2018) Serum magnesium levels and outcomes in patients with acute spontaneous intracerebral hemorrhage. J Am Heart Assoc 7:e008698. https://doi.org/10.1161/JAHA.118.008698

  21. Liotta EM, Prabhakaran S, Sangha RS, Bush RA, Long AE, Trevick SA, Potts MB, Jahromi BS, Kim M, Manno EM, Sorond FA, Naidech AM, Maas MB (2017) Magnesium, hemostasis, and outcomes in patients with intracerebral hemorrhage. Neurology 89:813–819

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Liotta EM, Karmarkar A, Batra A, Kim M, Prabhakaran S, Naidech AM, Maas MB (2020) Magnesium and hemorrhage volume in patients with aneurysmal subarachnoid hemorrhage. CRIT CARE MED 48:104–110

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Kosucu M, Tugcugil E, Arslan E, Omur S, Livaoglu M (2020) Effects of perioperative magnesium sulfate with controlled hypotension on intraoperative bleeding and postoperative ecchymosis and edema in open rhinoplasty. AM J OTOLARYNG 41:102722

    Article  CAS  Google Scholar 

  24. Göral N, Ergil J, Alptekin A, Ozkan D, Gürer B, Dolgun H, Gümüs H (2011) Effect of magnesium sulphate on bleeding during lumbar discectomy. Anaesthesia 66:1140–1145

    Article  PubMed  Google Scholar 

  25. Mannuss S, Schuff-Werner P, Dreissiger K, Burstein C (2020) Inhibition of agonist-induced platelet aggregation by magnesium sulfate warrants its use as an alternative in vitro anticoagulant in pseudothrombocytopenia. Platelets 31:680–684

    Article  CAS  PubMed  Google Scholar 

  26. Ardahanli I, Akhan O, Celik M (2022) The effect of serum magnesium level on stable anticoagulation in patients using warfarin for various cardiac indications. Biol Trace Elem Res. https://doi.org/10.1007/s12011-021-03036-y

  27. Sekiya F, Yoshida M, Yamashita T, Morita T (1996) Magnesium(II) is a crucial constituent of the blood coagulation cascade. Potentiation of coagulant activities of factor IX by Mg2+ ions. J BIOL CHEM 271:8541–8544

    Article  CAS  PubMed  Google Scholar 

  28. Sheu JR, Hsiao G, Shen MY, Fong TH, Chen YW, Lin CH, Chou DS (2002) Mechanisms involved in the antiplatelet activity of magnesium in human platelets. Br J Haematol 119:1033–1041

    Article  CAS  PubMed  Google Scholar 

  29. Toke AB (2010) GI bleeding risk in patients undergoing dialysis. GASTROINTEST ENDOSC 71:50–52

    Article  PubMed  Google Scholar 

  30. Leinig CE, Moraes T, Ribeiro S, Riella MC, Olandoski M, Martins C, Pecoits-Filho R (2011) Predictive value of malnutrition markers for mortality in peritoneal dialysis patients. J Ren Nutr 21:176–183

    Article  PubMed  Google Scholar 

  31. Yamada S, Yamamoto S, Fukuma S, Nakano T, Tsuruya K, Inaba M (2020) Geriatric nutritional risk index (GNRI) and creatinine index equally predict the risk of mortality in hemodialysis patients: J-DOPPS. Sci Rep 10:5756

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Louvet L, Buchel J, Steppan S, Passlick-Deetjen J, Massy ZA (2013) Magnesium prevents phosphate-induced calcification in human aortic vascular smooth muscle cells. Nephrol Dial Transplant 28:869–878

    Article  CAS  PubMed  Google Scholar 

  33. Herencia C, Rodríguez-Ortiz ME, Muñoz-Castañeda JR, Martinez-Moreno JM, Canalejo R, Montes de Oca A, Díaz-Tocados JM, Peralbo-Santaella E, Marín C, Canalejo A, Rodriguez M, Almaden Y (2015) Angiotensin II prevents calcification in vascular smooth muscle cells by enhancing magnesium influx. EUR J CLIN INVEST 45:1129–1144

    Article  CAS  PubMed  Google Scholar 

  34. Kang S, Madhan K (2019) Gastrointestinal manifestations in a patient with calciphylaxis: a case report. Case Rep Nephrol Dial 9:119–125

