(04-10-12) Relationship between Serum Magnesium Levels and Cardiovascular Events in Chronic Kidney Disease Patients.

Kanbay M, Yilmaz MI, Apetrii M, Saglam M, Yaman H, Unal HU, Gok M, Caglar K,
Oguz Y, Yenicesu M, Cetinkaya H, Eyileten T, Acikel C, Vural A, Covic A.
Source
Department of Nephrology, G?lhane School of Medicine, Ankara, Turkey.
Abstract
Background: Magnesium is an essential ion for all living cells because over
300 enzymes require the presence of magnesium for their catalytic action. To
date, no group has evaluated magnesium as a cardiovascular risk factor in
chronic kidney disease (CKD) subjects, in which closely interrelated factors
and potential confounders such as endothelial dysfunction, insulin resistance
(the homeostasis model assessment (HOMA) index) and inflammation (expressed as
serum C-reactive protein (CRP) levels) were also considered. Methods: Between
March 2006 and December 2010, 283 CKD patients were followed up for time-to-
event analysis until the occurrence of fatal or nonfatal cardiovascular events.
Endothelium-dependent vasodilatation (flow-mediated dilatation; FMD) and
endothelium-independent vasodilatation (nitroglycerin-mediated dilatation) of
the brachial artery were assessed noninvasively using high-resolution
ultrasound. Results: From the univariate analysis of FMD, it appears that a
higher magnesium level is associated with less endothelial dysfunction. When a
multivariate analysis was performed, magnesium and estimated glomerular
filtration rates (eGFR) maintained a strong positive correlation with FMD,
supporting the hypothesis that higher levels of magnesium may protect against
endothelial damage. In univariate Cox proportional hazards models, FMD,
magnesium, high sensitivity CRP, the HOMA index, eGFR, comorbid diabetes,
hypertension, smoking status, systolic blood pressure, serum phosphate and
intact parathormone emerged as significant predictors for cardiovascular
outcomes. Kaplan-Meier curves showed significantly higher cardiovascular
mortality rates in CKD patients whose serum magnesium levels were below 2.05
mg/dl. Conclusions: This observational cohort study showed that magnesium may
be an independent predictor of future cardiovascular outcomes and is the first
study demonstrating such a role in etiologically diagnosed CKD patients, across
different stages.

Source: Am J Nephrol. 2012 Aug 30;36(3):228-237. [Epub ahead of print]

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