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. 2021 Jan;7(1):24-33.
doi: 10.1159/000510513. Epub 2020 Nov 4.

Prognostic Value of Serum Magnesium in Mortality Risk among Patients on Hemodialysis: A Meta-Analysis of Observational Studies

Hongwei Wu  1 , Qiang Li  2 , Lijing Fan  1 , Dewang Zeng  1   3 , Xianggeng Chi  4   5 , Baozhang Guan  1 , Bo Hu  1 , Yongping Lu  1   5 , Chen Yun  5 , Bernhard Krämer  5 , Berthold Hocher  1   5 , Fanna Liu  1 , Lianghong Yin  1
Affiliations

Prognostic Value of Serum Magnesium in Mortality Risk among Patients on Hemodialysis: A Meta-Analysis of Observational Studies

Hongwei Wu et al. Kidney Dis (Basel). 2021 Jan.

Abstract

Background: Previous studies have reported that serum magnesium (Mg) deficiency is involved in the development of heart failure, particularly in patients with end-stage kidney disease. The association between serum Mg levels and mortality risk in patients receiving hemodialysis is controversial. We aimed to estimate the prognostic value of serum Mg concentration on all-cause mortality and cardiovascular mortality in patients receiving hemodialysis.

Methods: We did a systematic literature search in PubMed, EMBASE, Cochrane Library, and Web of Science to identify eligible studies that reported the prognostic value of serum Mg levels in mortality risk among patients on hemodialysis. We performed a meta-analysis by pooling and analyzing hazard ratios (HRs) and 95% confidence intervals (CIs).

Results: We identified 13 observational studies with an overall sample of 42,967 hemodialysis patients. Higher all-cause mortality (adjusted HR 1.58 [95% CI: 1.31-1.91]) and higher cardiovascular mortality (adjusted HR 3.08 [95% CI: 1.27-7.50]) were found in patients with lower serum Mg levels after multivariable adjustment. There was marked heterogeneity (I2 = 79.6%, p < 0.001) that was partly explained by differences in age stratification and study area. In addition, subgroup analysis showed that a serum Mg concentration of ≤1.1 mmol/L might be the vigilant cutoff value.

Conclusion: A lower serum Mg level was associated with higher all-cause mortality and cardiovascular mortality in patients receiving hemodialysis.

Keywords: Hemodialysis; Meta-analysis; Mortality; Serum magnesium.

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Conflict of interest statement

The authors declare that they have no conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
Flowchart of the selection process of included studies.
Fig. 2
Fig. 2
The association between serum Mg levels and all-cause mortality among patients on dialysis (low vs. high Mg groups).
Fig. 3
Fig. 3
Subgroup analysis by Mg cutoff level on all-cause mortality (low vs. high Mg groups).
Fig. 4
Fig. 4
The association between serum Mg levels and cardiovascular mortality risk (low vs. high Mg groups).
Fig. 5
Fig. 5
Funnel plot of the association between serum Mg and all-cause mortality. a The funnel plot with pseudo 95% confidence intervals (CIs). b Begg's funnel plot with pseudo 95% CIs. c Egger's publication bias plot. d Trimmed and filled funnel plot with pseudo 95% CIs.
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