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Magnesium Depletion Score is Associated with Long-Term Mortality in Chronic Kidney Diseases: A Prospective Population-Based Cohort Study

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Abstract

Background

Magnesium deficiency is common in patients with chronic kidney diseases (CKD) due to restricted magnesium intake and impaired magnesium reabsorption. Based on pathophysiological risk factors influencing kidney magnesium reabsorption, a magnesium depletion score (MDS) was developed. Using MDS as a novel indicator for assessing body magnesium status, we hypothesized that it was associated with clinical prognosis.

Methods

We conducted a prospective population-based cohort study using data from the National Health and Nutrition Examination Survey 1999–2014 to explore the impact of MDS on the clinical outcomes of CKD patients. Propensity score-matched analyses were conducted to increase comparability. The primary outcome was all-cause mortality, and the secondary outcomes were cardiovascular-cause and cancer-cause mortality.

Results

After propensity score matching, 3294 CKD patients were divided into 2 groups: MDS ≤ 2 (N = 1647), and MDS > 2 (N = 1647). During a median follow-up of 75 months, Kaplan–Meier analyses showed that MDS > 2 was associated with worse 5- and 10-year overall survival (78.5% vs 73.4%; 53.1% vs 43.1%, P < 0.001). After adjusting for confounding variables, MDS was found to be an independent risk factor for all-cause mortality (HR:1.34, 95% CI 1.20–1.50, P < 0.001). MDS > 2 was also associated with higher cardiovascular-cause mortality (16.2% VS 11.6%, P = 0.005). Multivariate competing risk analysis revealed that MDS > 2 was an independent risk factor (HR: 1.33, 95% CI 1.06–1.66, P = 0.012). Subgroup analyses reported that MDS > 2 increased all-cause mortality and cardiovascular-cause mortality only in patients with inadequate magnesium intake (P < 0.001, P < 0.001) but not in those with adequate intake (P = 0.068, P = 0.920).

Conclusions

A magnesium depletion score > 2 was independently associated with higher long-term cardiovascular-cause and all-cause mortality in CKD patients.

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Author notes

  1. Saifu Yin and Zhaoxia Zhou contributed equally to this article and share the co-first authorship.

Authors and Affiliations

  1. Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Guoxue Alley 37#, Wuhou District, Chengdu, 610041, Sichuan, China

    Saifu Yin, Zhaoxia Zhou, Tao Lin & Xianding Wang

  2. Ward of Nephrology and Urology, West China Hospital, West China School of Nursing, Sichuan University, Chengdu, 610041, Sichuan, China

    Zhaoxia Zhou

  3. Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China

    Saifu Yin, Tao Lin & Xianding Wang

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  1. Saifu Yin
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Correspondence to Tao Lin or Xianding Wang.

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Funding

This work was supported by grants from 1.3.5 Project for Disciplines of Excellence-Clinical Research Incubation Project, West China Hospital, Sichuan University (2021HXFH007). The funders had no role in study design, data collection or analysis, preparation of the manuscript, or the decision to publish.

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Ethics Approval Statement

This study involved secondary data analysis of a nationally representative publicly available dataset. The study we conducted was exempt from institutional review for this reason.

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All data are publicly available at [https://wwwn.cdc.gov/nchs/nhanes/Default.aspx].

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S-Figure 1: Propensity score before and after propensity-score matched analyses b

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Yin, S., Zhou, Z., Lin, T. et al. Magnesium Depletion Score is Associated with Long-Term Mortality in Chronic Kidney Diseases: A Prospective Population-Based Cohort Study. J Nephrol 36, 755–765 (2023). https://doi.org/10.1007/s40620-022-01489-5

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