Proteinuria-associated renal magnesium wasting leads to hypomagnesemia: a common electrolyte abnormality in chronic kidney disease
Oka T, Hamano T, Sakaguchi Y, Yamaguchi S, Kubota K, Senda M, Yonemoto S, Shimada K, Matsumoto A, Hashimoto N, Mori D, Monden C, Takahashi A, Obi Y, Yamamoto R, Takabatake Y, Kaimori JY, Moriyama T, Horio M, Matsui I, Isaka Y
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 50 citations
Review labels
Neutral facts our review recorded about how this study was done. They describe method, never whether we like the result.
How it was studied
- Design
- Randomized controlled trial (indexed by PubMed)
- Studied in
- People
- Main outcome
- Health markers and function
Who paid for it
- Funding
- Funding not disclosed
Publication
- Published
- 2018-04-12 · Nephrol Dial Transplant · vol. 34 · issue 7 · pp. 1154–1162
- Publisher
- Oxford University Press
- Cited
- 72 citations · more than 92% of similar papers · 3.1× the field average
- Impact
- Top 10% most cited in its field
- References
- 41 works
- Access
- Paywalled
- Research areas
- Magnesium in Health and Disease · Parathyroid Disorders and Treatments · Potassium and Related Disorders
- Keywords
- Medicine, Proteinuria, Internal medicine, Kidney disease, Hypomagnesemia, Gastroenterology, Odds ratio, Endocrinology, Creatinine, Urology, Kidney, Magnesium
- MeSH
- humans, renal tubular transport, inborn errors, proteinuria, disease progression, electrolytes, magnesium, magnesium oxide, kidney function tests, prevalence, retrospective studies, follow-up studies, cross-sectional studies, adult, middle aged, outpatients, japan, female, male, renal insufficiency, chronic, biomarkers
21 authors
From JP, US
- Tatsufumi OkaThe University of Osaka
- Takayuki Hamano · correspondingThe University of Osaka
- Yusuke SakaguchiThe University of Osaka
- Satoshi YamaguchiThe University of Osaka
- Keiichi KubotaThe University of Osaka
- Masamitsu SendaThe University of Osaka
Abstract
Background
Hypomagnesemia (Hypo-Mg) predicts mortality and chronic kidney disease (CKD) progression. However, in CKD, its prevalence, kidney-intrinsic risk factors, and the effectiveness of oral magnesium (Mg) therapy on serum Mg levels is uncertain.
Methods
In a cross-sectional study enrolling pre-dialysis outpatients with CKD, the prevalence of electrolyte abnormalities (Mg, sodium, potassium, calcium and phosphorus) was compared. In an open-label randomized controlled trial (RCT), we randomly assigned CKD patients to either the magnesium oxide (MgO) or control arm. The outcome was serum Mg levels at 1 year.
Results
In 5126 patients, Hypo-Mg was the most common electrolyte abnormality (14.7%) with similar prevalence across stages of CKD. Positive proteinuria was a risk factor of Hypo-Mg (odds ratio 2.2; 95% confidence interval 1.2-4.0). However, stratifying the analyses by diabetes mellitus (DM), it was not significant in DM (Pinteraction = 0.04). We enrolled 114 patients in the RCT. Baseline analyses showed that higher proteinuria was associated with higher fractional excretion of Mg. This relationship between proteinuria and renal Mg wasting was mediated by urinary tubular markers in mediation analyses. In the MgO arm, higher proteinuria or tubular markers predicted a significantly lower 1-year increase in serum Mg. In patients with a urinary protein-to-creatinine ratio (uPCR) <0.3 g/gCre, serum Mg at 1 year was 2.4 and 2.0 mg/dL in the MgO and control arms, respectively (P < 0.001), with no significant between-group difference in patients whose uPCR was ≥0.3 g/gCre (Pinteraction=0.001).
Conclusions
Proteinuria leads to renal Mg wasting through tubular injuries, which explains the high prevalence of Hypo-Mg in CKD.
Abstract via Europe PMC. Copyright remains with the authors or publisher.
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