TY - JOUR
T1 - The association between circulating magnesium and clinically relevant outcomes in patients with chronic kidney disease
T2 - A systematic review and meta-analysis
AU - Leenders, Nicoline H J
AU - Vermeulen, Emma A
AU - van Ballegooijen, Adriana J
AU - Hoekstra, Tiny
AU - de Vries, Ralph
AU - Beulens, Joline W
AU - Vervloet, Marc G
N1 - Funding Information:
This work was supported by the Dutch Kidney Foundation (PhD grant no. 15OP02 ). This collaboration project was also financed by the PPP Allowance made available by Top Sector Life Sciences & Health to The Dutch Kidney Foundation to stimulate public-private partnerships (grant no. LSHM17034-HSGF ).
Publisher Copyright:
© 2020 The Author(s)
PY - 2021/5
Y1 - 2021/5
N2 - BACKGROUND & AIMS: Despite modern treatment, risk for cardiovascular disease and mortality in patients with chronic kidney disease (CKD) is unacceptably high. Observational studies have shown associations of magnesium with risk for several clinical outcomes in CKD of variable magnitude. The aim of this review is to provide a systematic overview and meta-analysis of longitudinal studies assessing the association of plasma magnesium concentration with clinically relevant outcomes in adult patients with chronic kidney disease, with a minimal follow-up of 6 months. Primary outcomes of interest were all-cause mortality, cardiovascular mortality, cardiovascular events, sudden death and hospitalisation.METHODS: The electronic databases PubMed, Embase and The Cochrane Library were searched using terms relating to plasma magnesium and CKD patients, and two authors independently selected eligible studies. Study quality was assessed according to the Newcastle-Ottawa Scale. Results of studies with a comparable magnesium exposure and outcome measure, were pooled using a random-effects meta-regression analysis.RESULTS: The search yielded 6156 records of which 33 studies, involving 348,059 patients, met the eligibility criteria. Finally, 22 studies could be included in the meta-analysis. Higher magnesium was associated with a lower risk for all-cause mortality (HR 0.90 [0.87-0.94] per 0.1 mmol/L increase of magnesium) and cardiovascular mortality and events (HR 0.85 [0.77-0.94] per 0.1 mmol/L).CONCLUSIONS: Magnesium concentration is inversely associated with all-cause mortality and cardiovascular mortality and events. Therefore, increasing magnesium may improve risk in patients with chronic kidney disease. This meta-analysis forms a firm base for future prospective trials to test whether increasing plasma magnesium, indeed has beneficial effects on clinical outcomes.
AB - BACKGROUND & AIMS: Despite modern treatment, risk for cardiovascular disease and mortality in patients with chronic kidney disease (CKD) is unacceptably high. Observational studies have shown associations of magnesium with risk for several clinical outcomes in CKD of variable magnitude. The aim of this review is to provide a systematic overview and meta-analysis of longitudinal studies assessing the association of plasma magnesium concentration with clinically relevant outcomes in adult patients with chronic kidney disease, with a minimal follow-up of 6 months. Primary outcomes of interest were all-cause mortality, cardiovascular mortality, cardiovascular events, sudden death and hospitalisation.METHODS: The electronic databases PubMed, Embase and The Cochrane Library were searched using terms relating to plasma magnesium and CKD patients, and two authors independently selected eligible studies. Study quality was assessed according to the Newcastle-Ottawa Scale. Results of studies with a comparable magnesium exposure and outcome measure, were pooled using a random-effects meta-regression analysis.RESULTS: The search yielded 6156 records of which 33 studies, involving 348,059 patients, met the eligibility criteria. Finally, 22 studies could be included in the meta-analysis. Higher magnesium was associated with a lower risk for all-cause mortality (HR 0.90 [0.87-0.94] per 0.1 mmol/L increase of magnesium) and cardiovascular mortality and events (HR 0.85 [0.77-0.94] per 0.1 mmol/L).CONCLUSIONS: Magnesium concentration is inversely associated with all-cause mortality and cardiovascular mortality and events. Therefore, increasing magnesium may improve risk in patients with chronic kidney disease. This meta-analysis forms a firm base for future prospective trials to test whether increasing plasma magnesium, indeed has beneficial effects on clinical outcomes.
KW - Cardiovascular
KW - Chronic kidney disease
KW - Dialysis
KW - End-stage renal disease
KW - Magnesium
KW - Mortality
UR - http://www.scopus.com/inward/record.url?scp=85098886819&partnerID=8YFLogxK
U2 - 10.1016/j.clnu.2020.12.015
DO - 10.1016/j.clnu.2020.12.015
M3 - Article
C2 - 33419615
VL - 40
SP - 3133
EP - 3147
JO - Clinical Nutrition
JF - Clinical Nutrition
SN - 0261-5614
IS - 5
ER -