Magnesium Administration in Chronic Kidney Disease

Abstract

Awareness of the clinical relevance of magnesium in medicine has increased over the last years, especially for people with chronic kidney disease (CKD), due to magnesium's role in vascular calcification and mineral metabolism. The inverse association between serum magnesium and clinically relevant, adverse outcomes is well-established in people with CKD. Subsequent intervention studies have focused on the effect of magnesium administration, mainly in relation to cardiovascular diseases, mineral bone metabolism, and other metabolic parameters. The most commonly used routes of magnesium administration are orally and by increasing dialysate magnesium. Several oral magnesium formulations are available and the daily dosage of elemental magnesium varies highly between studies, causing considerable heterogeneity. Although data are still limited, several clinical studies demonstrated that magnesium administration could improve parameters of vascular function and calcification and mineral metabolism in people with CKD. Current clinical research has shown that magnesium administration in people with CKD is safe, without concerns for severe hypermagnesemia or negative interference with bone metabolism. It should be noted that there are several ongoing magnesium intervention studies that will contribute to the increasing knowledge on the potential of magnesium administration in people with CKD.

Keywords: cardiovascular disease; chronic kidney disease; magnesium; magnesium administration; magnesium supplementation.

Figure 1

Magnesium (Mg) homeostasis. Panels represent the daily amount of Mg intake and excretion. Daily, the intestines absorb ~120 mg and secrete 20 mg of Mg, resulting in a net absorption of 100 mg. In the kidney daily, ~2400 mg Mg is filtered by the glomerulus, of which 2300 mg is reabsorbed along the kidney tubule. This results in a net excretion of 100 mg, which matches the intestinal absorption. Bone and muscle provide the most important Mg stores. Reproduced with permission [2]. Copyright 2015, the American Physiological Society.