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Connolly BJ, Saxton SN. Recent updates on the influence of iron and magnesium on vascular, renal, and adipose inflammation and possible consequences for hypertension. J Hypertens 2024; 42:1848-1861. [PMID: 39258532 PMCID: PMC11451934 DOI: 10.1097/hjh.0000000000003829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 06/26/2024] [Accepted: 07/22/2024] [Indexed: 09/12/2024]
Abstract
The inflammatory status of the kidneys, vasculature, and perivascular adipose tissue (PVAT) has a significant influence on blood pressure and hypertension. Numerous micronutrients play an influential role in hypertension-driving inflammatory processes, and recent reports have provided bases for potential targeted modulation of these micronutrients to reduce hypertension. Iron overload in adipose tissue macrophages and adipocytes engenders an inflammatory environment and may contribute to impaired anticontractile signalling, and thus a treatment such as chelation therapy may hold a key to reducing blood pressure. Similarly, magnesium intake has proven to greatly influence inflammatory signalling and concurrent hypertension in both healthy animals and in a model for chronic kidney disease, demonstrating its potential clinical utility. These findings highlight the importance of further research to determine the efficacy of micronutrient-targeted treatments for the amelioration of hypertension and their potential translation into clinical application.
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Affiliation(s)
- Benjamin J Connolly
- Divison of Cardiovascular Sciences, The University of Manchester, Manchester, UK
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2
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Nogueira de Sa P, Narayanan M, Lim MAC. Electrolyte and Acid-Base Abnormalities After Kidney Transplantation. ADVANCES IN KIDNEY DISEASE AND HEALTH 2024; 31:450-457. [PMID: 39232615 DOI: 10.1053/j.akdh.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 03/14/2024] [Accepted: 03/25/2024] [Indexed: 09/06/2024]
Abstract
Kidney transplantation is the optimal therapeutic approach for individuals with end-stage kidney disease. The Scientific Registry of Transplant Recipients has reported a continuous rise in the total number of kidney transplants performed in the United States, with 25,500 new kidney recipients in 2022 alone. Despite an improved glomerular filtration rate, the post-transplant period introduces a unique set of electrolyte abnormalities that differ from those encountered in chronic kidney disease. A variety of factors contribute to the high prevalence of hypomagnesemia, hyperkalemia, metabolic acidosis, hypercalcemia, and hypophosphatemia seen after kidney transplantation. These include the degree of allograft function, immunosuppressive medications and their diverse mechanisms of action, and metabolic changes after transplant. This article aims to provide a comprehensive review of the key aspects surrounding the most commonly encountered electrolyte and acid-base abnormalities in the post-transplant setting.
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Affiliation(s)
- Patricia Nogueira de Sa
- Renal-Electrolyte and Hypertension Division, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA.
| | - Mohanram Narayanan
- Division of Nephrology and Hypertension, Department of Medicine, Baylor Scott & White, Medical Center, Temple, TX
| | - Mary Ann C Lim
- Renal-Electrolyte and Hypertension Division, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
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Pitzer Mutchler A, Huynh L, Patel R, Lam T, Bain D, Jamison S, Kirabo A, Ray EC. The role of dietary magnesium deficiency in inflammatory hypertension. Front Physiol 2023; 14:1167904. [PMID: 37293263 PMCID: PMC10244581 DOI: 10.3389/fphys.2023.1167904] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/10/2023] [Indexed: 06/10/2023] Open
Abstract
Nearly 30% of adults consume less than the estimated average daily requirement of magnesium (Mg2+), and commonly used medications, such as diuretics, promote Mg2+ deficiency. Higher serum Mg2+ levels, increased dietary Mg2+ in-take, and Mg2+ supplementation are each associated with lower blood pressure, suggesting that Mg2+-deficiency contributes to the pathogenesis of hypertension. Antigen-presenting cells, such as monocytes and dendritic cells, are well-known to be involved in the pathogenesis of hypertension. In these cells, processes implicated as necessary for increased blood pressure include activation of the NLRP3 inflammasome, IL-1β production, and oxidative modification of fatty acids such as arachidonic acid, forming isolevuglandins (IsoLGs). We hypothesized that increased blood pressure in response to dietary Mg2+-depletion leads to increased NLRP3, IL-1β, and IsoLG production in antigen presenting cells. We found that a Mg2+-depleted diet (0.01% Mg2+ diet) increased blood pressure in mice compared to mice fed a 0.08% Mg2+ diet. Mg2+-depleted mice did not exhibit an increase in total body fluid, as measured by quantitative magnetic resonance. Plasma IL-1β concentrations were increased (0.13 ± 0.02 pg/mL vs. 0.04 ± 0.02 pg/mL). Using flow cytometry, we observed increased NLRP3 and IL-1β expression in antigen-presenting cells from spleen, kidney, and aorta. We also observed increased IsoLG production in antigen-presenting cells from these organs. Primary culture of CD11c+ dendritic cells confirmed that low extracellular Mg2+ exerts a direct effect on these cells, stimulating IL-1β and IL-18 production. The present findings show that NLRP3 inflammasome activation and IsoLG-adduct formation are stimulated when dietary Mg2+ is depleted. Interventions and increased dietary Mg2+ consumption may prove beneficial in decreasing the prevalence of hypertension and cardiovascular disease.
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Affiliation(s)
- Ashley Pitzer Mutchler
- Vanderbilt University Department of Medicine, Division of Clinical Pharmacology, Nashville, TN, United States
| | - Linh Huynh
- University of Pittsburgh Department of Medicine, Renal-Electrolyte Division, Pittsburgh, PA, United States
| | - Ritam Patel
- University of Pittsburgh Department of Medicine, Renal-Electrolyte Division, Pittsburgh, PA, United States
| | - Tracey Lam
- University of Pittsburgh Department of Medicine, Renal-Electrolyte Division, Pittsburgh, PA, United States
| | - Daniel Bain
- University of Pittsburgh Department of Geology, Pittsburgh, PA, United States
| | - Sydney Jamison
- Meharry Medical College Nashville, Nashville, TN, United States
| | - Annet Kirabo
- Vanderbilt University Department of Medicine, Division of Clinical Pharmacology, Nashville, TN, United States
| | - Evan C. Ray
- University of Pittsburgh Department of Medicine, Renal-Electrolyte Division, Pittsburgh, PA, United States
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Goktepe B, Celtik A, Kivratma G, Sezer TO, Asci G, Toz H. Is Serum Magnesium Level Associated With Serum Lipid Levels in Kidney Transplant Recipients? Transplant Proc 2023:S0041-1345(23)00161-6. [PMID: 37045703 DOI: 10.1016/j.transproceed.2023.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/05/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Magnesium (Mg) is key in diabetes mellitus, hyperlipidemia, and cardiovascular disease. METHODS This is a retrospective cross-sectional study including 103 kidney transplant recipients. Patients aged under 18 years, patients treated with Mg supplementation, antihyperlipidemic agents, or diuretics, and patients with active infection or malignancy were not enrolled. Patients were divided into 2 groups according to median serum Mg level. The atherogenic index of plasma was calculated by a logarithmic transformation of the number acquired by dividing the molar concentrations of serum triglyceride by high-density lipoprotein value. RESULTS The mean serum Mg level was 1.91 ± 0.28 mg/dL. Six patients (5.8%) had hypomagnesemia (Mg <1.5 mg/dL), and 2 (1.9%) had hypermagnesemia (Mg >2.6 mg/dL). Serum Mg level was negatively correlated with body mass index, estimated glomerular filtration rate (eGFR), and tacrolimus trough level and positively correlated with levels of phosphorus, total cholesterol, and low-density lipoprotein (LDL-C). There was no correlation between serum Mg and triglyceride, high-density lipoprotein, atherogenic index of plasma, and cyclosporin A trough level. Patients with Mg >1.87 mg/dL had lower eGFR, tacrolimus, and cyclosporin A trough level and higher total cholesterol and LDL-C compared to those with Mg ≤1.87 mg/dL. In adjusted ordinal analysis, eGFR (hazard ratio (HR): 0.981, 95% CI 0.964-0.999, P = .036) and total cholesterol (HR: 1.015, 95% CI 1.004-1.027, P = .008) were independently associated with serum Mg. In multivariate linear regression analysis, serum Mg level was independently associated with LDL-C (β = .296, t = 3.079, P = .003) and total cholesterol (β = .295, t = 3.075, P = .003). CONCLUSION Serum Mg level may have an important impact on dyslipidemia in kidney transplant recipients.
