Skip to main content
SpringerLink
Log in

Magnesium supplementation helps to improve carotid intima media thickness in patients on hemodialysis

  • Nephrology-Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Background

The atherosclerotic process progresses more dynamically in hemodialysis (HD) patients than in the general population. In HD patients, lower magnesium levels were reported to be associated with increased atherosclerosis of the common carotid artery. We tested the hypotheses that magnesium supplementation helps to improve carotid intima media thickness (IMT) in HD patients.

Materials and methods

A total of 47 patients on HD were included in the study. Patients were randomly divided into two groups: group A (Mg group), in which patients were given magnesium citrate orally at a dosage of 610 mg every other day for 2 months and group B (control group), in which patients received only calcium acetate therapy as a phosphate binder. At baseline and 2 months later, all patients underwent a carotid artery ultrasound scan to measure carotid IMT.

Results

At the end of 2 months, mean serum calcium, phosphorus, and calcium × phosphorus product were not changed in both groups. As expected, mean serum Mg level significantly increased in the Mg group at the end of 2 months. In addition, serum parathyroid hormone (PTH) level significantly decreased in the Mg group at the end of 2 months (P = 0.003). Baseline carotid IMT was similar between the groups. Bilateral carotid IMT was significantly improved in patients treated with magnesium citrate compared to initial values (P = 0.001 for left, P = 0.002 for right).

Conclusion

Based on the present data, magnesium may play an important protective role in the progression of atherosclerosis in patients on dialysis. Further studies are needed to assess more accurately the role of magnesium in atherosclerotic regression in dialysis patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Collins AJ, Li S, Ma JZ et al (2001) Cardiovascular disease in end-stage renal disease patients. Am J Kidney Dis 38(4) (Suppl 1):26–29. doi:10.1053/ajkd.2001.27392

    Google Scholar 

  2. Foley RN, Parfrey PS, Sarnak MJ (1998) Epidemiology of cardiovascular disease in chronic renal disease. J Am Soc Nephrol 9(Suppl 12):16–23. doi:10.1159/000051199

    Google Scholar 

  3. United States Renal Data Systems (2006) Annual data report. US, Minneapolis, MN

    Google Scholar 

  4. Soubassi LP, Chiras TC, Papadakis ED, Poulos GD, Chaniotis DI, Tsapakidis IP, Soubassi SP, Zerefos SN, Zerefos NS, Valis DA (2006) Incidence and risk factors of coronary heart disease in elderly patients on chronic hemodialysis. Int Urol Nephrol 38(3–4):795–800

    PubMed  Google Scholar 

  5. Vanholder R, Meert N, Schepers E et al European Uremic Toxin Work Group(EUTox) (2007) Review on uraemic solutes II–variability in reported concentrations: causes and consequences. Nephrol Dial Transplant 22:3115–3121. doi:10.1093/ndt/gfm151

  6. Bots ML, Hoes AW, Koudstaal PJ et al (1997) Common carotid intima-media thickness and risk of stroke and myocardial infarction: the Rotterdam study. Circulation 96:1432–1437

    PubMed  CAS  Google Scholar 

  7. Buzello M, Törnig J, Faulhaber J et al (2003) The apolipoprotein e knockout mouse: a model documenting accelerated atherogenesis in uremia. J Am Soc Nephrol 14:311–316. doi:10.1097/01.ASN.0000045048.71975.FC

    Article  PubMed  CAS  Google Scholar 

  8. Schwarz U, Buzello M, Ritz E et al (2000) Morphology of coronary atherosclerotic lesions in patients with end-stage renal failure. Nephrol Dial Transplant 15:218–223. doi:10.1093/ndt/15.2.218

    Article  PubMed  CAS  Google Scholar 

  9. Covic A, Mardare N, Gusbeth-Tatomir P et al (2006) Increased arterial stiffness in children on haemodialysis. Nephrol Dial Transplant 21:729–735. doi:10.1093/ndt/gfi196

    Article  PubMed  Google Scholar 

  10. Massy ZA, Ivanovski O, Nguyen-Khoa T et al (2005) Uremia accelerates both atherosclerosis and arterial calcification in apolipoprotein E knockout mice. J Am Soc Nephrol 16:109–116. doi:10.1681/ASN.2004060495

    Article  PubMed  CAS  Google Scholar 

  11. Bursztyn M, Motro M, Grossman E et al (2003) Accelerated coronary artery calcification in mildly reduced renal function of high-risk hypertensives: a 3-year prospective observation. J Hypertens 21:1953–1959. doi:10.1097/00004872-200310000-00024

