Abstract
Magnesium, an essential mineral for human health, plays a pivotal role in the cardiovascular system. Epidemiological studies in the general population have found an association between lower dietary magnesium intake and an elevated risk of cardiovascular events. In addition, magnesium supplementation was shown to improve blood pressure control, insulin sensitivity, and endothelial function. The relationship between magnesium and cardiovascular prognosis among patients with chronic kidney disease (CKD) has been increasingly investigated as it is becoming evident that magnesium can inhibit vascular calcification, a prominent risk of cardiovascular events, which commonly occurs in CKD patients. Cohort studies in patients receiving dialysis have shown a lower serum magnesium level as a significant risk for cardiovascular mortality. Interestingly, the cardiovascular mortality risk associated with hyperphosphatemia is alleviated among those with high serum magnesium levels, consistent with in vitro evidence that magnesium inhibits high-phosphate induced calcification of vascular smooth muscle cells. Furthermore, a harmful effect of high phosphate on the progression of CKD is also attenuated among those with high serum magnesium levels. The potential usefulness of magnesium as a remedy for phosphate toxicity should be further explored by future intervention studies.
Highlights
Magnesium is an essential mineral for human health and acts as a co-factor for more than 500 enzymatic reactions in the body
We recently analyzed the density of coronary artery calcification of 109 non-dialysis chronic kidney disease (CKD) patients mainly with type 2 diabetes mellitus and showed that the density increased as serum magnesium levels became lower [28]
We examined the relationship between serum magnesium levels and cardiovascular mortality risk in a cohort of 142,555 patients undergoing hemodialysis with a one-year follow-up period [47]
Summary
Magnesium is an essential mineral for human health and acts as a co-factor for more than 500 enzymatic reactions in the body. A number of experimental studies have demonstrated that magnesium is protective against endothelial cell damage and oxidative stress [12]. Despite this evidence implicating magnesium as a protective mineral for the cardiovascular system, this divalent cation has received little attention in the field of chronic kidney disease. Given the huge impact of the dysregulated mineral and bone metabolism on cardiovascular risk of patients with CKD, where calcium, phosphate, and parathyroid hormone have been regarded as central players, magnesium may serve a unique function. We will summarize the recent advances of magnesium research in CKD with a particular focus on vascular calcification and phosphate toxicity
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