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Affiliation(s)
- Berk Goktepe
- Ege University, School of Medicine, Department of General Surgery, Bornova, Izmir, Turkey
| | - Aygul Celtik
- Ege University, School of Medicine, Department of Internal Medicine, Division of Nephrology, Bornova, Izmir, Turkey.
| | - Goktug Kivratma
- Ege University, School of Medicine, Department of General Surgery, Bornova, Izmir, Turkey
| | - Taylan Ozgur Sezer
- Ege University, School of Medicine, Department of General Surgery, Bornova, Izmir, Turkey
| | - Gulay Asci
- Ege University, School of Medicine, Department of Internal Medicine, Division of Nephrology, Bornova, Izmir, Turkey
| | - Huseyin Toz
- Ege University, School of Medicine, Department of Internal Medicine, Division of Nephrology, Bornova, Izmir, Turkey
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Lahav I, Steinmetz T, Molcho M, Lev N, Agur T, Nesher E, Rozen-Zvi B, Rahamimov R. The Association Between Exposure to Low Magnesium Blood Levels After Renal Transplantation and Cardiovascular Morbidity and Mortality. Front Med (Lausanne) 2021; 8:690273. [PMID: 34322504 PMCID: PMC8310919 DOI: 10.3389/fmed.2021.690273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/10/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Serum magnesium levels are associated with cardiovascular disease and all-cause mortality in the general population and chronic kidney disease patients, but the association between serum magnesium levels and cardiovascular risk after kidney transplantation is not established. We sought to evaluate whether exposure to low serum magnesium levels after renal transplantation is related to cardiovascular morbidity and mortality. Methods: We conducted a single center retrospective study that included all transplanted patients who had a functioning graft for at least 6 months after transplantation between January 2001 and December 2013. We calculated exposure to magnesium using time weighted average for serum magnesium levels, using all values available during the follow-up. Several statistical methods were used, including liner regression analysis, χ2 test, and multivariate Cox proportional hazard model. Results: Four hundred ninety-eight patients were included. Median follow-up was 5.26 years. High time weighted average of serum magnesium was associated with a hazard ratio of 1.94 for all-cause mortality and major cardiovascular outcome compared to low levels (95% CI 1.18–3.19, p = 0.009). The high quartile of time weighted average of serum magnesium was associated with death censored major cardiovascular outcome (hazard ratio 2.13, 95% CI 1.17–3.86, p = 0.013) in multivariate analysis. Conclusions: Exposure to low serum magnesium levels in renal transplant recipients was associated with a lower risk for all-cause mortality and major cardiovascular outcome. These findings contrast the higher risk found in the general population.
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Affiliation(s)
- Itay Lahav
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tali Steinmetz
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Nephrology, Rabin Medical Center, Petah Tikva, Israel
| | - Maya Molcho
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Neta Lev
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Nephrology, Rabin Medical Center, Petah Tikva, Israel
| | - Timna Agur
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Nephrology, Rabin Medical Center, Petah Tikva, Israel
| | - Eviatar Nesher
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Organ Transplantation, Rabin Medical Center-Beilinson Hospital, Petah Tikva, Israel
| | - Benaya Rozen-Zvi
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Nephrology, Rabin Medical Center, Petah Tikva, Israel
| | - Ruth Rahamimov
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Nephrology, Rabin Medical Center, Petah Tikva, Israel.,Department of Organ Transplantation, Rabin Medical Center-Beilinson Hospital, Petah Tikva, Israel
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6
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Panthofer AM, Lyu B, Astor BC, Singh T, Aziz F, Mandelbrot D, Parajuli S, Mohamed M, Djamali A, Garg N. Post-kidney transplant serum magnesium exhibits a U-shaped association with subsequent mortality: an observational cohort study. Transpl Int 2021; 34:1853-1861. [PMID: 34081803 DOI: 10.1111/tri.13932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/10/2021] [Accepted: 05/27/2021] [Indexed: 11/30/2022]
Abstract
Hypomagnesemia is common in kidney transplant recipients (KTRs). We sought to explore the relationship between Mg and outcomes in KTRs, which may be associated with mortality and thus may be a potential intervention target to improve outcomes. We followed KTRs performed between 01/2000 and 6/2016 at a large US transplant center from 6 months post-transplant to graft failure, death, or loss to follow-up. Using Mg as a time-dependent variable, associations between Mg and outcomes any time after 6 months post-transplant were evaluated. 3680 KTRs with 50 413 Mg measurements met inclusion criteria. 657 deaths occurred over a median follow-up of 5.1 years. Compared to Mg of 1.5-1.8 mg/dl, both lower (HR 1.17, 95% confidence interval (CI): 1.07-1.28) and higher (HR 1.16, 95% CI: 1.09-1.23) Mg levels were associated with greater risk of mortality. Similar U-shaped associations were observed for Mg and cardiovascular disease-related mortality (HR for Mg ≤1.5 mg/dl: 1.31; CI: 1.03-1.68) and infection-related mortality (HR for Mg ≤1.5 mg/dl: 1.28; CI: 1.09-1.51), although relationships for Mg >1.8 mg/dl were not statistically significant. Mg exhibits a U-shaped association with mortality in KTRs, with levels between 1.5 and 1.8 mg/dl associated with the lowest risk.
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Affiliation(s)
- Annalise M Panthofer
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Beini Lyu
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Brad C Astor
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Tripti Singh
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Fahad Aziz
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Didier Mandelbrot
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Sandesh Parajuli
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Maha Mohamed
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Arjang Djamali
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Division of Transplant Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Neetika Garg
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Odler B, Deak AT, Pregartner G, Riedl R, Bozic J, Trummer C, Prenner A, Söllinger L, Krall M, Höflechner L, Hebesberger C, Boxler MS, Berghold A, Schemmer P, Pilz S, Rosenkranz AR. Hypomagnesemia Is a Risk Factor for Infections after Kidney Transplantation: A Retrospective Cohort Analysis. Nutrients 2021; 13:1296. [PMID: 33919913 PMCID: PMC8070921 DOI: 10.3390/nu13041296] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/07/2021] [Accepted: 04/07/2021] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Magnesium (Mg2+) deficiency is a common finding in the early phase after kidney transplantation (KT) and has been linked to immune dysfunction and infections. Data on the association of hypomagnesemia and the rate of infections in kidney transplant recipients (KTRs) are sparse. METHODS We conducted a single-center retrospective cohort study of KTRs transplanted between 2005 and 2015. Laboratory data, including serum Mg2+ (median time of the Mg2+ measurement from KT: 29 days), rate of infections including mainly urinary tract infections (UTI), and common transplant-related viral infections (CMV, polyoma, EBV) in the early phase after KT were recorded. The primary outcome was the incidence of infections within one year after KT, while secondary outcomes were hospitalization due to infection, incidence rates of long-term (up to two years) infections, and all-cause mortality. RESULTS We enrolled 376 KTRs of whom 229 patients (60.9%) suffered from Mg2+ deficiency defined as a serum Mg2+ < 0.7 mmol/L. A significantly higher incidence rate of UTIs and viral infections was observed in patients with versus without Mg2+ deficiency during the first year after KT (58.5% vs. 47.6%, p = 0.039 and 69.9% vs. 51.7%, p < 0.001). After adjustment for potential confounders, serum Mg2+ deficiency remained an independent predictor of both UTIs and viral infections (odds ratio (OR): 1.73, 95% CI: 1.04-2.86, p = 0.035 and OR: 2.05, 95% CI: 1.23-3.41, p = 0.006). No group differences according to Mg2+ status in hospitalizations due to infections and infection incidence rates in the 12-24 months post-transplant were observed. In the Cox regression analysis, Mg2+ deficiency was not significantly associated with all-cause mortality (HR: 1.15, 95% CI: 0.70-1.89, p = 0.577). CONCLUSIONS KTRs suffering from Mg2+ deficiency are at increased risk of UTIs and viral infections in the first year after KT. Interventional studies investigating the effect of Mg2+ supplementation on Mg2+ deficiency and viral infections in KTRs are needed.
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Affiliation(s)
- Balazs Odler
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, A-8036 Graz, Austria; (B.O.); (A.T.D.); (J.B.); (A.P.); (L.S.); (M.K.); (L.H.); (C.H.); (M.S.B.)
- Transplant Center Graz, Medical University of Graz, A-8036 Graz, Austria;
| | - Andras T. Deak
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, A-8036 Graz, Austria; (B.O.); (A.T.D.); (J.B.); (A.P.); (L.S.); (M.K.); (L.H.); (C.H.); (M.S.B.)
- Transplant Center Graz, Medical University of Graz, A-8036 Graz, Austria;
| | - Gudrun Pregartner
- Institute of Medical Informatics, Statistics and Documentation, Medical University of Graz, A-8036 Graz, Austria; (G.P.); (R.R.); (A.B.)
| | - Regina Riedl
- Institute of Medical Informatics, Statistics and Documentation, Medical University of Graz, A-8036 Graz, Austria; (G.P.); (R.R.); (A.B.)
| | - Jasmin Bozic
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, A-8036 Graz, Austria; (B.O.); (A.T.D.); (J.B.); (A.P.); (L.S.); (M.K.); (L.H.); (C.H.); (M.S.B.)
| | - Christian Trummer
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, A-8036 Graz, Austria; (C.T.); (S.P.)
| | - Anna Prenner
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, A-8036 Graz, Austria; (B.O.); (A.T.D.); (J.B.); (A.P.); (L.S.); (M.K.); (L.H.); (C.H.); (M.S.B.)