    Article  PubMed  CAS  Google Scholar 

  12. Block GA, Hulbert-Shearon TE, Levin NW et al (1998) Association of serum phosphorus and calciumxphosphate product with mortality risk in chronic hemodialysis patients: a national study. Am J Kidney Dis 31:607–617. doi:10.1053/ajkd.1998.v31.pm9531176

    Article  PubMed  CAS  Google Scholar 

  13. Ganesh SK, Stack AG, Levin NW et al (2001) Association of elevated serum PO(4), CaxPO(4) product, and parathyroid hormone with cardiac mortality risk in chronic hemodialysis patients. J Am Soc Nephrol 12:2131–2138

    PubMed  CAS  Google Scholar 

  14. Wei M, Esbaei K, Bargman JM, Oreopoulos DG (2006) Inverse correlation between serum magnesium and parathyroid hormone in peritoneal dialysis patients: a contributing factor to adynamic bone disease? Int Urol Nephrol 38(2):317–322

    Article  PubMed  CAS  Google Scholar 

  15. Liao F, Folsom AR, Brancati FL (1998) Is low magnesium concentration a risk factor for coronary heart disease? The Atherosclerosis Risk in Communities (ARIC) study. Am Heart J 136:480–490. doi:10.1016/S0002-8703(98)70224-8

    Article  PubMed  CAS  Google Scholar 

  16. Ma J, Folsom AR, Melnick SL et al (1995) Associations of serum and dietary magnesium with cardiovascular disease, hypertension, diabetes, insulin, and carotid arterial wall thickness: the ARIC study. Atherosclerosis Risk in Communities study. J Clin Epidemiol 48:927–940. doi:10.1016/0895-4356(94)00200-A

    Article  PubMed  CAS  Google Scholar 

  17. Wei M, Esbaei K, Bargman J (2006) Relationship between serum magnesium, parathyroid hormone, and vascular calcification in patient on dialysis: a literature review. Perit Dial Int 26:366–373

    PubMed  CAS  Google Scholar 

  18. Tzanakis I, Virvidakis K, Tsomi A et al (2004) Intra- and extracellular magnesium levels and atheromatosis in hemodialysis patients. Magnes Res 17:102–108

    PubMed  CAS  Google Scholar 

  19. Lindeman RD (1986) Chronic renal failure and magnesium metabolism. Magnesium 5:293–300

    PubMed  CAS  Google Scholar 

  20. Guillot AP, Hood VL, Runge CF et al (1982) The use of magnesium–containing phosphate binders in patients with end-stage renal disease on maintenance hemodialysis. Nephron 30:114–117

    PubMed  CAS  Google Scholar 

  21. Fabbian F, Cacici G, Franceschini L et al (2007) The relationship between carotid and coronary atherosclerotic damage in dialysis patients. Int J Artif Organs 30:315–320

    PubMed  CAS  Google Scholar 

  22. Kawagishi T, Nishizawa Y, Konishi T et al (1995) High-resolution B-mode ultrasonography in evaluation of atherosclerosis in uremia. Kidney Int 48:820–826. doi:10.1038/ki.1995.356

    Article  PubMed  CAS  Google Scholar 

  23. Grobbee DE, Bots ML (1994) Carotid artery intima-media thickness as an indicator of generalized atherosclerosis. J Intern Med 236:567–573

    Article  PubMed  CAS  Google Scholar 

  24. Lorenz MW, Markus HS, Bots ML et al (2007) Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and meta-analysis. Circulation 115:459–467. doi:10.1161/CIRCULATIONAHA.106.628875

    Article  PubMed  Google Scholar 

  25. Parfrey PS, Foley RN (1999) The clinical epidemiology of cardiac disease in chronic renal failure. J Am Soc Nephrol 10:1606–1615

    PubMed  CAS  Google Scholar 

  26. Nishizawa Y, Shoji T, Kawagishi T et al (1997) Atherosclerosis in uremia: possible roles of hyperparathyroidism and intermediate density lipoprotein accumulation. Kidney Int 62:90–92

    Google Scholar 

  27. Altura BT, Brust M, Bloom S et al (1990) Magnesium dietary intake modulates blood lipid levels and atherogenesis. Proc Natl Acad Sci USA 87:1840–1844. doi:10.1073/pnas.87.5.1840

