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Cited by 188Magnesium in Health and DiseaseParathyroid Disorders and TreatmentsDialysis and Renal Disease Management

Magnesium in chronic kidney disease Stages 3 and 4 and in dialysis patients

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Cunningham, J., Rodriguez, M., Messa, P.·2012·Clinical Kidney Journal
DOI 10.1093/ndtplus/sfr166PMC PMC4455820
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Abstract

The kidney has a vital role in magnesium homeostasis and, although the renal handling of magnesium is highly adaptable, this ability deteriorates when renal function declines significantly. In moderate chronic kidney disease (CKD), increases in the fractional excretion of magnesium largely compensate for the loss of glomerular filtration rate to maintain normal serum magnesium levels. However, in more advanced CKD (as creatinine clearance falls <30 mL/min), this compensatory mechanism becomes inadequate such that overt hypermagnesaemia develops frequently in patients with creatinine clearances <10 mL/min. Dietary calcium and magnesium may affect the intestinal uptake of each other, though results are conflicting, and likewise the role of vitamin D on intestinal magnesium absorption is somewhat uncertain. In patients undergoing dialysis, the effect of various magnesium and calcium dialysate concentrations has been investigated in haemodialysis (HD) and peritoneal dialysis (PD). Results generally show that dialysate magnesium, at 0.75 mmol/L, is likely to cause mild hypermagnesaemia, results for a magnesium dialysate concentration of 0.5 mmol/L were less consistent, whereas serum magnesium levels were mostly normal to hypomagnesaemic when 0.2 and 0.25 mmol/L were used. While dialysate magnesium concentration is a major determinant of HD or PD patients' magnesium balance, other factors such as nutrition and medications (e.g. laxatives or antacids) also play an important role. Also examined in this review is the role of magnesium on parathyroid hormone (PTH) levels in dialysis patients. Although various studies have shown that patients with higher serum magnesium tend to have lower PTH levels, many of these suffer from methodological limitations. Finally, we examine the complex and often conflicting results concerning the interplay between magnesium and bone in uraemic patients. Although the exact role of magnesium in bone metabolism is unclear, it may have both positive and negative effects, and it is uncertain what the optimal magnesium levels are in uraemic patients.

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  • Magnesium is involved in numerous enzymatic reactions as a cofactor, stabilizing and activating many enzymes and ATP-generating reactions, and has a crucial role in muscle relaxation, muscle function, normal neurological function, and neurotransmitter release.

    “Magnesium is also involved in numerous enzymatic reactions in which it functions as a cofactor, stabilizing and activating many enzymes and many reactions that generate adenosine triphosphate (ATP), in addition to its crucial role in muscle relaxation and muscle function, normal neurological function, and release of neurotransmitters [79].”

    From Novel Insights on Intake of Fish and Prevention of Sarcopenia: All Reasons for an Adequate Consumption (2020) · cites this paper as [79]

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  1. [51]Passlick-Deetjen J Wang W Magnesium and mortality risk in hemodialysis patients 2010 Munich, Germany, European Renal Association (ERA) and European Dialysis and Transplant Association (EDTA), XLVII Congress, 25-28 June, Presentation 26190226

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Authors
Cunningham, J., Rodriguez, M., & Messa, P.
Affiliations
The Royal Free Hospital (GB)
Corresponding author
Cunningham, J.
Venue
Clinical Kidney Journal
Publisher
Oxford University Press (OUP)
Published
2012-02-01
Volume
5
Issue
Suppl 1
Pages
i39-i51
ISSN
  • 2048-8505 (ISSN-L)
  • 2048-8513
DOI
10.1093/ndtplus/sfr166
PMC
PMC4455820
OpenAlex
W2155794381
Cited by
188
References
112
Citations by year
2026: 9 · 2025: 16 · 2024: 16 · 2023: 13 · 2022: 14 · 2021: 21 · 2020: 27 · 2019: 11 · 2018: 18 · 2017: 11 · 2016: 7 · 2015: 7 · 2014: 10 · 2013: 4 · 2012: 4
FWCI
7.45
Type
journal article
Language
en
Open access
Licence
Locations
  • Clinical Kidney Journal (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (submittedVersion)
Funders
Fresenius Medical Care North America
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Magnesium in Health and Disease
  • Health Sciences › Medicine › Nephrology › Parathyroid Disorders and Treatments
  • Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
Keywords
magnesium homeostasis, dialysis, hypermagnesemia, hemodialysis, peritoneal dialysis, parathyroid hormone, bone metabolism, uremia, vitamin D, hypomagnesemia

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