- Transplant Center Graz, Medical University of Graz, A-8036 Graz, Austria;
| | - Lukas Söllinger
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, A-8036 Graz, Austria; (B.O.); (A.T.D.); (J.B.); (A.P.); (L.S.); (M.K.); (L.H.); (C.H.); (M.S.B.)
| | - Marcell Krall
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, A-8036 Graz, Austria; (B.O.); (A.T.D.); (J.B.); (A.P.); (L.S.); (M.K.); (L.H.); (C.H.); (M.S.B.)
| | - Lukas Höflechner
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, A-8036 Graz, Austria; (B.O.); (A.T.D.); (J.B.); (A.P.); (L.S.); (M.K.); (L.H.); (C.H.); (M.S.B.)
| | - Carina Hebesberger
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, A-8036 Graz, Austria; (B.O.); (A.T.D.); (J.B.); (A.P.); (L.S.); (M.K.); (L.H.); (C.H.); (M.S.B.)
- Transplant Center Graz, Medical University of Graz, A-8036 Graz, Austria;
| | - Matias S. Boxler
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, A-8036 Graz, Austria; (B.O.); (A.T.D.); (J.B.); (A.P.); (L.S.); (M.K.); (L.H.); (C.H.); (M.S.B.)
| | - Andrea Berghold
- Institute of Medical Informatics, Statistics and Documentation, Medical University of Graz, A-8036 Graz, Austria; (G.P.); (R.R.); (A.B.)
| | - Peter Schemmer
- Transplant Center Graz, Medical University of Graz, A-8036 Graz, Austria;
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, A-8036 Graz, Austria
| | - Stefan Pilz
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, A-8036 Graz, Austria; (C.T.); (S.P.)
| | - Alexander R. Rosenkranz
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, A-8036 Graz, Austria; (B.O.); (A.T.D.); (J.B.); (A.P.); (L.S.); (M.K.); (L.H.); (C.H.); (M.S.B.)
- Transplant Center Graz, Medical University of Graz, A-8036 Graz, Austria;
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8
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Song CC, Brown A, Winstead R, Yakubu I, Demehin M, Kumar D, Gupta G. Early initiation of sodium-glucose linked transporter inhibitors (SGLT-2i) and associated metabolic and electrolyte outcomes in diabetic kidney transplant recipients. Endocrinol Diabetes Metab 2021; 4:e00185. [PMID: 33855198 PMCID: PMC8029504 DOI: 10.1002/edm2.185] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 08/12/2020] [Accepted: 08/15/2020] [Indexed: 12/16/2022] Open
Abstract
There is a paucity of data on the use of SGLT2 inhibitors on outcomes in kidney transplant recipients. There may be concern in initiating these agents, especially within the first year post-transplant when renal function is more labile and immunosuppression more intense, due to a presumed high risk of urinary infections and acute kidney injury. This is a retrospective study on 50 kidney transplant recipients, half of whom were started on therapy within the first year of transplant. Over a follow-up period of 6 months, overall patients had a statistically significant improvement in weight by -2.95 kg [SD 3.54, P = <.0001 (CI: 3.53, 1.50)] as well as hypomagnesemia 0.13 [SD 1.73, P = .0004 (CI: 0.06, 0.20)]. Overall insulin usage declined by -3.7 units [SD 22.8, P = .17]. 14% of patients had at least one urinary tract infection although this rate is not different (~20%) than that reported historically in this high-risk population.
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Affiliation(s)
- Chelsey Chenxi Song
- Hume‐Lee Transplant CenterVirginia Commonwealth University HealthRichmondVAUSA
| | - Andrew Brown
- Hume‐Lee Transplant CenterVirginia Commonwealth University HealthRichmondVAUSA
| | - Ryan Winstead
- Hume‐Lee Transplant CenterVirginia Commonwealth University HealthRichmondVAUSA
| | - Idris Yakubu
- Hume‐Lee Transplant CenterVirginia Commonwealth University HealthRichmondVAUSA
| | - Moses Demehin
- Hume‐Lee Transplant CenterVirginia Commonwealth University HealthRichmondVAUSA
| | - Dhiren Kumar
- Hume‐Lee Transplant CenterVirginia Commonwealth University HealthRichmondVAUSA
| | - Gaurav Gupta
- Hume‐Lee Transplant CenterVirginia Commonwealth University HealthRichmondVAUSA
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9
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Rodelo-Haad C, Pendón-Ruiz de Mier MV, Díaz-Tocados JM, Martin-Malo A, Santamaria R, Muñoz-Castañeda JR, Rodríguez M. The Role of Disturbed Mg Homeostasis in Chronic Kidney Disease Comorbidities. Front Cell Dev Biol 2020; 8:543099. [PMID: 33282857 PMCID: PMC7688914 DOI: 10.3389/fcell.2020.543099] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 10/09/2020] [Indexed: 12/19/2022] Open
Abstract
Some of the critical mechanisms that mediate chronic kidney disease (CKD) progression are associated with vascular calcifications, disbalance of mineral metabolism, increased oxidative and metabolic stress, inflammation, coagulation abnormalities, endothelial dysfunction, or accumulation of uremic toxins. Also, it is widely accepted that pathologies with a strong influence in CKD progression are diabetes, hypertension, and cardiovascular disease (CVD). A disbalance in magnesium (Mg) homeostasis, more specifically hypomagnesemia, is associated with the development and progression of the comorbidities mentioned above, and some mechanisms might explain why low serum Mg is associated with negative clinical outcomes such as major adverse cardiovascular and renal events. Furthermore, it is likely that hypomagnesemia causes the release of inflammatory cytokines and C-reactive protein and promotes insulin resistance. Animal models have shown that Mg supplementation reverses vascular calcifications; thus, clinicians have focused on the potential benefits that Mg supplementation may have in humans. Recent evidence suggests that Mg reduces coronary artery calcifications and facilitates peripheral vasodilation. Mg may reduce vascular calcification by direct inhibition of the Wnt/β-catenin signaling pathway. Furthermore, Mg deficiency worsens kidney injury induced by an increased tubular load of phosphate. One important consequence of excessive tubular load of phosphate is the reduction of renal tubule expression of α-Klotho in moderate CKD. Low Mg levels worsen the reduction of Klotho induced by the tubular load of phosphate. Evidence to support clinical translation is yet insufficient, and more clinical studies are required to claim enough evidence for decision-making in daily practice. Meanwhile, it seems reasonable to prevent and treat Mg deficiency. This review aims to summarize the current understanding of Mg homeostasis, the potential mechanisms that may mediate the effect of Mg deficiency on CKD progression, CVD, and mortality.
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Affiliation(s)
- Cristian Rodelo-Haad
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain.,University of Córdoba, Córdoba, Spain.,Nephrology Service, Reina Sofia University Hospital, Córdoba, Spain.,Spanish Renal Research Network (REDinREN), Institute of Health Carlos III, Madrid, Spain
| | - M Victoria Pendón-Ruiz de Mier
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain.,University of Córdoba, Córdoba, Spain.,Nephrology Service, Reina Sofia University Hospital, Córdoba, Spain.,Spanish Renal Research Network (REDinREN), Institute of Health Carlos III, Madrid, Spain
| | - Juan Miguel Díaz-Tocados
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain.,University of Córdoba, Córdoba, Spain
| | - Alejandro Martin-Malo
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain.,University of Córdoba, Córdoba, Spain.,Nephrology Service, Reina Sofia University Hospital, Córdoba, Spain.,Spanish Renal Research Network (REDinREN), Institute of Health Carlos III, Madrid, Spain
| | - Rafael Santamaria
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain.,University of Córdoba, Córdoba, Spain.,Nephrology Service, Reina Sofia University Hospital, Córdoba, Spain.,Spanish Renal Research Network (REDinREN), Institute of Health Carlos III, Madrid, Spain
| | - Juan Rafael Muñoz-Castañeda
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain.,University of Córdoba, Córdoba, Spain.,Nephrology Service, Reina Sofia University Hospital, Córdoba, Spain.,Spanish Renal Research Network (REDinREN), Institute of Health Carlos III, Madrid, Spain
| | - Mariano Rodríguez
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain.,University of Córdoba, Córdoba, Spain.,Nephrology Service, Reina Sofia University Hospital, Córdoba, Spain.,Spanish Renal Research Network (REDinREN), Institute of Health Carlos III, Madrid, Spain
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10
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Proton-Pump Inhibitors and Hypomagnesaemia in Kidney Transplant Recipients. J Clin Med 2019; 8:jcm8122162. [PMID: 31817776 PMCID: PMC6947083 DOI: 10.3390/jcm8122162] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/01/2019] [Accepted: 12/04/2019] [Indexed: 02/06/2023] Open
Abstract
Proton-pump inhibitors (PPIs) are commonly used after kidney transplantation and there is rarely an incentive to discontinue treatment. In the general population, PPI use has been associated with hypomagnesaemia. We aimed to investigate whether PPI use is associated with plasma magnesium, 24-h urinary magnesium excretion and hypomagnesaemia, in kidney transplant recipients (KTR). Plasma magnesium and 24-h urinary magnesium excretion were measured in 686 stable outpatient KTR with a functioning allograft for ≥1 year from the TransplantLines Food and Nutrition Biobank and Cohort-Study (NCT02811835). PPIs were used by 389 KTR (56.6%). In multivariable linear regression analyses, PPI use was associated with lower plasma magnesium (β: −0.02, P = 0.02) and lower 24-h urinary magnesium excretion (β: −0.82, P < 0.001). Moreover, PPI users had a higher risk of hypomagnesaemia (plasma magnesium <0.70 mmol/L), compared with non-users (Odds Ratio (OR): 2.12; 95% confidence interval (CI) 1.43–3.15, P < 0.001). This risk tended to be highest among KTR taking high PPI dosages (>20 mg omeprazole Eq/day) and was independent of adjustment for potential confounders (OR: 2.46; 95% CI 1.32–4.57, P < 0.005). No interaction was observed between PPI use and the use of loop diuretics, thiazide diuretics, tacrolimus, or diabetes (Pinteraction > 0.05). These results demonstrate that PPI use is independently associated with lower magnesium status and hypomagnesaemia in KTR. The concomitant decrease in urinary magnesium excretion indicates that this likely is the consequence of reduced intestinal magnesium absorption. Based on these results, it might be of benefit to monitor magnesium status periodically in KTR on chronic PPI therapy.
