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Kothari M, Wanjari A, Shaikh SM, Tantia P, Waghmare BV, Parepalli A, Hamdulay KF, Nelakuditi M. A Comprehensive Review on Understanding Magnesium Disorders: Pathophysiology, Clinical Manifestations, and Management Strategies. Cureus 2024; 16:e68385. [PMID: 39355467 PMCID: PMC11444808 DOI: 10.7759/cureus.68385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Accepted: 09/01/2024] [Indexed: 10/03/2024] Open
Abstract
Magnesium is vital in a broad spectrum of physiological processes, including enzyme activity, energy production, and neuromuscular function. Despite its crucial role, magnesium disorders - comprising both deficiency (hypomagnesemia) and excess (hypermagnesemia) - are frequently underrecognized and inadequately managed in clinical practice. Magnesium deficiency is widespread, particularly among populations with chronic illnesses, the elderly, and those experiencing malnutrition, often leading to significant neuromuscular, cardiovascular, and metabolic complications. Conversely, hypermagnesemia, though less common, poses serious risks, especially in individuals with impaired renal function or those receiving high doses of magnesium supplements or medications. This review comprehensively examines magnesium disorders, detailing their pathophysiology, clinical manifestations, and management strategies. It highlights the essential functions of magnesium in maintaining cellular integrity, cardiovascular health, and bone structure and discusses the global prevalence and risk factors associated with magnesium imbalances. By offering insights into the current understanding of magnesium homeostasis and its disruptions, this review aims to enhance the awareness and treatment of magnesium-related conditions, ultimately improving patient outcomes across diverse clinical settings.
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Affiliation(s)
- Manjeet Kothari
- Internal Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Anil Wanjari
- Internal Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Suhail M Shaikh
- Internal Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Parav Tantia
- Internal Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Bhavana V Waghmare
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Avinash Parepalli
- Internal Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Khadija F Hamdulay
- Internal Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Manikanta Nelakuditi
- Internal Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Ahn SY, Ko GJ, Hwang HS, Jeong KH, Jin K, Kim YG, Moon JY, Lee SH, Lee SY, Yang DH, Jung JY, Oh KH, Lee YK, Kim GH, Kim SW, Kim YH, Lee DY, Hong YA, Park HC, Yoon SA, Choi BS, Ban TH, Kim HJ, Kwon YJ. Understanding the Korean Dialysis Cohort for Mineral, Vascular Calcification, and Fracture (ORCHESTRA) Study: Design, Method, and Baseline Characteristics. Kidney Blood Press Res 2024; 49:326-335. [PMID: 38657581 DOI: 10.1159/000539030] [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: 07/09/2023] [Accepted: 03/23/2024] [Indexed: 04/26/2024] Open
Abstract
INTRODUCTION End-stage renal disease (ESRD) is a growing disease worldwide, including Korea. This is an important condition that affects patient outcome. To provide optimal management for mineral disturbance, vascular calcification, and bone disease in ESRD patients, the Korean dialysis cohort for mineral, vascular calcification, and fracture (ORCHESTRA) study was conducted by enrolling Korean dialysis patients. METHODS Sixteen university-affiliated hospitals and one Veterans' Health Service Medical Center participated in this study. This prospective cohort study enrolled approximately 900 consecutive patients on dialysis between May 2019 and January 2021. Enrolled subjects were evaluated at baseline for demographic information, laboratory tests, radiologic imaging, and bone mineral densitometry (BMD) scans. After enrollment, regular assessments of the patients were performed, and their biospecimens were collected according to the study protocol. The primary outcomes were the occurrence of major adverse cardiovascular events, invasive treatment for peripheral artery disease, and osteoporotic fractures. The secondary outcomes were hospitalization for cerebrovascular disease or progression of abdominal aortic calcification. Participants will be assessed for up to 3 years to determine whether primary or secondary outcomes occur. RESULTS Between May 2019 and January 2021, all participating centers recruited 900 consecutive dialysis patients, including 786 undergoing hemodialysis (HD) and 114 undergoing peritoneal dialysis (PD). The mean age of the subjects was 60.4 ± 12.3 years. Males accounted for 57.7% of the total population. The mean dialysis vintage was 6.1 ± 6.0 years. The HD group was significantly older, had a longer dialysis vintage, and more comorbidities. Overall, the severity of vascular calcification was higher and the level of BMD was lower in the HD group than in the PD group. CONCLUSION This nationwide, multicenter, prospective cohort study focused on chronic kidney disease-mineral and bone disorder and aimed to provide clinical evidence to establish optimal treatment guidelines for Asian dialysis patients.
