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The Effect of Increasing Dialysate Magnesium on Serum Calcification Propensity in Subjects with End Stage Kidney Disease: A Randomized, Controlled Clinical Trial

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BACKGROUND AND OBJECTIVES: Serum calcification propensity is a novel functional test that quantifies the functionality of the humeral system of calcification control. Low serum calcification propensity is associated with higher risk of cardiovascular events and death in patients with ESKD. Increasing magnesium in serum increases (i.e., improves) serum calcification propensity in vitro, but so far, no clinical trials have investigated whether increasing serum magnesium increases serum calcification propensity in subjects with ESKD.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We conducted a single-center, randomized, double-blinded, parallel group, controlled clinical trial, in which we examined the effect of increasing dialysate magnesium from 1.0 to 2.0 mEq/L for 28 days compared with maintaining dialysate magnesium at 1.0 mEq/L on serum calcification propensity in subjects undergoing hemodialysis for ESKD. The primary end point was the value of calcification propensity, measured by T50, at the end of the intervention.

RESULTS: Fifty-nine subjects were enrolled in the trial, and of these, 57 completed the intervention and were analyzed for the primary outcome. In the standard dialysate magnesium group, serum calcification propensity was 233±81 minutes (mean±SD) at baseline (mean of days -7 and 0) and 229±93 minutes at follow-up (mean of days 21 and 28), whereas in the high dialysate magnesium group, serum calcification propensity was 247±69 minutes at baseline and 302±66 minutes at follow-up. The difference in serum calcification propensity between the two groups at follow-up (primary analysis) was 73 minutes (between-group difference; 95% confidence interval, 30 to 116; P<0.001), and the between-group difference in serum magnesium was 0.88 mg/dl (95% confidence interval, 0.66 to 1.10; P=0.001).

CONCLUSIONS: Increasing dialysate magnesium increases serum calcification propensity in subjects undergoing maintenance hemodialysis.

PODCAST: This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2018_08_21_CJASNPodcast_18_9_B.mp3.

Original languageEnglish
JournalClinical journal of the American Society of Nephrology : CJASN
Volume13
Issue number9
Pages (from-to)1373-1380
ISSN1555-9041
DOIs
Publication statusPublished - 2018

ID: 55070969