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Magnesium Citrate Protects Against Vascular Calcification in an Adenine-induced Chronic Renal Failure Rat Model. J Cardiovasc Pharmacol 2019; 72:270-276. [PMID: 29738375 DOI: 10.1097/fjc.0000000000000590] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hypomagnesemia was identified as a strong risk factor for cardiovascular disease in patients with chronic renal failure (CRF). However, the effects of magnesium (Mg) on vascular calcification (VC) have not been fully elucidated. Thus, we aim to determine the effects of Mg citrate (MgCit) on VC in CRF rats. METHODS Rats were divided into 5 groups: group 1 (normal diet), group 2 (normal diet with MgCit), group 3 (the VC model of CRF induced by 0.75% adenine and 0.9% phosphorus diet from day 1 to day 28), group 4 (group 3 treated with low-dose MgCit from day 1 to day 42), and group 5 (same as group 3 except the high-dose MgCit). All rats were killed at day 43 with collection of blood and aortas. Then, serum biochemical parameters, VC-related staining, calcium and P contents, alkaline phosphatase contents and activity, expression of alpha smooth muscle actin, and runt-related transcription factor 2 (RUNX2) in aortas were assessed. RESULTS Group 3 had extensive VC. The VC degree decreased in groups 4 and 5 in a dose-depended manner with reduced calcium content, P levels, alkaline phosphatase content and activity, and protein levels of RUNX2 and increased protein levels of alpha smooth muscle actin in aortas. CONCLUSIONS MgCit exerted a protective role in VC in adenine-induced CRF rats; thus, it may be a potential drug for the prevention of VC in patients with CRF.
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12
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Kurstjens S, de Baaij JHF, Overmars-Bos C, van den Munckhof ICL, Garzero V, de Vries MA, Burggraaf B, van Diepen JA, Riksen NP, Rutten JHW, Netea MG, Castro Cabezas M, Bindels RJM, Ashcroft FM, Tack CJJ, Hoenderop JGJ. Increased NEFA levels reduce blood Mg 2+ in hypertriacylglycerolaemic states via direct binding of NEFA to Mg 2. Diabetologia 2019; 62:311-321. [PMID: 30426168 PMCID: PMC6323097 DOI: 10.1007/s00125-018-4771-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 10/05/2018] [Indexed: 11/28/2022]
Abstract
AIMS/HYPOTHESIS The blood triacylglycerol level is one of the main determinants of blood Mg2+ concentration in individuals with type 2 diabetes. Hypomagnesaemia (blood Mg2+ concentration <0.7 mmol/l) has serious consequences as it increases the risk of developing type 2 diabetes and accelerates progression of the disease. This study aimed to determine the mechanism by which triacylglycerol levels affect blood Mg2+ concentrations. METHODS Using samples from 285 overweight individuals (BMI >27 kg/m2) who participated in the 300-Obesity study (an observational cross-sectional cohort study, as part of the Human Functional Genetics Projects), we investigated the association between serum Mg2+ with laboratory variables, including an extensive lipid profile. In a separate set of studies, hyperlipidaemia was induced in mice and in healthy humans via an oral lipid load, and blood Mg2+, triacylglycerol and NEFA concentrations were measured using colourimetric assays. In vitro, NEFAs harvested from albumin were added in increasing concentrations to several Mg2+-containing solutions to study the direct interaction between Mg2+ and NEFAs. RESULTS In the cohort of overweight individuals, serum Mg2+ levels were inversely correlated with triacylglycerols incorporated in large VLDL particles (r = -0.159, p ≤ 0.01). After lipid loading, we observed a postprandial increase in plasma triacylglycerol and NEFA levels and a reciprocal reduction in blood Mg2+ concentration both in mice (Δ plasma Mg2+ -0.31 mmol/l at 4 h post oral gavage) and in healthy humans (Δ plasma Mg2+ -0.07 mmol/l at 6 h post lipid intake). Further, in vitro experiments revealed that the decrease in plasma Mg2+ may be explained by direct binding of Mg2+ to NEFAs. Moreover, Mg2+ was found to bind to albumin in a NEFA-dependent manner, evidenced by the fact that Mg2+ did not bind to fatty-acid-free albumin. The NEFA-dependent reduction in the free Mg2+ concentration was not affected by the presence of physiological concentrations of other cations. CONCLUSIONS/INTERPRETATION This study shows that elevated NEFA and triacylglycerol levels directly reduce blood Mg2+ levels, in part explaining the high prevalence of hypomagnesaemia in metabolic disorders. We show that blood NEFA level affects the free Mg2+ concentration, and therefore, our data challenge how the fractional excretion of Mg2+ is calculated and interpreted in the clinic.
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Affiliation(s)
- Steef Kurstjens
- Department of Physiology (286), Radboud Institute for Molecular Life Sciences, Radboud university medical center, P. O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Jeroen H F de Baaij
- Department of Physiology (286), Radboud Institute for Molecular Life Sciences, Radboud university medical center, P. O. Box 9101, 6500 HB, Nijmegen, the Netherlands
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - Caro Overmars-Bos
- Department of Physiology (286), Radboud Institute for Molecular Life Sciences, Radboud university medical center, P. O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | | | - Veronica Garzero
- Department of Physiology (286), Radboud Institute for Molecular Life Sciences, Radboud university medical center, P. O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Marijke A de Vries
- Department of Internal Medicine, Center for Diabetes and Vascular Medicine, Franciscus Gasthuis Rotterdam, Rotterdam, the Netherlands
| | - Benjamin Burggraaf
- Department of Internal Medicine, Center for Diabetes and Vascular Medicine, Franciscus Gasthuis Rotterdam, Rotterdam, the Netherlands
| | - Janna A van Diepen
- Department of Internal Medicine, Radboud university medical center, Nijmegen, the Netherlands
| | - Niels P Riksen
- Department of Internal Medicine, Radboud university medical center, Nijmegen, the Netherlands
| | - Joost H W Rutten
- Department of Internal Medicine, Radboud university medical center, Nijmegen, the Netherlands
| | - Mihai G Netea
- Department of Internal Medicine, Radboud university medical center, Nijmegen, the Netherlands
- Department for Genomics & Immunoregulation, Life and Medical Sciences Institute (LIMES), University of Bonn, Bonn, Germany
| | - Manuel Castro Cabezas
- Department of Internal Medicine, Center for Diabetes and Vascular Medicine, Franciscus Gasthuis Rotterdam, Rotterdam, the Netherlands
| | - René J M Bindels
- Department of Physiology (286), Radboud Institute for Molecular Life Sciences, Radboud university medical center, P. O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Frances M Ashcroft
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - Cees J J Tack
- Department of Internal Medicine, Radboud university medical center, Nijmegen, the Netherlands
| | - Joost G J Hoenderop
- Department of Physiology (286), Radboud Institute for Molecular Life Sciences, Radboud university medical center, P. O. Box 9101, 6500 HB, Nijmegen, the Netherlands.
