Diabetes Mellitus Modifies the Associations of Serum Magnesium Concentration With Arterial Calcification and Stiffness In Incident Hemodialysis Patients

Overview

Journal Kidney Int Rep

Publisher Elsevier

Specialty Nephrology

Date 2019 Jun 14

PMID 31194171

Citations 4

Authors

Wei Chen

Jessica Fitzpatrick

Jose M Monroy-Trujillo

Stephen M Sozio

Bernard G Jaar

Michelle M Estrella

Tong Tong Wu

Michal L Melamed

Rulan S Parekh

David A Bushinsky

Affiliations

Soon will be listed here.

Abstract

Introduction: Magnesium (Mg) may protect against arterial calcification. We tested the hypotheses that a higher serum Mg concentration is associated with less arterial calcification and stiffness in patients on hemodialysis (HD) and that these associations are modified by diabetes mellitus.

Methods: We performed cross-sectional analyses of 367 incident HD patients from the Predictors of Arrhythmic and Cardiovascular Risk in End Stage Renal Disease (PACE) cohort. Measures of arterial calcification and stiffness included coronary arterial calcification (CAC) and thoracic aortic calcification (TAC) scores, ankle brachial index (ABI; high ABI: >1.4 or incompressible vessels), pulse wave velocity (PWV), and pulse pressure.

Results: Mean Mg was 1.8 ± 0.2 mEq/l and 58% had diabetes. Among nondiabetic individuals, per 0.1 mEq/l higher Mg, non-zero CAC score was lower (% difference: -15.4%; 95% confidence interval [CI]: -28% to -0.55%; = 0.03), the odds of having TAC score >0 and the odds of having high ABI were lower (odds ratio [OR]: 0.66; 95% CI 0.47-0.93; = 0.02, and 0.23; 95% CI: 0.06-0.83, = 0.03, respectively) while adjusting for demographics, comorbidities, markers of mineral metabolism, and dialysis clearance. Among diabetic individuals, per 0.1 mEq/l higher Mg, the odds of having TAC score >0 was higher (OR: 1.57; 95% CI: 1.09-2.26; = 0.02). Mg was not associated with CAC or high ABI among diabetic individuals. Mg was not associated with PWV or pulse pressure regardless of diabetes status.

Conclusion: Diabetes modified the associations of serum Mg with arterial calcification and stiffness in incident HD patients. Higher Mg was associated with less arterial calcification and less peripheral arterial stiffness among nondiabetic individuals, but Mg was only associated with TAC among diabetic individuals with higher Mg being associated with higher likelihood of having TAC score >0.

Citing Articles

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Magnesium and Zinc Intake Ratio Mediates the Increase of Coronary Artery Calcification through Upregulating Interleukin 6.

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Magnesium to prevent kidney disease-associated vascular calcification: crystal clear?.

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References

Tintut Y, Patel J, Parhami F, Demer L . Tumor necrosis factor-alpha promotes in vitro calcification of vascular cells via the cAMP pathway. Circulation. 2000; 102(21):2636-42. DOI: 10.1161/01.cir.102.21.2636. View

Tamashiro M, Iseki K, Sunagawa O, Inoue T, HIGA S, Afuso H . Significant association between the progression of coronary artery calcification and dyslipidemia in patients on chronic hemodialysis. Am J Kidney Dis. 2001; 38(1):64-9. DOI: 10.1053/ajkd.2001.25195. View

London G, Guerin A, Marchais S, Metivier F, Pannier B, Adda H . Arterial media calcification in end-stage renal disease: impact on all-cause and cardiovascular mortality. Nephrol Dial Transplant. 2003; 18(9):1731-40. DOI: 10.1093/ndt/gfg414. View

Mohler 3rd E . Peripheral arterial disease: identification and implications. Arch Intern Med. 2003; 163(19):2306-14. DOI: 10.1001/archinte.163.19.2306. View

Tzanakis I, Virvidakis K, Tsomi A, Mantakas E, Girousis N, Karefyllakis N . Intra- and extracellular magnesium levels and atheromatosis in haemodialysis patients. Magnes Res. 2004; 17(2):102-8. View

Giachelli C . Vascular calcification mechanisms. J Am Soc Nephrol. 2004; 15(12):2959-64. DOI: 10.1097/01.ASN.0000145894.57533.C4. View