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Affiliation(s)
- Shin Young Ahn
- Department of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea,
| | - Gang Jee Ko
- Department of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Hyeon Seok Hwang
- Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Kyung Hwan Jeong
- Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Kyubok Jin
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Yang Gyun Kim
- Department of Internal Medicine, Kyung Hee University East-West Neo Medical Center, Seoul, Republic of Korea
| | - Ju-Young Moon
- Department of Internal Medicine, Kyung Hee University East-West Neo Medical Center, Seoul, Republic of Korea
| | - Sang Ho Lee
- Department of Internal Medicine, Kyung Hee University East-West Neo Medical Center, Seoul, Republic of Korea
| | - So-Young Lee
- Department of Internal Medicine, CHA Medical School Bundang CHA Medical Center, Seongnam, Republic of Korea
| | - Dong-Ho Yang
- Department of Internal Medicine, CHA Medical School Bundang CHA Medical Center, Seongnam, Republic of Korea
| | - Ji Yong Jung
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young-Ki Lee
- Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
| | - Gheun-Ho Kim
- Department of Internal Medicine, Hanyang University Seoul Hospital, Seoul, Republic of Korea
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Yeong Hoon Kim
- Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Dong-Young Lee
- Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Yu Ah Hong
- Department of Internal Medicine, The Catholic University of Korea Daejeon St. Mary's Hospital, Daejeon, Republic of Korea
| | - Hyeong Cheon Park
- Department of Internal Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea
| | - Sun Ae Yoon
- Department of Internal Medicine, The Catholic University of Korea Uijeongbu St. Mary's Hospital, Uijeongbu, Republic of Korea
| | - Bum Soon Choi
- Department of Internal Medicine, The Catholic University of Korea Eunpyeong St. Mary's Hospital, Seoul, Republic of Korea
| | - Tae Hyun Ban
- Department of Internal Medicine, The Catholic University of Korea Eunpyeong St. Mary's Hospital, Seoul, Republic of Korea
| | - Hyo Jin Kim
- Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Young Joo Kwon
- Department of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
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Zaslow SJ, Oliveira-Paula GH, Chen W. Magnesium and Vascular Calcification in Chronic Kidney Disease: Current Insights. Int J Mol Sci 2024; 25:1155. [PMID: 38256228 PMCID: PMC10816532 DOI: 10.3390/ijms25021155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/12/2024] [Accepted: 01/14/2024] [Indexed: 01/24/2024] Open
Abstract
Magnesium (Mg) plays crucial roles in multiple essential biological processes. As the kidneys are the primary organ responsible for maintaining the blood concentration of Mg, people with chronic kidney disease (CKD) may develop disturbances in Mg. While both hyper- and hypomagnesemia may lead to adverse effects, the consequences associated with hypomagnesemia are often more severe and lasting. Importantly, observational studies have shown that CKD patients with hypomagnesemia have greater vascular calcification. Vascular calcification is accelerated and contributes to a high mortality rate in the CKD population. Both in vitro and animal studies have demonstrated that Mg protects against vascular calcification via several potential mechanisms, such as inhibiting the formation of both hydroxyapatite and pathogenic calciprotein particles as well as limiting osteogenic differentiation, a process in which vascular smooth muscle cells in the media layer of the arteries transform into bone-like cells. These preclinical findings have led to several important clinical trials that have investigated the effects of Mg supplementation on vascular calcification in people with CKD. Interestingly, two major clinical studies produced contradictory findings, resulting in a state of equipoise. This narrative review provides an overview of our current knowledge in the renal handling of Mg in health and CKD and the underlying mechanisms by which Mg may protect against vascular calcification. Lastly, we evaluate the strength of evidence from clinical studies on the efficacy of Mg supplementation and discuss future research directions.