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13
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Kazemi-Darabadi S, Akbari G. Evaluation of magnesium sulfate effects on fetus development in experimentally induced surgical fetal growth restriction in rat. J Matern Fetal Neonatal Med 2018; 33:2459-2465. [PMID: 30486703 DOI: 10.1080/14767058.2018.1554048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: The objective of this study was to evaluate the effect of magnesium sulfate in the prevention of fetal growth restriction due to the impaired uterine blood supply in the rat model.Methods: A total number of 24 female rats were used in this study. They were mated overnight and randomly divided into control and treatment groups. After anesthesia and incising abdominal midline in day 17 of gestation, the uterine artery was occluded by an atraumatic clamp for 60 min. The rats of the control group received normal saline after surgery and the rats of treatment group received magnesium sulfate subcutaneously. The laparotomy was repeated on day 21 of gestation, and the number of alive and dead fetuses was counted in each horn. The viability of fetuses was evaluated. The weight of the placenta and fetuses and the distance between the head and tail as well as back to the abdomen of the fetuses were also measured. Samples of the amniotic fluid (AF) were collected during both surgeries for biochemical analyses of the glucose, urea, lactate, and pyruvate levels by an AutoAnalyzer.Results: Among the total fetuses in ischemic horn, only 50% survived in the control group. Dead fetuses had less body consistency and had a dark color. In contrary, only 7.6% of the fetuses in the treatment group were absorbed and 92.4% were completely healthy and developed. Parameters related to placenta weight, fetus weight, fetus length, and fetus width had significant differences and those of the treatment group were higher. Glucose and lactate levels of the AF in the treatment group were significantly lower and urea level was significantly higher than the control group in day 21 of gestation. The changes in pyruvate levels were not significant.Conclusion: In conclusion, magnesium sulfate may counteract with the effects of temporary uterine ischemia in pregnant rats and prevent intrauterine growth restriction.
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Affiliation(s)
- Siamak Kazemi-Darabadi
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Tabriz, Tabriz, Iran
| | - Ghasem Akbari
- Department of Basic Sciences, Faculty of Veterinary Medicine, University of Tabriz, Tabriz, Iran
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14
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Pochineni V, Rondon-Berrios H. Electrolyte and Acid-Base Disorders in the Renal Transplant Recipient. Front Med (Lausanne) 2018; 5:261. [PMID: 30333977 PMCID: PMC6176109 DOI: 10.3389/fmed.2018.00261] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 08/29/2018] [Indexed: 12/17/2022] Open
Abstract
Kidney transplantation is the current treatment of choice for patients with end-stage renal disease. Innovations in transplantation and immunosuppression regimens have greatly improved the renal allograft survival. Based on recently published data from the Scientific Registry of Transplant recipients, prevalence of kidney transplants is steadily rising in the United States. Over 210,000 kidney transplant recipients were alive with a functioning graft in mid-2016, which is nearly twice as many as in 2005. While successful renal transplantation corrects most of the electrolyte and mineral abnormalities seen in advanced renal failure, the abnormalities seen in the post-transplant period are surprisingly different from those seen in chronic kidney disease. Multiple factors contribute to the high prevalence of these abnormalities that include level of allograft function, use of immunosuppressive medications and metabolic changes in the post-transplant period. Electrolyte disturbances are common in patients after renal transplantation, and several studies have tried to determine the clinical significance of these disturbances. In this manuscript we review the key aspects of the most commonly found post-transplant electrolyte abnormalities. We focus on their epidemiology, pathophysiology, clinical manifestations, and available treatment approaches.
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Affiliation(s)
- Vaishnavi Pochineni
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
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15
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Serum Magnesium after Kidney Transplantation: A Systematic Review. Nutrients 2018; 10:nu10060729. [PMID: 29882768 PMCID: PMC6024843 DOI: 10.3390/nu10060729] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 05/28/2018] [Accepted: 05/31/2018] [Indexed: 12/15/2022] Open
Abstract
Magnesium (Mg) status has recently drawn close attention in chronic kidney disease and in kidney transplant recipients. This review aims to evaluate the body of evidence linking hypomagnesemia to clinical consequences in these specific populations. After a brief summary of the main mechanisms involved in Mg regulation and of Mg status in end-stage renal disease, the review focuses on the relationship between hypomagnesemia and cardiovascular risk in kidney transplant recipients. A body of evidence in recent studies points to a negative impact of hypomagnesemia on post-transplant diabetes mellitus (PTDM) and cardiovascular risk, which currently represent the main threat for morbidity and mortality in kidney transplantation. Deleterious biological mechanisms induced by hypomagnesemia are also discussed. While data analysis enables us to conclude that hypomagnesemia is linked to the development of PTDM, studies prospectively evaluating the impact of hypomagnesemia correction after kidney transplantation are still lacking and needed.
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16
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Schutten JC, Joosten MM, de Borst MH, Bakker SJ. Magnesium and Blood Pressure: A Physiology-Based Approach. Adv Chronic Kidney Dis 2018; 25:244-250. [PMID: 29793663 DOI: 10.1053/j.ackd.2017.12.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 12/08/2017] [Accepted: 12/12/2017] [Indexed: 12/22/2022]
Abstract
Hypertension is an important public health challenge because of its high prevalence and strong association with cardiovascular disease and premature death. Hypertension is a major cause of CKD, is present in more than 80% of CKD patients, and contributes to CKD progression. Risk factors for hypertension include, but are not limited to, age, race, family history, obesity, physical inactivity, tobacco use, and inadequate intake of minerals such as calcium, potassium, and magnesium. Magnesium is the second most abundant intracellular cation in the human body and plays an important role in insulin and adenosine triphosphate metabolism. Low dietary magnesium intake has been associated with an increased risk of developing hypertension in prospective cohort studies. Moreover, clinical trials suggest that magnesium supplementation has blood pressure-lowering effects. In addition, emerging data reveal potential mechanisms by which magnesium may influence blood pressure. Here, we will review these mechanisms, using a physiology-based approach, focusing on the effects of magnesium on total peripheral resistance and cardiac output.
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17
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Tangvoraphonkchai K, Davenport A. Magnesium and Cardiovascular Disease. Adv Chronic Kidney Dis 2018; 25:251-260. [PMID: 29793664 DOI: 10.1053/j.ackd.2018.02.010] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 02/12/2018] [Accepted: 02/13/2018] [Indexed: 12/21/2022]
Abstract
Magnesium is the most abundant intracellular divalent cation and essential for maintaining normal cellular physiology and metabolism, acting as a cofactor of numerous enzymes, regulating ion channels and energy generation. In the heart, magnesium plays a key role in modulating neuronal excitation, intracardiac conduction, and myocardial contraction by regulating a number of ion transporters, including potassium and calcium channels. Magnesium also has a role in regulating vascular tone, atherogenesis and thrombosis, vascular calcification, and proliferation and migration of endothelial and vascular smooth muscle cells. As such, magnesium potentially has a major influence on the pathogenesis of cardiovascular disease. As the kidney is a major regulator of magnesium homeostasis, kidney disorders can potentially lead to both magnesium depletion and overload, and as such increase the risk of cardiovascular disease. Observational data have shown an association between low serum magnesium concentrations or magnesium intake and increased atherosclerosis, coronary artery disease, arrhythmias, and heart failure. However, major trials of supplementation with magnesium have reported inconsistent benefits and also raised potential adverse effects of magnesium overload. As such, there is currently no firm recommendation for routine magnesium supplementation except when hypomagnesemia has been proven or suspected as a cause for cardiac arrhythmias.
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18
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Hénaut L, Massy ZA. Magnesium as a Calcification Inhibitor. Adv Chronic Kidney Dis 2018; 25:281-290. [PMID: 29793668 DOI: 10.1053/j.ackd.2017.12.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 12/05/2017] [Accepted: 12/05/2017] [Indexed: 12/25/2022]
Abstract
Vascular calcification (VC) is associated with elevated cardiovascular mortality rates in patients with CKD. Recent clinical studies of patients with advanced CKD have observed an association between low serum magnesium (Mg) levels on one hand and elevated VC and cardiovascular mortality on the other. These findings have stimulated interest in understanding Mg's impact on CKD in general and the associated VC in particular. In vitro and preclinical in vivo data indicate that Mg has the potential to protect vascular smooth muscle cells against calcification via several different molecular mechanisms. Accordingly, data from pilot interventional studies in the clinic suggest that oral Mg supplementation reduces VC in patients with CKD. The present review provides an overview of our current understanding of the impact of Mg on the development of VC in patients with CKD.
