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Introduction <p>Though low serum magnesium (Mg) levels are associated with adverse outcomes in patients on haemodialysis, the interaction with calcimimetics remains uncertain. We hypothesized a potential interaction between serum Mg levels and calcimimetic use in cardiovascular events (CVEs), all-cause mortality, and&#xa0;new fractures during follow-up in patients on haemodialysis.</p> Materials and Methods <p>This single-centre retrospective cohort included 399 Japanese adults on maintenance haemodialysis, followed for ≤ 5&#xa0;years. Cox models with time-dependent serum Mg levels and calcimimetic usage interaction adjusted for clinicodemographic and biochemical covariates.</p> Results <p>At baseline, 205 patients (51.4%) were prescribed calcimimetics (median serum Mg, 2.5&#xa0;mg/dL). The mean observational period was 40.6&#xa0;months, and 122 CVEs, 159 all-cause mortality, and 69 new fractures occurred (incidence rates: 0.09, 0.10-, and 0.05 per patient-year), respectively. The time-dependent model showed serum Mg &lt; 2.4&#xa0;mg/dL was associated with a markedly higher risk for new fractures in&#xa0;calcimimetic-naïve patients. Serum Mg levels were not significantly associated with CVEs and all-cause mortality, regardless of calcimimetic usage. The restricted cubic spline curve demonstrated linear inverse trends of serum Mg levels with all-cause mortality and new fractures in calcimimetic-naïve patients. However, no significant interaction between Mg and calcimimetic use was observed for any outcome.</p> Conclusion <p>We did not detect a statistically significant interaction between serum Mg levels and calcimimetic use. Nonetheless, low serum Mg (&lt; 2.4&#xa0;mg/dL) was associated with a higher risk of fractures, particularly among calcimimetic-naïve patients. Thus, low serum Mg is a potentially modifiable risk marker associated with fracture risk, particularly in calcimimetic-naïve patients.</p>

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Association of serum magnesium levels and calcimimetic use: fractures and cardiovascular events in Japanese haemodialysis patients

  • 期刊论文

  • 发表日期：

    2026年2月1日

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  • Tomohiro Saito,
  • Masahide Mizobuchi,
  • Kiryu Yoshida,
  • Tadashi Kato,
  • Kazuki Abe,
  • Toshiaki Takezaki,
  • Noriyuki Kato,
  • Eisuke Inoue,
  • Hiroaki Ogata,
  • Fumihiko Koiwa,
  • Hirokazu Honda

摘要

Introduction

Though low serum magnesium (Mg) levels are associated with adverse outcomes in patients on haemodialysis, the interaction with calcimimetics remains uncertain. We hypothesized a potential interaction between serum Mg levels and calcimimetic use in cardiovascular events (CVEs), all-cause mortality, and new fractures during follow-up in patients on haemodialysis.

Materials and Methods

This single-centre retrospective cohort included 399 Japanese adults on maintenance haemodialysis, followed for ≤ 5 years. Cox models with time-dependent serum Mg levels and calcimimetic usage interaction adjusted for clinicodemographic and biochemical covariates.

Results

At baseline, 205 patients (51.4%) were prescribed calcimimetics (median serum Mg, 2.5 mg/dL). The mean observational period was 40.6 months, and 122 CVEs, 159 all-cause mortality, and 69 new fractures occurred (incidence rates: 0.09, 0.10-, and 0.05 per patient-year), respectively. The time-dependent model showed serum Mg < 2.4 mg/dL was associated with a markedly higher risk for new fractures in calcimimetic-naïve patients. Serum Mg levels were not significantly associated with CVEs and all-cause mortality, regardless of calcimimetic usage. The restricted cubic spline curve demonstrated linear inverse trends of serum Mg levels with all-cause mortality and new fractures in calcimimetic-naïve patients. However, no significant interaction between Mg and calcimimetic use was observed for any outcome.

Conclusion

We did not detect a statistically significant interaction between serum Mg levels and calcimimetic use. Nonetheless, low serum Mg (< 2.4 mg/dL) was associated with a higher risk of fractures, particularly among calcimimetic-naïve patients. Thus, low serum Mg is a potentially modifiable risk marker associated with fracture risk, particularly in calcimimetic-naïve patients.