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Meta-Analysis
. 2022 Oct 11:10:e14203.
doi: 10.7717/peerj.14203. eCollection 2022.

Association between hypomagnesemia and mortality among dialysis patients: a systematic review and meta-analysis

Chi-Ya Huang #  1 , Chi-Chen Yang #  1 , Kuo-Chuan Hung  2 , Ming-Yan Jiang  3 , Yun-Ting Huang  3 , Jyh-Chang Hwang  3   4 , Chih-Chieh Hsieh  5 , Min-Hsiang Chuang  1 , Jui-Yi Chen  3   6
Affiliations
Meta-Analysis

Association between hypomagnesemia and mortality among dialysis patients: a systematic review and meta-analysis

Chi-Ya Huang et al. PeerJ. .

Abstract

Background: Malnutrition-inflammation-atherosclerosis (MIA) syndrome is caused by the inflammatory cytokines in end stage renal disease (ESRD) patients, and MIA complex-related factors may be associated with hypomagnesemia and mortality. However, the association between serum magnesium level and mortality for dialysis patients is still not clear. Additionally, no meta-analysis has investigated the impact of serum magnesium on peritoneal dialysis and hemodialysis, separately.

Methods: We searched published studies in PubMed, Embase, Cochrane, Collaboration Central Register of Controlled Clinical Trials, and Cochrane Systematic Reviews through April 2022. Studies associated with serum magnesium and all-cause mortality or cardiovascular (CV) mortality in ESRD on kidney replacement therapy (KRT) patients were included. A hazard ratio (HR) with 95% confidence intervals (CI) was used to report the outcomes.

Results: Twenty-one studies involving 55,232 patients were included. Overall, there was a significant association between hypomagnesemia and all-cause mortality for dialysis patients (HR: 1.67, 95% CI [1.412-2.00], p < 0.001; certainty of evidence: moderate) using a mixed unadjusted and adjusted HR for analysis. There was also a significantly increased risk of CV mortality for individuals with hypomagnesemia compared with the non-hypomagnesemia group (HR 1.56, 95% CI [1.08-2.25], p < 0.001; certainty of evidence: moderate). In addition, a subgroup analysis demonstrated that hypomagnesemia was associated with a high risk of both all-cause mortality and CV mortality (all-cause mortality, HR:1.80, 95% CI [1.48-2.19]; CV mortality, HR:1.84, 95% CI [1.10-3.07]) in hemodialysis (HD) patients, but not in participants receiving peritoneal dialysis (PD; all-cause mortality, HR:1.26, 95% CI [0.84-1.91]; CV mortality, HR:0.66, 95% CI [0.22-2.00]). The systematic review protocol was prespecified and registered in PROSPERO [CRD42021256187].

Conclusions: Hypomagnesemia may be a significant risk factor for all-cause mortality and CV mortality in KRT patients, especially in those receiving hemodialysis. However, because of the limited certainty of evidence, more studies are required to investigate this association.

Keywords: Dialysis; Hemodialysis; Hypomagnesemia; Magnesium; Mortality.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1. Flowchart of study selection for meta-analysis.
Figure 2
Figure 2. Forest plot showing increased risk of (A) all-cause mortality (B) cardiovascular mortality, comparing hypoMg vs. non-hypoMg in a population dialysis patients.
Figure 3
Figure 3. Subgroup analysis for (A) all-cause mortality (B) cardiovascular mortality comparing hypoMg vs. non-hypoMg in a population of dialysis patients.
See this image and copyright information in PMC

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References

    1. Ago R, Shindo T, Banshodani M, Shintaku S, Moriishi M, Masaki T, Kawanishi H. Hypomagnesemia as a predictor of mortality in hemodialysis patients and the role of proton pump inhibitors: a cross-sectional, 1-year, retrospective cohort study. Hemodialysis International. 2016;20(4):580–588. doi: 10.1111/hdi.12437. - DOI - PubMed
    1. Allawi AAD. Malnutrition, inflamation and atherosclerosis (MIA syndrome) in patients with end stage renal disease on maintenance hemodialysis (a single centre experience) Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2018;12(2):91–97. doi: 10.1016/j.dsx.2017.09.003. - DOI - PubMed
    1. Barbagallo M, Dominguez LJ, Galioto A, Ferlisi A, Cani C, Malfa L, Pineo A, Busardo A, Paolisso G. Role of magnesium in insulin action, diabetes and cardio-metabolic syndrome X. Molecular Aspects of Medicine. 2003;24(1–3):39–52. doi: 10.1016/s0098-2997(02)00090-0. - DOI - PubMed
    1. Brandao K, Deason-Towne F, Perraud AL, Schmitz C. The role of Mg2+ in immune cells. Immunologic Research. 2013;55(1–3):261–269. doi: 10.1007/s12026-012-8371-x. - DOI - PubMed
    1. Cai K, Luo Q, Dai Z, Zhu B, Fei J, Xue C, Wu D. Hypomagnesemia is associated with increased mortality among peritoneal dialysis patients. PLOS ONE. 2016;11(3):e0152488. doi: 10.1371/journal.pone.0152488. - DOI - PMC - PubMed

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