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2012 ; 5
(Suppl 1
): i52-i61
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Magnesium and outcomes in patients with chronic kidney disease: focus on vascular
calcification, atherosclerosis and survival
#MMPMID26069821
Massy ZA
; Drüeke TB
Clin Kidney J
2012[Feb]; 5
(Suppl 1
): i52-i61
PMID26069821
show ga
Patients with chronic kidney disease (CKD) have a high prevalence of vascular
calcification, and cardiovascular disease is the leading cause of death in this
population. However, the molecular mechanisms of vascular calcification, which
are multifactorial, cell-mediated and dynamic, are not yet fully understood. We
need to address ways to improve outcomes in CKD patients, both in terms of
vascular calcification and cardiovascular morbidity and mortality-and to these
ends, we investigate the role of magnesium. Magnesium's role in the pathogenesis
of vascular calcification has not been extensively studied. Nonetheless, several
in vitro and animal studies point towards a protective role of magnesium through
multiple molecular mechanisms. Magnesium is a natural calcium antagonist and both
human and animal studies have shown that low circulating magnesium levels are
associated with vascular calcification. Clinical evidence from observational
studies of dialysis patients has shown that low-magnesium levels occur
concurrently with mitral annular calcification, peripheral arterial calcification
and increased carotid intima-media thickness. Few interventional studies have
been performed. Two interventional studies suggest that there may be benefits
such as retardation of arterial calcification and/or reductions in carotid
intima-media thickness in response to magnesium supplementation in CKD patients,
though both studies have limitations. Finally, observational studies have shown
that low serum magnesium may be an independent risk factor for premature death in
CKD patients, and patients with mildly elevated serum magnesium levels could have
a survival advantage over those with lower magnesium levels.