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Affiliation(s)
- Shari J. Zaslow
- Department of Medicine, Nephrology Division, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT 05405, USA
| | - Gustavo H. Oliveira-Paula
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Wei Chen
- Department of Medicine, Nephrology Division, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Department of Developmental and Molecular Biology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
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Su N, Tang X, Wang X, Wen Y, Feng X, Zhou Q, Zhan X, Shang S. Association of Serum Magnesium with Gastrointestinal Bleeding in Peritoneal Dialysis Patients: a Multicentre Retrospective Study. Biol Trace Elem Res 2023; 201:2775-2783. [PMID: 36008701 DOI: 10.1007/s12011-022-03391-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 08/11/2022] [Indexed: 11/02/2022]
Abstract
Serum magnesium is involved in the process of blood coagulation, and low serum magnesium is associated with haemorrhagic diseases. No studies have explored the relationship between serum magnesium and gastrointestinal bleeding (GIB). This study aimed to explore the association between serum magnesium and GIB in peritoneal dialysis (PD) patients. This was a multicentre retrospective cohort study. The primary endpoint was GIB. According to the baseline serum magnesium level of 0.7 mmol/L, patients were divided into two groups: the hypomagnesaemia group and the nonhypomagnesaemia group. A multivariate Cox regression model was used to investigate the association between hypomagnesaemia and GIB. A total of 654 PD patients from four Chinese peritoneal dialysis centres were recruited from February 1, 2010 to January 31, 2020. During the follow-up, 47 patients experienced GIB. Kaplan-Meier curves showed that there was a significant difference in the risk of GIB between the two groups (log-rank = 11.82, P < 0.001). The multivariable Cox regression model showed that the risk of GIB was higher in the hypomagnesaemia group than the nonhypomagnesaemia group after adjustment for demographic variables and laboratory indicators (HR = 3.007, 95% CI 1.488-6.079, P = 0.002). A baseline lower serum magnesium level was associated with a higher risk of GIB in PD patients.
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Affiliation(s)
- Ning Su
- Department of Nephrology, The Sixth Affiliated Hospital, Sun Yat-Sen University, 26 Yuan-cun, Er-heng Road, Tian-He District, Guangzhou 510000, 510655, China
- Department of Hematology, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xingming Tang
- Department of Nephrology, DongGuan SongShan Lake Hospital, Dongguan, China
| | - Xiaoyang Wang
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yueqiang Wen
- Department of Nephrology, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Xiaoran Feng
- Department of Nephrology, Jiujiang No. 1 People's Hospital, Jiujiang, China
| | - Qian Zhou
- Department of Medical Statistics, Clinical Trials Unit, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiaojiang Zhan
- Department of Nephrology, The First Affiliated Hospital, Nanchang University, Nanchang, China
| | - Sijia Shang
- Department of Nephrology, The Sixth Affiliated Hospital, Sun Yat-Sen University, 26 Yuan-cun, Er-heng Road, Tian-He District, Guangzhou 510000, 510655, China.
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Wang J, Lin S, Li HY, Tang W, Liu Y, Zhou T. Influencing factors of serum magnesium in CKD5 patients: A multicenter study in southern China. Front Public Health 2022; 10:1047602. [PMID: 36589976 PMCID: PMC9794747 DOI: 10.3389/fpubh.2022.1047602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Magnesium (Mg) disturbances are related to cardiac, bone, and renal patient mortality. In this study, we compared biochemical markers in hemodialysis (HD) and peritoneal dialysis (PD) patients and explored the influencing factors of serum Mg in stage 5 chronic kidney disease (CKD5) patients. MATERIAL AND METHODS All 598 patients with CKD5 from three medical centers in South China were recruited into this prospective cohort study from March 1, 2018, to January 31, 2021. Our study recorded the clinical characteristics and laboratory data of the patients. RESULTS Hemodialysis patients (0.99 ± 0.19 mmol/L) had a higher mean serum Mg level than PD patients (0.86 ± 0.20 mmol/L; p < 0.01). Regression analysis showed that only corrected calcium (Ca), phosphate (P), Ca/Mg, Ca × P, albumin (Alb), total protein and creatine (Cr) predicted Mg levels in CKD5 patients (p < 0.01). Ca/Mg predicts hypomagnesemia with 78% sensitivity and 85% specificity in CKD5 patients. The AUC value corresponding to Ca/Mg was 0.88. CONCLUSIONS This multicenter study in southern China showed that for all CKD5 patients, corrected Ca and Alb had a significant positive effect on serum Mg, while Ca/Mg had a significant negative effect on serum Mg. In 123 HD patients, Ca × P was positively associated with Mg while Ca/Mg and P were negatively associated with Mg. In 398 PD patients, Ca × P, Alb, and total protein were positively associated with Mg while Ca/Mg and P were negatively associated with Mg. In 77 non-dialysis patients, corrected Ca, Cr, and total protein were positively associated with Mg while Ca/Mg was negatively associated with Mg. Furthermore, Ca/Mg might be another useful technique to monitor blood Mg levels in CKD5 patients. CLINICAL TRIAL REGISTRATION ChiCTR1800014557.
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Affiliation(s)
- Jiali Wang
- Department of Nephrology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Shujun Lin
- Department of Nephrology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Hong-Yan Li
- Department of Nephrology, Huadu District People's Hospital of Guangzhou, Southern Medical University, Guangzhou, China
| | - Wenzhuang Tang
- Department of Blood Purification, The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Yiping Liu
- Department of Nephrology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Tianbiao Zhou
- Department of Nephrology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
- *Correspondence: Tianbiao Zhou
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