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19
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van den Broek DHN, Chang YM, Elliott J, Jepson RE. Prognostic importance of plasma total magnesium in a cohort of cats with azotemic chronic kidney disease. J Vet Intern Med 2018; 32:1359-1371. [PMID: 29704284 PMCID: PMC6060321 DOI: 10.1111/jvim.15141] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 01/10/2018] [Accepted: 03/28/2018] [Indexed: 12/28/2022] Open
Abstract
Background Hypomagnesemia is associated with increased mortality and renal function decline in humans with chronic kidney disease (CKD). Magnesium is furthermore inversely associated with fibroblast growth factor 23 (FGF23), an important prognostic factor in CKD in cats. However, the prognostic significance of plasma magnesium in cats with CKD is unknown. Objectives To explore associations of plasma total magnesium concentration (tMg) with plasma FGF23 concentration, all‐cause mortality, and disease progression in cats with azotemic CKD. Animals Records of 174 client‐owned cats with IRIS stage 2‐4 CKD. Methods Cohort study. Cats with azotemic CKD were identified from the records of two London‐based first opinion practices (1999–2013). Possible associations of baseline plasma tMg with FGF23 concentration and risks of death and progression were explored using, respectively, linear, Cox, and logistic regression. Results Plasma tMg (reference interval, 1.73–2.57 mg/dL) was inversely associated with plasma FGF23 when controlling for plasma creatinine and phosphate concentrations (partial correlation coefficient, −0.50; P < .001). Hypomagnesemia was observed in 12% (20/174) of cats, and independently associated with increased risk of death (adjusted hazard ratio, 2.74; 95% confidence interval [CI], 1.35–5.55; P = .005). The unadjusted associations of hypermagnesemia (prevalence, 6%; 11/174 cats) with survival (hazard ratio, 2.88; 95% CI, 1.54–5.38; P = .001), and hypomagnesemia with progressive CKD (odds ratio, 17.7; 95% CI, 2.04–154; P = .009) lost significance in multivariable analysis. Conclusions and Clinical Importance Hypomagnesemia was associated with higher plasma FGF23 concentrations and increased risk of death. Measurement of plasma tMg augments prognostic information in cats with CKD, but whether these observations are associations or causations warrants further investigation.
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Affiliation(s)
- D Hendrik N van den Broek
- Department of Clinical Science and Services, Royal Veterinary College, University of London, London, United Kingdom
| | - Yu-Mei Chang
- Research Support Office, Royal Veterinary College, University of London, London, United Kingdom
| | - Jonathan Elliott
- Department of Comparative Biomedical Sciences, Royal Veterinary College, University of London, London, United Kingdom
| | - Rosanne E Jepson
- Department of Clinical Science and Services, Royal Veterinary College, University of London, London, United Kingdom
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Melilli E, Manonelles A, Montero N, Grinyo J, Martinez-Castelao A, Bestard O, Cruzado J. Impact of immunosuppressive therapy on arterial stiffness in kidney transplantation: are all treatments the same? Clin Kidney J 2017; 11:413-421. [PMID: 29988241 PMCID: PMC6007381 DOI: 10.1093/ckj/sfx120] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 09/06/2017] [Indexed: 02/07/2023] Open
Abstract
Arterial stiffness is a biologic process related to ageing and its relationship with cardiovascular risk is well established. Several methods are currently available for non-invasive measurement of arterial stiffness that provide valuable information to further assess patients’ vascular status in real time. In kidney transplantation recipients, several factors could accelerate the stiffness process, such as the use of calcineurin inhibitors (CNIs), the presence of chronic kidney disease and other classical cardiovascular factors, which would explain, at least in part, the high cardiovascular mortality and morbidity. Despite the importance of arterial stiffness as a biomarker of cardiovascular risk, and unlike other cardiovascular risk factors (e.g. left ventricular hypertrophy), only a few clinical trials or retrospective studies of kidney recipients have evaluated its impact. In this review we describe the clinical impact of arterial stiffness as a prognostic marker of cardiovascular disease and the effects of different immunosuppressive regimens on its progression, focusing on the potential benefits of CNI-sparing protocols and supporting the rationale for individualization of immunosuppression in patients with lower arterial elasticity. Among the immunosuppressive drugs, a belatacept-based regimen seems to offer better vascular protection compared with CNIs, although further studies are needed to confirm the preliminary positive results.
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Affiliation(s)
- Edoardo Melilli
- Department of Nephrology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Cataluny, Spain
- Correspondence and offprint requests to: Edoardo Melilli; E-mail:
| | - Anna Manonelles
- Department of Nephrology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Cataluny, Spain
| | - Nuria Montero
- Department of Nephrology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Cataluny, Spain
| | - Josep Grinyo
- Department of Nephrology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Cataluny, Spain
| | | | - Oriol Bestard
- Department of Nephrology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Cataluny, Spain
| | - Josep Cruzado
- Department of Nephrology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Cataluny, Spain
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Li L, Streja E, Rhee CM, Mehrotra R, Soohoo M, Brunelli SM, Kovesdy CP, Kalantar-Zadeh K. Hypomagnesemia and Mortality in Incident Hemodialysis Patients. Am J Kidney Dis 2015; 66:1047-55. [PMID: 26184377 DOI: 10.1053/j.ajkd.2015.05.024] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 05/20/2015] [Indexed: 01/17/2023]
Abstract
BACKGROUND In the general population, low serum magnesium levels are associated with poor outcomes and death. While limited data suggest that low baseline magnesium levels may be associated with higher mortality in hemodialysis (HD) patients, the impact of changes in magnesium levels over time is unknown. STUDY DESIGN We examined the association of time-varying serum magnesium levels with all-cause mortality using multivariable time-varying survival models adjusted for clinical characteristics and other time-varying laboratory measures. SETTING & PARTICIPANTS 9,359 maintenance HD patients treated in a large dialysis organization between 2007 and 2011. PREDICTOR Time-varying serum magnesium levels across 5 magnesium increments (<1.8, 1.8-<2.0, 2.0-<2.2, 2.2-<2.4, and ≥2.4mg/dL). OUTCOME All-cause mortality. RESULTS 2,636 individuals died over 5 years. Time-varying serum magnesium levels < 2.0mg/dL were associated with higher mortality after adjustment for demographics and comorbid conditions, including hypertension, diabetes, and malignancies (reference: magnesium, 2.2-<2.4mg/dL): adjusted HRs for serum magnesium level < 1.8 and 1.8 to <2.0mg/dL were 1.39 (95% CI, 1.23-1.58; P<0.001) and 1.20 (95% CI, 1.06-1.36; P=0.004), respectively. Some associations were attenuated to the null after incremental adjustment for laboratory test results, particularly serum albumin. However, among patients with serum albumin measurements, low albumin level (<3.5g/dL) and magnesium level < 2.0mg/dL were associated with an additional death risk (adjusted HR, 1.17; 95% CI, 1.05-1.31; P=0.004), whereas patients with high serum albumin levels (≥3.5g/dL) exhibited low death risk (adjusted HRs of 0.53 and 0.53 [P≤0.001] for magnesium < 2.0 and ≥2.0mg/dL, respectively; reference: albumin < 3.5g/dL and magnesium ≥ 2.0mg/dL). LIMITATIONS Causality cannot be determined, and residual confounding cannot be excluded given the observational study design. CONCLUSIONS Lower serum magnesium levels are associated with higher mortality in HD patients, including those with hypoalbuminemia. Interventional studies are warranted to examine whether correction of hypomagnesemia ameliorates adverse outcomes in this population.
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Affiliation(s)
- Lin Li
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA
| | - Elani Streja
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA
| | - Connie M Rhee
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA
| | - Rajnish Mehrotra
- Kidney Research Institute, Division of Nephrology, University of Washington, Seattle, WA
| | - Melissa Soohoo
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA
| | | | - Csaba P Kovesdy
- Division of Nephrology, Memphis Veterans Affairs Medical Center, Memphis, TN
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA.
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Abstract
Magnesium fulfils important roles in multiple physiological processes. Accordingly, a tight regulation of magnesium homeostasis is essential. Dysregulated magnesium serum levels, in particular hypomagnesaemia, are common in patients with chronic kidney disease (CKD) and have been associated with poor clinical outcomes. In cell culture studies as well as in clinical situations magnesium levels were associated with vascular calcification, cardiovascular disease and altered bone-mineral metabolism. Magnesium has also been linked to diseases such as metabolic syndrome, diabetes, hypertension, fatigue and depression, all of which are common in CKD. The present review summarizes and discusses the latest clinical data on the impact of magnesium and possible effects of higher levels on the health status of patients with CKD, including an outlook on the use of magnesium-based phosphate-binding agents in this context.
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Affiliation(s)
- Jürgen Floege
- Division of Nephrology and Clinical Immunology, RWTH University of Aachen, Pauwelsstr. 30, 52057, Aachen, Germany,
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Abstract
Cardiovascular complications are the leading cause of death in patients with chronic kidney disease (CKD). Abundant experimental evidence suggests a physiological role of magnesium in cardiovascular function, and clinical evidence suggests a role of the cation in cardiovascular disease in the general population. The role of magnesium in CKD-mineral and bone disorder, and in particular its impact on cardiovascular morbidity and mortality in patients with CKD, is however not well understood. Experimental studies have shown that magnesium inhibits vascular calcification, both by direct effects on the vessel wall and by indirect, systemic effects. Moreover, an increasing number of epidemiologic studies in patients with CKD have shown associations of serum magnesium levels with intermediate and hard outcomes, including vascular calcification, cardiovascular events and mortality. Intervention trials in these patients conducted to date have had small sample sizes and have been limited to the study of surrogate parameters, such as arterial stiffness, vascular calcification and atherosclerosis. Randomized controlled trials are clearly needed to determine the effects of magnesium supplementation on hard outcomes in patients with CKD.
