Abstract
Background: Serum magnesium levels are associated with cardiovascular disease and all-cause mortality in the general population and chronic kidney disease patients, but the association between serum magnesium levels and cardiovascular risk after kidney transplantation is not established. We sought to evaluate whether exposure to low serum magnesium levels after renal transplantation is related to cardiovascular morbidity and mortality.Methods: We conducted a single center retrospective study that included all transplanted patients who had a functioning graft for at least 6 months after transplantation between January 2001 and December 2013. We calculated exposure to magnesium using time weighted average for serum magnesium levels, using all values available during the follow-up. Several statistical methods were used, including liner regression analysis, χ2 test, and multivariate Cox proportional hazard model.Results: Four hundred ninety-eight patients were included. Median follow-up was 5.26 years. High time weighted average of serum magnesium was associated with a hazard ratio of 1.94 for all-cause mortality and major cardiovascular outcome compared to low levels (95% CI 1.18–3.19, p = 0.009). The high quartile of time weighted average of serum magnesium was associated with death censored major cardiovascular outcome (hazard ratio 2.13, 95% CI 1.17–3.86, p = 0.013) in multivariate analysis.Conclusions: Exposure to low serum magnesium levels in renal transplant recipients was associated with a lower risk for all-cause mortality and major cardiovascular outcome. These findings contrast the higher risk found in the general population.
Highlights
Magnesium (Mg) is the second most prevalent intracellular cation [1] and has a vital role in cellular and biological processes
We evaluated cumulative TWA of Serum magnesium (sMg) from time of transplantation for each time point, by calculating TWA between the time of Abbreviations: BMI, body mass index; CHF, congestive heart failure; CI, Confidence Interval; CKD, chronic kidney disease; CNI, calcineurin inhibitors; CV, cardiovascular; CVA, cerebrovascular accident; CVD, cardiovascular disease; estimated glomerular filtrate rate (eGFR), estimate glomerular filtrate rate; HBA1C, hemoglobin A1C; HDL, Highdensity lipoprotein; HR, Hazard Ratio; ischemic heart disease (IHD), Ischemic Heart Disease; IQR, interquartile range; LDL, low-density lipoprotein; MACE, major cardiovascular outcome; Mg, magnesium; MI, myocardial infarction; PPI, proton-pump inhibitors; PVD, peripheral vascular disease; WBC, white blood cells; sMg, serum magnesium; TWA, time weighted average
Low TWA of serum magnesium was associated with younger donor age, higher estimated glomerular filtrate rate, treatment with magnesium supplementation, and non-smoker status
Summary
Magnesium (Mg) is the second most prevalent intracellular cation [1] and has a vital role in cellular and biological processes. Data from epidemiological studies suggests that low sMg levels are associated with increased cardiovascular disease (CVD) and all-cause mortality in the general population [3, 4]. In chronic kidney disease (CKD) patients, there is an increasing body of evidence for an inverse association between sMg and insulin resistance, new onset diabetes [5], hypertension [6], atherosclerosis [7], inflammation [8], CVD [3, 9], vascular calcification [10], dyslipidemia [11], and renal function decline and mortality risk [12, 13]. We sought to evaluate whether exposure to low serum magnesium levels after renal transplantation is related to cardiovascular morbidity and mortality
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