Mehrotra R, Budoff M, Hokanson J, Ipp E, Takasu J, Adler S . Progression of coronary artery calcification in diabetics with and without chronic kidney disease. Kidney Int. 2005; 68(3):1258-66. DOI: 10.1111/j.1523-1755.2005.00522.x. View

Pham P, Pham P, V Pham S, Miller J, Pham P . Hypomagnesemia in patients with type 2 diabetes. Clin J Am Soc Nephrol. 2007; 2(2):366-73. DOI: 10.2215/CJN.02960906. View

Ishimura E, Okuno S, Kitatani K, Tsuchida T, Yamakawa T, Shioi A . Significant association between the presence of peripheral vascular calcification and lower serum magnesium in hemodialysis patients. Clin Nephrol. 2007; 68(4):222-7. DOI: 10.5414/cnp68222. View

10.

Turgut F, Kanbay M, Metin M, Uz E, Akcay A, Covic A . Magnesium supplementation helps to improve carotid intima media thickness in patients on hemodialysis. Int Urol Nephrol. 2008; 40(4):1075-82. DOI: 10.1007/s11255-008-9410-3. View

11.

Shroff R, McNair R, Skepper J, Figg N, Schurgers L, Deanfield J . Chronic mineral dysregulation promotes vascular smooth muscle cell adaptation and extracellular matrix calcification. J Am Soc Nephrol. 2009; 21(1):103-12. PMC: 2799273. DOI: 10.1681/ASN.2009060640. View

12.

Gorgels T, Waarsing J, de Wolf A, Ten Brink J, Loves W, Bergen A . Dietary magnesium, not calcium, prevents vascular calcification in a mouse model for pseudoxanthoma elasticum. J Mol Med (Berl). 2010; 88(5):467-75. PMC: 2859158. DOI: 10.1007/s00109-010-0596-3. View

13.

Montezano A, Zimmerman D, Yusuf H, Burger D, Chignalia A, Wadhera V . Vascular smooth muscle cell differentiation to an osteogenic phenotype involves TRPM7 modulation by magnesium. Hypertension. 2010; 56(3):453-62. DOI: 10.1161/HYPERTENSIONAHA.110.152058. View

14.

Hassan N, DOrsi E, DOrsi C, ONeill W . The risk for medial arterial calcification in CKD. Clin J Am Soc Nephrol. 2011; 7(2):275-9. PMC: 3280033. DOI: 10.2215/CJN.06490711. View

15.

Block G, Wheeler D, Persky M, Kestenbaum B, Ketteler M, Spiegel D . Effects of phosphate binders in moderate CKD. J Am Soc Nephrol. 2012; 23(8):1407-15. PMC: 3402292. DOI: 10.1681/ASN.2012030223. View

16.

Shroff R, Long D, Shanahan C . Mechanistic insights into vascular calcification in CKD. J Am Soc Nephrol. 2012; 24(2):179-89. DOI: 10.1681/ASN.2011121191. View

17.

Aboyans V, Criqui M, Abraham P, Allison M, Creager M, Diehm C . Measurement and interpretation of the ankle-brachial index: a scientific statement from the American Heart Association. Circulation. 2012; 126(24):2890-909. DOI: 10.1161/CIR.0b013e318276fbcb. View

18.

Louvet L, Buchel J, Steppan S, Passlick-Deetjen J, Massy Z . Magnesium prevents phosphate-induced calcification in human aortic vascular smooth muscle cells. Nephrol Dial Transplant. 2012; 28(4):869-78. PMC: 3611891. DOI: 10.1093/ndt/gfs520. View

19.

Mortazavi M, Moeinzadeh F, Saadatnia M, Shahidi S, McGee J, Minagar A . Effect of magnesium supplementation on carotid intima-media thickness and flow-mediated dilatation among hemodialysis patients: a double-blind, randomized, placebo-controlled trial. Eur Neurol. 2013; 69(5):309-16. DOI: 10.1159/000346427. View

20.

Avramovski P, Janakievska P, Sotiroski K, Sikole A . Accelerated progression of arterial stiffness in dialysis patients compared with the general population. Korean J Intern Med. 2013; 28(4):464-74. PMC: 3712155. DOI: 10.3904/kjim.2013.28.4.464. View