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Published on: June 16, 2014
Serum Magnesium and Cardiovascular Outcomes and Mortality in CKD: The Chronic Renal Insufficiency Cohort (CRIC)
Lavinia Negrea1, Sarah J DeLozier2, Jessica L Janes2
1Division of Nephrology and Hypertension, University Hospital Case Medical Center, Case Western Reserve University, Cleveland, OH.
Insights
Low and high serum magnesium levels increase mortality risk in chronic kidney disease (CKD) patients. While low magnesium is linked to atrial fibrillation, it did not predict cardiovascular events in this study.
Area of Science:
- Nephrology
- Cardiology
- Clinical Biochemistry
Background:
- Serum magnesium is linked to mortality, but its predictive role for cardiovascular disease (CVD) in chronic kidney disease (CKD) is uncertain.
- Understanding magnesium's impact is crucial for managing CKD patients, who are at high risk for adverse outcomes.
Purpose of the Study:
- To investigate the association between serum magnesium levels and cardiovascular events and all-cause mortality in a large cohort of individuals with CKD.
Main Methods:
- A prospective cohort study involving 3,867 participants with CKD from the Chronic Renal Insufficiency Cohort (CRIC) Study.
- Serum magnesium was measured at baseline. Cox proportional hazards models were used for analysis, adjusting for various demographic, clinical, and laboratory factors.
Main Results:
- Over a median follow-up of 14.6 years, 1,384 participants died and 1,227 experienced composite cardiovascular events.
- A nonlinear association was found between serum magnesium and all-cause mortality; both low (<1.9 mg/dL) and high (>2.1 mg/dL) levels increased mortality risk.
- No significant association was observed between serum magnesium levels and composite cardiovascular events, but low magnesium was linked to incident atrial fibrillation.
Conclusions:
- Serum magnesium levels outside the 1.9-2.1 mg/dL range are associated with increased all-cause mortality in CKD patients.
- Low serum magnesium is a risk factor for atrial fibrillation but not for composite cardiovascular events in this population.
- Further research is needed to establish optimal serum magnesium levels for preventing adverse outcomes in CKD.
Rationale & Objective:
Low serum magnesium level has been shown to be associated with increased mortality, but its role as a predictor of cardiovascular disease is unclear. This study evaluates the association between serum magnesium level and cardiovascular events and all-cause mortality in a large cohort of individuals with chronic kidney disease (CKD).
Study Design:
Prospective cohort study.
Setting & Participants:
3,867 participants with CKD, enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study.
Exposures:
Serum magnesium measured at study baseline.
Outcomes:
Composite cardiovascular events (myocardial infarction, cerebrovascular accident, heart failure, and peripheral arterial disease) and all-cause mortality.
Analytical Approach:
Cox proportional hazards models adjusted for demographic, clinical, and laboratory characteristics.
Results:
During the 14.6 (4.4) years (standard deviation) of follow-up, 1,384 participants died (36/1,000 person-years), and 1,227 (40/1,000 person-years) had a composite cardiovascular event. There was a nonlinear association between serum magnesium level and all-cause mortality. Low and high magnesium levels were associated with greater rates of all-cause mortality after adjusting for demographics, comorbid conditions, medications including diuretics, estimated glomerular filtration rate, and proteinuria (P < 0.001). No significant associations were observed between serum magnesium levels and the composite cardiovascular events. Low serum magnesium level was associated with incident atrial fibrillation (HR, 1.36; 95% CI, 1.01-1.82; P = 0.04).
Limitations:
Single measurement of serum magnesium.
Conclusions:
In this large CKD cohort, serum magnesium level < 1.9 mg/dL and >2.1 mg/dL was associated with increased risk for all-cause mortality. Low magnesium level was associated with incident atrial fibrillation but not with composite cardiovascular disease events. Further studies are needed to determine the optimal range of serum magnesium in CKD to prevent adverse clinical outcomes.
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