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Van Laecke S, Van Biesen W. Hypomagnesaemia in kidney transplantation. Transplant Rev (Orlando) 2015; 29:154-60. [PMID: 26001746 DOI: 10.1016/j.trre.2015.05.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 05/03/2015] [Indexed: 01/14/2023]
Abstract
In the era of calcineurin inhibitors, hypomagnesaemia is a very common finding in kidney transplant recipients. Especially the first weeks after transplantation it is the rule rather than the exception. Hypomagnesaemia or low magnesium intake have been associated with a higher mortality or more cardiovascular events in the general population, but this association has never been explored in kidney transplant recipients, despite their increased cardiovascular risk. Kidney transplant recipients with pre- or post-transplant hypomagnesaemia seem to have an aberrant glucose metabolism and develop diabetes mellitus more frequently. Moreover, observations from alternate study populations, animal experiments or in vitro studies suggest a possible role of magnesium deficiency in graft dysfunction, bone metabolism and transplant immunology. Future observational and especially interventional studies should further define whether and to what extent we should make effort to correct this electrolyte disturbance in transplant recipients. Considering the mechanism of renal magnesium wasting, normalizing the serum magnesium concentration by oral supplementation alone might turn out to be cumbersome in kidney transplant recipients.
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Affiliation(s)
| | - Wim Van Biesen
- Renal Division, Ghent University Hospital, Ghent, Belgium.
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Dinic M, Maillard N, Thibaudin D, Jannot M, Masson I, Alamartine E, Mariat C. Serum cystatin C is a determinant of central pressure augmentation index measured by oscillometric method in renal transplant recipients. BMC Nephrol 2014; 15:196. [PMID: 25495910 PMCID: PMC4292990 DOI: 10.1186/1471-2369-15-196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 11/18/2014] [Indexed: 12/31/2022] Open
Abstract
Background Serum cystatin C (ScysC) may help predicting cardiovascular outcome not only through its ability to detect renal dysfunction but also through its potential connection to others factors that are directly related to cardiovascular diseases. We explored the potential association of ScysC with arterial stiffness - a major contributor to cardiovascular disease - in renal transplant recipients (RTR). Methods Traditional and non-traditional cardio-vascular risk factors were collected from 215 stable RTR whom arterial stiffness was evaluated by the measure of the augmentation index of central pressure (AIx) determined by the arteriograph device. Serum creatinine and ScysC were measured the same day using standardized methods. Association between ScysC and AIx was examined in univariate and multivariate linear regression analysis. Results In univariate analysis, ScysC was strongly associated with AIx. This relationship was not confounded by age, gender, length of time spent on dialysis and transplantation vintage. Adjustment on the level of GFR estimated by the MDRD Study equation attenuated but did not abolish the association between ScysC and AIx. Conclusions In conclusion, ScysC is an independent predictor of AIx in RTR. Our data suggest that arterial stiffness may partially mediate the association between ScysC and cardiovascular risk in renal transplantation.
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Affiliation(s)
- Miriana Dinic
- Service de Néphrologie, Transplantation Rénale, Dialyse, Centre d'Hypertension Artérielle, Hôpital Nord, CHU de Saint-Etienne, Université Jean Monnet, PRES Université de Lyon, 42055 Saint Etienne, Cedex 04, France.
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Cosaro E, Bonafini S, Montagnana M, Danese E, Trettene MS, Minuz P, Delva P, Fava C. Effects of magnesium supplements on blood pressure, endothelial function and metabolic parameters in healthy young men with a family history of metabolic syndrome. Nutr Metab Cardiovasc Dis 2014; 24:1213-1220. [PMID: 24984823 DOI: 10.1016/j.numecd.2014.05.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 05/13/2014] [Accepted: 05/19/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Magnesium plays an important role in the modulation of vascular tone and endothelial function and can regulate glucose and lipid metabolism. Patients with hypertension, metabolic syndrome (MetS) and diabetes mellitus (T2DM) have low body magnesium content; indeed, magnesium supplementation has been shown to have a positive effect on blood pressure (BP) and gluco-metabolic parameters. The aim of our study was to evaluate the effect of magnesium supplements on hemodynamic and metabolic parameters in healthy men with a positive family history of MetS or T2DM. METHODS AND RESULTS In a randomized, double-blind, placebo-controlled 8-week crossover trial with a 4 week wash-out period, oral supplements of 8.1 mmol of magnesium-pidolate or placebo were administered twice a day to 14 healthy normomagnesemic participants, aged 23-33 years. The primary endpoint was office BP, measured with a semiautomatic oscillometric device. Secondary endpoints included characteristics of the MetS, namely endothelial function, arterial stiffness and inflammation. Plasma and urinary magnesium were measured in all participants while free intracellular magnesium was measured only in a subsample. There was no significant difference in either systolic and diastolic BP in participants post-magnesium supplementation and post-placebo treatment when compared to baseline BP measurements. Further, the metabolic, inflammatory and hemodynamic parameters did not vary significantly during the study. CONCLUSIONS Our study showed no beneficial effect of magnesium supplements on BP, vascular function and glycolipid profile in young men with a family history of MetS/T2DM (trial registration at clinicaltrial.gov ID: NCT01181830; 12th of Aug 2010).
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Affiliation(s)
- E Cosaro
- Department of Medicine, Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Italy
| | - S Bonafini
- Department of Medicine, Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Italy
| | - M Montagnana
- Department of Life and Reproduction Sciences, Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Italy
| | - E Danese
- Department of Life and Reproduction Sciences, Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Italy
| | - M S Trettene
- Department of Medicine, Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Italy
| | - P Minuz
- Department of Medicine, Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Italy
| | - P Delva
- Department of Medicine, Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Italy
| | - C Fava
- Department of Medicine, Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Italy.
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Dousdampanis P, Trigka K, Fourtounas C. Hypomagnesemia, chronic kidney disease and cardiovascular mortality: Pronounced association but unproven causation. Hemodial Int 2014; 18:730-9. [PMID: 24641780 DOI: 10.1111/hdi.12159] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
| | - Konstantina Trigka
- Hemodialysis Unit; Hemodialysis Unit Kyanos Stavros Patras; Patras Greece
| | - Costas Fourtounas
- Department of Internal Medicine-Nephrology; Patras University Hospital; Patras Greece
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Fragoso A, Silva AP, Gundlach K, Büchel J, Neves PL. Magnesium and FGF-23 are independent predictors of pulse pressure in pre-dialysis diabetic chronic kidney disease patients. Clin Kidney J 2014; 7:161-6. [PMID: 25852865 PMCID: PMC4377779 DOI: 10.1093/ckj/sfu003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 01/20/2014] [Indexed: 12/20/2022] Open
Abstract
Background The aim of our study was to evaluate the relevance of magnesium and FGF-23 in terms of cardiovascular disease in a population of type 2 diabetic patients with nephropathy. Methods In a cross-sectional study, we included 80 type 2 diabetic patients with chronic kidney disease (CKD) stages 2, 3 and 4. We analysed mineral metabolism, inflammation, oxidative stress and insulin resistance. Our population was divided into two groups according to their pulse pressure (PP) as follows: G-1 with PP < 50 mmHg (n = 34) and G-2 with PP ≥ 50 mmHg (n = 46). Results We found that G-2 patients showed lower calcium (P = 0.004), eGFR (P = 0.001), magnesium (P = 0.0001), osteocalcin (P = 0.0001) and 25(OH)D3 (P = 0.001), and higher iPTH (P = 0.001), FGF-23 (P = 0.0001), malonaldehyde (P = 0.0001), interleukin 6 (P = 0.001) and HOMA-IR (P = 0.033). No differences were found between the two groups regarding age, duration of disease, haemoglobin, HgA1c and phosphorus. In a multivariate analysis, we found that FGF-23 and magnesium independently influenced the PP [OR = 1.239 (1.001–2.082), P = 0.039 and OR = 0.550 (0.305–0.727), P = 0.016, respectively]. Conclusions In our diabetic population with early stages of CKD, FGF-23 as well as lower magnesium levels were significantly and independently associated with higher PP levels, an established marker of cardiovascular morbidity and mortality.
