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<p>Hypomagnesemia status assessed with the total serum magnesium (tsMg) level is associated with increased all-cause mortality risk in patients on maintenance hemodialysis. However, the relationships between the level of ionized Mg (Mg<sup>2+</sup>), an “active form” of magnesium, and mortality remain unclear. We examined this issue in a cohort of 249 patients (median age: 71&#xa0;years, male 64%) who were enrolled from August 2021 to July 2022 (Mg<sup>2+</sup> monitoring period) at our institute. The associations of all-cause mortality with Mg<sup>2+</sup> levels were analyzed by the use of tertiles of Mg<sup>2+</sup> levels (Mg<sup>2+</sup>-T1, &lt; 0.55; Mg<sup>2+</sup>-T2, 0.54–0.64; Mg<sup>2+</sup>-T3, &gt; 0.64&#xa0;mmol/L) or tsMg levels (tsMg-T1, &lt; 0.92; tsMg-T2, 0.92–1.04; tsMg-T3, &gt; 1.07&#xa0;mmol/L) at baseline. Multivariate Cox regression analysis indicated that high Mg<sup>2+</sup> levels were associated with an increased risk of all-cause mortality (hazard ratio [HR] = 2.09, 95% confidence interval [CI] 1.20–3.63 in Mg<sup>2+</sup>-T3; HR = 0.97, 95% CI 0.52–1.81 in Mg<sup>2+</sup>-T1, with Mg<sup>2+</sup>-T2 as the reference), along with advanced age, high corrected serum calcium level, low serum albumin, and pre-existing cardiovascular diseases. Such an association with mortality was not detected for the tsMg tertiles. The association of high Mg<sup>2+</sup> levels with all-cause mortality risk was confirmed by restricted mean survival time analysis and sensitivity analyses using continuous Mg<sup>2+</sup> values and a subgroup of patients without magnesium supplements. These findings support the notion that elevated Mg<sup>2+</sup> levels are an independent risk factor for mortality and merits being monitored in hemodialysis patients.</p>

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Elevation of ionized magnesium level in the blood is a risk factor for mortality in patients undergoing maintenance hemodialysis

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  • 发表日期：

    2025年11月2日

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  • Makoto Fukushima,
  • Kenjiro Kikuchi,
  • Masayuki Koyama,
  • Hirofumi Ohnishi,
  • Akihito Tsuchida,
  • Tetsuji Miura

摘要

Hypomagnesemia status assessed with the total serum magnesium (tsMg) level is associated with increased all-cause mortality risk in patients on maintenance hemodialysis. However, the relationships between the level of ionized Mg (Mg2+), an “active form” of magnesium, and mortality remain unclear. We examined this issue in a cohort of 249 patients (median age: 71 years, male 64%) who were enrolled from August 2021 to July 2022 (Mg2+ monitoring period) at our institute. The associations of all-cause mortality with Mg2+ levels were analyzed by the use of tertiles of Mg2+ levels (Mg2+-T1, < 0.55; Mg2+-T2, 0.54–0.64; Mg2+-T3, > 0.64 mmol/L) or tsMg levels (tsMg-T1, < 0.92; tsMg-T2, 0.92–1.04; tsMg-T3, > 1.07 mmol/L) at baseline. Multivariate Cox regression analysis indicated that high Mg2+ levels were associated with an increased risk of all-cause mortality (hazard ratio [HR] = 2.09, 95% confidence interval [CI] 1.20–3.63 in Mg2+-T3; HR = 0.97, 95% CI 0.52–1.81 in Mg2+-T1, with Mg2+-T2 as the reference), along with advanced age, high corrected serum calcium level, low serum albumin, and pre-existing cardiovascular diseases. Such an association with mortality was not detected for the tsMg tertiles. The association of high Mg2+ levels with all-cause mortality risk was confirmed by restricted mean survival time analysis and sensitivity analyses using continuous Mg2+ values and a subgroup of patients without magnesium supplements. These findings support the notion that elevated Mg2+ levels are an independent risk factor for mortality and merits being monitored in hemodialysis patients.