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Serum magnesium, mortality, and cardiovascular disease in chronic kidney disease and end-stage renal disease patients: a systematic review and meta-analysis

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Abstract

Background

Previous studies reported that magnesium deficiency was associated with vascular calcifications, atherosclerosis and cardiovascular disease, which might play an independent pathogenic role in chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients. However, the results of these studies were somewhat underpowered and inconclusive.

Methods

Literature was identified by searching PubMed, EMBASE, Web of Science and the Cochrane Central Register of Controlled Trials (CENTRAL). We included studies that investigated the association between serum magnesium with mortality risk in CKD and ESRD patients. Unadjusted and adjusted hazard ratios (HRs) with 95% confidence intervals (95% CIs) were pooled.

Results

Twenty studies involving 200,934 participants were included, and the results showed that there was a strong association between hypomagnesemia and the risk of all-cause mortality in patients with CKD and ESRD (HR 1.32; 95% CI 1.19–1.47; p < 0.00001) (hypomagnesemia vs. normal magnesium or hypermagnesemia) after multivariable adjusted. On the contrary, hypermagnesemia was inversely associated with all-cause mortality in patients with CKD and ESRD (HR 0.86; 95% CI 0.79–0.94; p = 0.001) (per unit increase). Moreover, a significant association between hypermagnesemia and decreased risk of cardiovascular mortality was observed (HR 0.71; 95% CI 053–0.97, p = 0.03) in the adjusted model. In addition, subgroup analysis found that hypomagnesemia was strongly associated with increased all-cause mortality in hemodialysis patients (HR 1.29; 95% CI 1.12–1.50; p = 0.0005) (hypomagnesemia vs. normal magnesium or hypermagnesemia).

Conclusions

Our results indicate that hypomagnesemia is significantly associated with cardiovascular and all-cause mortality in patients with CKD and ESRD. Further studies evaluating benefits of magnesium correction in CKD and dialysis patients with hypomagnesemia should be performed.

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Author notes

  1. Jiachuan Xiong and Ting He contribute equally.

Authors and Affiliations

  1. Department of Nephrology, Institute of Nephrology of Chongqing and Kidney Center of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, People’s Republic of China

    Jiachuan Xiong, Ting He, Ling Nie, Ying Zhang, Yiqin Wang, Yunjian Huang, Bing Feng, Jingbo Zhang & Jinghong Zhao

  2. Department of Otorhinolaryngology and Head-Neck Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, People’s Republic of China

    Min Wang

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Contributions

JCX and MW carried out the literature search and drafted the manuscript. LN, YZ, and TH were involved in the design of the study and performed the statistical analysis. YQW and YJH assisted with the database searches and data extraction and examined the manuscript. JBZ, JHZ, and BF conceived the study, participated in the study design and was instrumental in drafting the manuscript and critically reviewed the manuscript. All authors read and agreed to the final manuscript.

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Correspondence to Jinghong Zhao.

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Xiong, J., He, T., Wang, M. et al. Serum magnesium, mortality, and cardiovascular disease in chronic kidney disease and end-stage renal disease patients: a systematic review and meta-analysis. J Nephrol 32, 791–802 (2019). https://doi.org/10.1007/s40620-019-00601-6

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