    Article  PubMed  PubMed Central  Google Scholar 

  35. Nigwekar SU, Thadhani R, Brandenburg VM (2018) Calciphylaxis. N Engl J Med 378:1704–1714

    Article  CAS  PubMed  Google Scholar 

  36. Gupta N, Haq KF, Mahajan S, Nagpal P, Doshi B (2015) Gastrointestinal bleeding secondary to calciphylaxis. Am J Case Rep 16:818–822

    Article  PubMed  PubMed Central  Google Scholar 

  37. 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 85:174–181

    Article  CAS  PubMed  Google Scholar 

  38. Al Menhali A, Keeley TM, Demitrack ES, Samuelson LC (2017) Gastrin induces parathyroid hormone-like hormone expression in gastric parietal cells. American journal of physiology. Gastrointest liver physiol 312:G649–G657

    Article  Google Scholar 

  39. Houston BA, Schneider ALC, Vaishnav J, Cromwell DM, Miller PE, Faridi KF, Shah A, Sciortino C, Whitman G, Tedford RJ, Stevens GR, Judge DP, Russell SD, Rouf R (2017) Angiotensin II antagonism is associated with reduced risk for gastrointestinal bleeding caused by arteriovenous malformations in patients with left ventricular assist devices. J Heart Lung Transplant 36:380–385

    Article  PubMed  Google Scholar 

  40. Lin X, Lin C, Wang Y, Luo J, Young S, Chen P, Hou M, Lee F (2018) Risk factors of the peptic ulcer bleeding in aging uremia patients under regular hemodialysis. J Chin Med Assoc : JCMA 81:1027–1032

    Article  PubMed  Google Scholar 

  41. Liang C, Wang S, Kuo H, Chang C, Liu J, Lin H, Wang I, Yang Y, Lu Y, Chou C, Huang C (2014) Upper gastrointestinal bleeding in patients with CKD. Clin J Am Soc Nephrol : CJASN 9:1354–1359

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Funding

This study was supported by the National Natural Science Foundation of China (No. 81500552) and the Key Project of Social Science and Technology of Dongguan (No. 201950715046061).

Author information

Authors and Affiliations

  1. Department of Nephrology, The Sixth Affiliated Hospital, Sun Yat-Sen University, 26 Yuan-cun, Er-heng Road, Tian-He District, Guangzhou 510000, 510655, China

    Ning Su & Sijia Shang

  2. Department of Hematology, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China

    Ning Su

  3. Department of Nephrology, DongGuan SongShan Lake Hospital, Dongguan, China

    Xingming Tang

  4. Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China

    Xiaoyang Wang

  5. Department of Nephrology, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China

    Yueqiang Wen

  6. Department of Nephrology, Jiujiang No. 1 People’s Hospital, Jiujiang, China

    Xiaoran Feng

  7. Department of Medical Statistics, Clinical Trials Unit, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China

    Qian Zhou

  8. Department of Nephrology, The First Affiliated Hospital, Nanchang University, Nanchang, China

    Xiaojiang Zhan

Authors
  1. Ning Su
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xingming Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xiaoyang Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yueqiang Wen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Xiaoran Feng
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Qian Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Xiaojiang Zhan
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Sijia Shang
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Ning Su and Xingming Tang conceived the design of this manuscript. Ning Su drafted the original manuscript. Xiaoyang Wang, Yueqiang Wen, Xiaoran Feng and Xiaojiang Zhan provided the data. Qian Zhou checked the appraisals of risk of bias and applicability concerns. Sijia Shang accessed and was responsible for the raw data associated with the study. All the authors commented on drafts of the paper. Each author contributed important intellectual content during manuscript drafting or revision and agrees to be personally accountable for the individual’s own contributions and to ensure that questions pertaining to the accuracy or integrity of any portion of the work, even one in which the author was not directly involved, are appropriately investigated and resolved, including with documentation in the literature if appropriate.

Corresponding author

Correspondence to Sijia Shang.

Ethics declarations

Competing Interests

The authors declare no competing interests.

Additional information

Publisher's Note

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

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Su, N., Tang, X., Wang, X. et al. Association of Serum Magnesium with Gastrointestinal Bleeding in Peritoneal Dialysis Patients: a Multicentre Retrospective Study. Biol Trace Elem Res 201, 2775–2783 (2023). https://doi.org/10.1007/s12011-022-03391-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12011-022-03391-4

Keywords

Search

Navigation