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Open AccessArticle

Reduced Mortality in Maintenance Haemodialysis Patients on High versus Low Dialysate Magnesium: A Pilot Study

1
Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany
2
Institute of Medical Statistics and Epidemiology (IMSE), Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany
3
Section of Nephrology, Klinikum Ansbach, Escherichstraße 1, 91522 Ansbach, Germany
4
Praxen Dr. Braun, Dialysis Center Dingolfing, Aitrachstraße 5, 84130 Dingolfing, Germany
*
Author to whom correspondence should be addressed.
Equally contributed
Nutrients 2017, 9(9), 926; https://doi.org/10.3390/nu9090926
Received: 17 July 2017 / Revised: 13 August 2017 / Accepted: 21 August 2017 / Published: 23 August 2017
Background: Although low magnesium levels have been associated with an increased mortality in dialysis patients, they are kept low by routinely-used dialysates containing 0.50 mmol/L magnesium. Thus, we investigated the impact of a higher dialysate magnesium concentration on mortality. Methods: 25 patients on high dialysate magnesium (HDM) of 0.75 mmol/L were 1:2 matched to 50 patients on low dialysate magnesium (LDM) of 0.50 mmol/L and followed up for 3 years with regards to all-cause and cardiovascular mortality. Patients were matched according to age, gender, a modified version of the Charlson Comorbidity Index (CCI), and smoking status. Results: During the follow-up period, five patients died in the HDM and 18 patients in the LDM group. Patients in the HDM group had significantly higher ionized serum magnesium levels than matched controls (0.64 ± 0.12 mmol/L vs. 0.57 ± 0.10 mmol/L, p = 0.034). Log rank test showed no difference between treatment groups for all-cause mortality. After adjustment for age and CCI, Cox proportional hazards regression showed that HDM independently predicted a 65% risk reduction for all-cause mortality (hazard ratio 0.35, 95% confidence interval [CI]: 0.13, 0.97). Estimated 3-year probability of death from a cardiovascular event was 14.5% (95% CI: 7.9, 25.8) in the LDM group vs. 0% in the HDM group. Log rank test found a significant group difference for cardiovascular mortality (χ2 = 4.15, p = 0.042). Conclusions: Our data suggests that there might be a beneficial effect of an increased dialysate magnesium on cardiovascular mortality in chronic dialysis patients. View Full-Text
Keywords: chronic haemodialysis; dialysate magnesium; cardiovascular mortality; ionized magnesium; matched patients chronic haemodialysis; dialysate magnesium; cardiovascular mortality; ionized magnesium; matched patients
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Schmaderer, C.; Braunisch, M.C.; Suttmann, Y.; Lorenz, G.; Pham, D.; Haller, B.; Angermann, S.; Matschkal, J.; Renders, L.; Baumann, M.; Braun, J.R.; Heemann, U.; Küchle, C. Reduced Mortality in Maintenance Haemodialysis Patients on High versus Low Dialysate Magnesium: A Pilot Study. Nutrients 2017, 9, 926.

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