Routine hemodialysis induces a decline in plasma magnesium concentration in most patients: a prospective observational cohort study

Abstract

In hemodialysis patients, lower plasma magnesium (Mg) concentrations are associated with a higher overall and cardiovascular mortality. The optimal concentration appears to be above the reference range for the healthy population. Plasma Mg is not routinely measured after hemodialysis. Aim of this study was to determine the effect of routine hemodialysis on plasma Mg. Plasma Mg was measured in duplicate before (Mg_pre) and after (Mg_post) dialysis in 6 consecutive hemodialysis sessions of 34 patients using a fixed 0.50 mmol/L dialysate Mg concentration. Mean Mg_pre was 0.88 mmol/L (±0.14) and mean Mg_post was statistically significantly lower: mean intra-dialytic decline 0.10 mmol/L (95%-CI 0.06-0.13). A 0.10 mmol/L higher Mg_pre was associated with a 0.03 mmol/L higher Mg_post (95%-CI 0.024-0.037). At a Mg_pre of 0.74 mmol/L, Mg_post equalled Mg_pre. There was an intra-dialytic decline of plasma Mg at higher Mg_pre values and an increase at lower Mg_pre values. In conclusion, in the majority of the hemodialysis patients, Mg_pre concentrations are in the reference range of the healthy population, which may be too low for hemodialysis patients. Routine hemodialysis with the widely used 0.50 mmol/L dialysate Mg concentration, further declines magnesium in the majority of patients. Current dialysate Mg concentrations may be too low.

Figure 1

Flow-chart of patient enrolment in the study.

Figure 2

Distribution of pre-dialysis plasma magnesium concentrations in the individuals. The concentrations are the means of pooled values of the dialysis sessions in an individual.

Figure 3

Distribution of post-dialysis plasma magnesium concentrations in the individuals. The concentrations are the means of pooled values of the dialysis sessions in an individual.

Figure 4

Association of plasma magnesium pre-dialysis with plasma magnesium post-dialysis. The regression line resulting from the linear mixed model is shown.

Figure 5

Association of plasma magnesium pre-dialysis with the intra-dialytic plasma magnesium change. The regression line resulting from the linear mixed model is shown. The regression line crosses the X-axis (no intra-dialytic change) at a pre-dialysis magnesium concentration of 0.74 mmol/L.