Disclosures: The authors report no relevant financial disclosures.
September 16, 2021
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Magnesium supplementation benefits patients on dialysis with mineral, bone disorder

Disclosures: The authors report no relevant financial disclosures.
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A meta-analysis of randomized controlled trials suggested magnesium supplementation alone might benefit patients on hemodialysis with chronic kidney disease-mineral bone disorder.

The beneficial effects were due to the role magnesium supplementation plays in regulating serum calcium and parathyroid hormone metabolism, while also decreasing carotid intima-media thickness, according to investigators.

Magnesium supplementation
Infographic content was derived from Guo G, et al. J Ren Nutrit.2021;doi:10.1053/j.jrn.2021.07.009.

“CKD-mineral bone disorder (CKD-MBD) is a broad and complex disorder caused by CKD, including abnormal levels of serum calcium (Ca), phosphate (P) and parathyroid hormone (PTH). These abnormalities are believed to contribute to vascular calcification (VC), which increase the risk of cardiovascular disease (CVD) and all-cause mortality and play a predominant role in the poor prognosis of [hemodialysis] HD patients,” Guangying Guo, MD, of the department of nephrology at the First Hospital of China Medical University in Shenyang, and colleagues wrote. “An arterial ultrasound is a non-invasive and reliable technique that is used to measure the exact location of VC. Previous studies have linked carotid intima-media thickness (CIMT) to VC in [hemodialysis] HD patients and shown that CIMT is an independent predictor of CVD events.”

Citing several studies that have reached “controversial conclusions” regarding the impact of magnesium supplementation on patients with CKD-MBD, Guo and colleagues conducted a search for English language studies that assessed serum Mg, calcium, phosphate, parathyroid hormone and CRP levels, as well as carotid intima-media thickness, after supplementation. Researchers included a total of eight randomized controlled trials in the meta-analysis, which had been conducted in the United States, Turkey, Iran, Pisa, Denmark and the United Kingdom (the studies consisted of a total of 309 patients on hemodialysis, with intervention duration ranging from 1 month to 6 months; five trials were double-blinded).

When all the studies were examined together, Guo and colleagues found no affect from magnesium supplementation on serum magnesium, calcium, phosphate or CRP levels. However, when conducting a subgroup analysis based on intervention type (oral vs. dialysate), researchers found findings pointed to a significant improvement in serum magnesium (when administered via dialysate; weighted mean difference [WMD] = 1.08) and calcium (when administered orally; WMD = -0.50).

Further, magnesium supplementation alone produced a negative effect on serum PTH levels (WMD = 236.56) and CIMT (WMD = 0.18).

Although Guo and colleagues contended that more high-quality clinical trials and prospective studies with large sample sizes are needed, they wrote that the findings, “provide further evidence for physicians that Mg can be prescribed as a type of assisted therapy to HD patients with CKD-MBD.”