Relationship between Serum Magnesium Levels and Cardiovascular Events in Chronic Kidney Disease Patients

被引:122
作者
Kanbay, Mehmet [2 ]
Yilmaz, Mahmut Ilker [2 ]
Apetrii, Mugurel [1 ]
Saglam, Mutlu [3 ]
Yaman, Halil [4 ]
Unal, Hilmi Umut [2 ]
Gok, Mahmut [2 ]
Caglar, Kayser [2 ]
Oguz, Yusuf [2 ]
Yenicesu, Mujdat [2 ]
Cetinkaya, Hakki [2 ]
Eyileten, Tayfun [2 ]
Acikel, Cengizhan [5 ]
Vural, Abdulgaffar [2 ]
Covic, Adrian [1 ]
机构
[1] Gr T Popa Univ Med & Pharm, Parhon Univ Hosp, Nephrol Clin, RO-700503 Iasi, Romania
[2] Gulhane Mil Med Acad, Dept Nephrol, Ankara, Turkey
[3] Gulhane Mil Med Acad, Dept Radiol, Ankara, Turkey
[4] Gulhane Mil Med Acad, Dept Biochem, Ankara, Turkey
[5] Gulhane Mil Med Acad, Dept Epidemiol, Ankara, Turkey
关键词
Chronic kidney disease; Magnesium; Cardiovascular disease; Endothelial dysfunction; Risk factors; CHRONIC-RENAL-FAILURE; INFLAMMATORY RESPONSE; HEMODIALYSIS-PATIENTS; RISK; CALCIFICATION; HYPERTENSION; DEFICIENCY; THICKNESS; DIALYSIS; ARTERY;
D O I
10.1159/000341868
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
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. Copyright (c) 2012 S. Karger AG, Basel
引用
收藏
页码:228 / 237
页数:10
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