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Affiliation(s)
- André Fragoso
- Nephrology Department, Hospital de Faro E.P.E., Faro, Portugal
- Correspondence and offprint requests to: André Fragoso; E-mail:
| | - Ana Paula Silva
- Nephrology Department, Hospital de Faro E.P.E., Faro, Portugal
| | - Kristina Gundlach
- Fresenius Medical Care Deutschland GmbH, Renal Pharma/Biomedical & Pharmaceutical Research, Bad Homburg, Germany
| | - Janine Büchel
- Fresenius Medical Care Deutschland GmbH, Renal Pharma/Biomedical & Pharmaceutical Research, Bad Homburg, Germany
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Cunha AR, Medeiros F, Umbelino B, Oigman W, Touyz RM, Neves MF. Altered vascular structure and wave reflection in hypertensive women with low magnesium levels. ACTA ACUST UNITED AC 2013; 7:344-52. [DOI: 10.1016/j.jash.2013.04.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 04/03/2013] [Accepted: 04/21/2013] [Indexed: 11/15/2022]
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De Schutter TM, Behets GJ, Geryl H, Peter ME, Steppan S, Gundlach K, Passlick-Deetjen J, D'Haese PC, Neven E. Effect of a magnesium-based phosphate binder on medial calcification in a rat model of uremia. Kidney Int 2013; 83:1109-17. [PMID: 23486515 PMCID: PMC3674404 DOI: 10.1038/ki.2013.34] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 11/21/2012] [Accepted: 11/30/2012] [Indexed: 12/13/2022]
Abstract
Calcium-based phosphate binders are used to control hyperphosphatemia; however, they promote hypercalcemia and may accelerate aortic calcification. Here we compared the effect of a phosphate binder containing calcium acetate and magnesium carbonate (CaMg) to that of sevelamer carbonate on the development of medial calcification in rats with chronic renal failure induced by an adenine diet for 4 weeks. After 1 week, rats with chronic renal failure were treated with vehicle, 375 or 750 mg/kg CaMg, or 750 mg/kg sevelamer by daily gavage for 5 weeks. Renal function was significantly impaired in all groups. Vehicle-treated rats with chronic renal failure developed severe hyperphosphatemia, but this was controlled in treated groups, particularly by CaMg. Neither CaMg nor sevelamer increased serum calcium ion levels. Induction of chronic renal failure significantly increased serum PTH, dose-dependently prevented by CaMg but not sevelamer. The aortic calcium content was significantly reduced by CaMg but not by sevelamer. The percent calcified area of the aorta was significantly lower than vehicle-treated animals for all three groups. The presence of aortic calcification was associated with increased sox9, bmp-2, and matrix gla protein expression, but this did not differ in the treatment groups. Calcium content in the carotid artery was lower with sevelamer than with CaMg but that in the femoral artery did not differ between groups. Thus, treatment with either CaMg or sevelamer effectively controlled serum phosphate levels in CRF rats and reduced aortic calcification.
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Affiliation(s)
- Tineke M De Schutter
- Laboratory of Pathophysiology, Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Geert J Behets
- Laboratory of Pathophysiology, Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Hilde Geryl
- Laboratory of Pathophysiology, Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Mirjam E Peter
- Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
| | - Sonja Steppan
- Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
| | | | | | - Patrick C D'Haese
- Laboratory of Pathophysiology, Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Ellen Neven
- Laboratory of Pathophysiology, Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
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Walker TL, Shil AB. Magnesium Homeostasis and Metabolic Complications in Elderly Adults with Chronic Kidney Disease. J Am Geriatr Soc 2012; 60:1794-5; author reply 1795. [DOI: 10.1111/j.1532-5415.2012.04130.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Van Laecke S, Van Biesen W, Vanholder R. Hypomagnesaemia, the kidney and the vessels. Nephrol Dial Transplant 2012; 27:4003-10. [PMID: 22610987 DOI: 10.1093/ndt/gfs126] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Sumukadas D, McMurdo MET, Habicht D. Proton pump inhibitors are associated with lower magnesium levels in older people with chronic kidney disease. J Am Geriatr Soc 2012; 60:392-3. [PMID: 22332695 DOI: 10.1111/j.1532-5415.2011.03808.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Endothelial cells and magnesium: implications in atherosclerosis. Clin Sci (Lond) 2012; 122:397-407. [PMID: 22248353 DOI: 10.1042/cs20110506] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There is no doubt that the functional and structural integrity of the endothelium is critical in maintaining vascular homoeostasis and in preventing atherosclerosis. In the light of epidemiological and experimental studies, magnesium deficiency is emerging as an inducer of endothelial dysfunction. In particular, data on the effects of low extracellular magnesium on cultured endothelial cells reinforce the idea that correcting magnesium homoeostasis might be a helpful and inexpensive intervention to prevent and treat endothelial dysfunction and, consequently, atherosclerosis.
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Magnesium and vascular changes in hypertension. Int J Hypertens 2012; 2012:754250. [PMID: 22518291 PMCID: PMC3299255 DOI: 10.1155/2012/754250] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 12/19/2011] [Indexed: 12/15/2022] Open
Abstract
Many factors have been implicated in the pathogenesis of hypertension, including changes in intracellular concentrations of calcium, sodium, potassium, and magnesium. There is a significant inverse correlation between serum magnesium and incidence of cardiovascular diseases. Magnesium is a mineral with important functions in the body such as antiarrhythmic effect, actions in vascular tone, contractility, glucose metabolism, and insulin homeostasis. In addition, lower concentrations of magnesium are associated with oxidative stress, proinflammatory state, endothelial dysfunction, platelet aggregation, insulin resistance, and hyperglycemia. The conflicting results of studies evaluating the effects of magnesium supplements on blood pressure and other cardiovascular outcomes indicate that the action of magnesium in the vascular system is present but not yet established. Therefore, this mineral supplementation is not indicated as part of antihypertensive treatment, and further studies are needed to better clarify the role of magnesium in the prevention and treatment of cardiovascular diseases.
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Van Laecke S, Nagler EVT, Vanholder R. Thrombotic microangiopathy: a role for magnesium? Thromb Haemost 2012; 107:399-408. [PMID: 22274299 DOI: 10.1160/th11-08-0593] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2011] [Accepted: 12/01/2011] [Indexed: 12/15/2022]
Abstract
Despite advances in more recent years, the pathophysiology and especially treatment modalities of thrombotic microangiopathy (TMA) largely remain enigmatic. Disruption of endothelial homeostasis plays an essential role in TMA. Considering the proven causal association between magnesium and both endothelial function and platelet aggregability, we speculate that a magnesium deficit could influence the course of TMA and the related haemolytic uraemic syndrome and thrombotic thrombocytopenic purpura. A predisposition towards TMA is seen in many conditions with both extracellular and intracellular magnesium deficiency. We propose a rationale for magnesium supplementation in TMA, in analogy with its evidence-based therapeutic application in pre-eclampsia and suggest, based on theoretical grounds, that it might attenuate the development of TMA, minimise its severity and prevent its recurrence. This is based on several lines of evidence from both in vitro and in vivo data showing dose-dependent effects of magnesium supplementation on nitric oxide production, platelet aggregability and inflammation. Our hypothesis, which is further amenable to assessment in animal models before therapeutic applications in humans are implemented, could be explored both in vitro and in vivo to decipher the potential role of magnesium deficit in TMA and of the effects of its supplementation.
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Affiliation(s)
- Steven Van Laecke
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium.
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Verbeke F, Maréchal C, Van Laecke S, Van Biesen W, Devuyst O, Van Bortel LM, Jadoul M, Vanholder R. Aortic stiffness and central wave reflections predict outcome in renal transplant recipients. Hypertension 2011; 58:833-8. [PMID: 21896935 DOI: 10.1161/hypertensionaha.111.176594] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although renal transplantation improves survival, cardiovascular morbidity and mortality remain significantly elevated compared with nonrenal populations. The negative impact of traditional, uremia-related, and transplantation-related risk factors in this process remains, however, largely unexplored. Surrogate markers such as aortic stiffness and central wave reflections may lead to more accurate cardiovascular risk stratification, but outcome data in renal transplant recipients are scarce. We aimed to establish the prognostic significance of these markers for fatal and nonfatal cardiovascular events in renal transplant recipients. Carotid-femoral pulse wave velocity, central augmentation pressure, and central augmentation index were measured in a cohort of 512 renal transplant recipients using the SphygmoCor system. After a mean follow-up of 5 years, 20 fatal and 75 nonfatal cardiovascular events were recorded. Using receiver operating characteristic curves, the area under the curve for predicting cardiovascular events was 0.718 (95% CI 0.659-0.776) for pulse wave velocity, 0.670 (95% CI 0.604-0.736) for central augmentation pressure, and 0.595 (95% CI 0.529-0.660) for central augmentation index. When we accounted for age, gender, and C-reactive protein in Cox-regression analysis, pulse wave velocity (hazard ratio: 1.349 per 1 SD increase; 95% CI 1.104-1.649; P=0.003) and central augmentation pressure (hazard ratio: 1.487 per 1 SD increase; 95% CI 1.219-1.814; P<0.001) remained independent predictors of outcome. Aortic stiffness and increased wave reflections are independent predictors of cardiovascular events in renal transplant recipients. As single parameter of wave reflection, central augmentation pressure was better than central augmentation index. Combined measurement of pulse wave velocity and central augmentation pressure may contribute to an accurate cardiovascular risk estimation in this heterogeneous population.
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Affiliation(s)
- Francis Verbeke
- Department of Internal Medicine, Nephrology Section, University Hospital Ghent, De Pintelaan 185, B-9000 Ghent, Belgium.
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