    Article  PubMed  CAS  Google Scholar 

  28. Mazur A, Maier JA, Rock E et al (2007) Magnesium and the inflammatory response: potential physiopathological implications. Arch Biochem Biophys 458:48–56. doi:10.1016/j.abb.2006.03.031

    Article  PubMed  CAS  Google Scholar 

  29. Malpuech-Brugère C, Nowacki W, Gueux E et al (1999) Accelerated thymus involution in magnesium-deficient rats is related to enhanced apoptosis and sensitivity to oxidative stress. Br J Nutr 81:405–411

    PubMed  Google Scholar 

  30. Rukshin V, Azarbal B, Shah PK et al (2001) Intravenous magnesium in experimental stent thrombosis in swine. Arterioscler Thromb Vasc Biol 21:1544–1549. doi:10.1161/hq0901.094493

    Article  PubMed  CAS  Google Scholar 

  31. Touyz RM (2003) Role of magnesium in the pathogenesis of hypertension. Mol Aspects Med 24:107–136. doi:10.1016/S0098-2997(02)00094-8

    Article  PubMed  CAS  Google Scholar 

  32. Boskey AL, Posner AS (1980) Effect of magnesium on lipid-induced calcification: an in vitro model for bone mineralization. Calcif Tissue Int 32:139–143. doi:10.1007/BF02408533

    Article  PubMed  CAS  Google Scholar 

  33. Altura BM, Altura BT, Gebrewold A et al (1984) Magnesium deficiency and hypertension: correlation between magnesium-deficient diets and microcirculatory changes in situ. Science 223:1315–1317. doi:10.1126/science.6701524

    Article  PubMed  CAS  Google Scholar 

  34. Meema HE, Oreopoulos DG, Rapoport A (1987) Serum magnesium level and arterial calcification in end-stage renal disease. Kidney Int 32:388–394. doi:10.1038/ki.1987.222

    Article  PubMed  CAS  Google Scholar 

  35. Ouchi Y, Tabata RE, Stergiopoulos K et al (1990) Effect of dietary magnesium on development of atherosclerosis in cholesterol-fed rabbits. Arteriosclerosis 10:732–737

    PubMed  CAS  Google Scholar 

  36. Orimo H, Ouchi Y (1990) The role of calcium and magnesium in the development of atherosclerosis. Experimental and clinical evidence. Ann N Y Acad Sci 598:444–457. doi:10.1111/j.1749-6632.1990.tb42315.x

    Article  PubMed  CAS  Google Scholar 

  37. Abbott RD, Ando F, Masaki KH (2003) Dietary magnesium intake and the future risk of coronary heart disease (the Honolulu Heart Program). Am J Cardiol 92:665–669. doi:10.1016/S0002-9149(03)00819-1

    Article  PubMed  CAS  Google Scholar 

  38. Neglen P, Qvarfordt P, Eklof B (1985) Peroral magnesium hydroxide therapy and intermittent claudication—a preliminary report. Vasa 14:285–288

    PubMed  CAS  Google Scholar 

  39. Tahara H, Nishizawa Y (2007) Hypomagnesemia and hypoparathyroidism. Clin Calcium 17:1200–1204

    PubMed  CAS  Google Scholar 

  40. Navarro-González JF (1998) Magnesium in dialysis patients: serum levels and clinical implications. Clin Nephrol 49:373–378

    PubMed  Google Scholar 

  41. Navarro JF, Mora C, Jiménez A (1999) Relationship between serum magnesium and parathyroid hormone levels in hemodialysis patients. Am J Kidney Dis 34:43–48. doi:10.1016/S0272-6386(99)70106-X

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Section of Nephrology, Fatih University School of Medicine, Hosdere cad no:145, Y. Ayranci, 06540, Ankara, Turkey

    Faruk Turgut, Mehmet Kanbay, Ebru Uz & Ali Akcay

  2. Department of Radiology, Fatih University School of Medicine, Ankara, Turkey

    Melike Rusen Metin

  3. Department of Nephrology Clinic and Dialysis and Transplantation Center, “C. I. PARHON” University Hospital, Lasi, Romania

    Adrian Covic

Authors
  1. Faruk Turgut
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mehmet Kanbay
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Melike Rusen Metin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ebru Uz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ali Akcay
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Adrian Covic
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Faruk Turgut.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Turgut, F., Kanbay, M., Metin, M.R. et al. Magnesium supplementation helps to improve carotid intima media thickness in patients on hemodialysis. Int Urol Nephrol 40, 1075–1082 (2008). https://doi.org/10.1007/s11255-008-9410-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-008-9410-3

Keywords

Search

Navigation