Serum magnesium and its association with vascular calcification in chronic kidney disease patients on haemodialysis

Prasanna K. B., Sharavanan T. V. K., Ekanthalingam S., Kannan I.


Background: Cardiovascular disease is one of the leading causes of death in chronic kidney disease (CKD). It has been observed that haemodialysis patients have a high prevalence of cardiac risk factors with further risk due to abnormal mineral metabolism. A study has demonstrated that a higher serum magnesium significantly decreased the mortality risk in haemodialysis patients and lower serum Mg level has been found to be associated with increased mortality in them. The aim of the study was to characterize the relationship between Mg level and vascular calcification in CKD patients.

Methods: It was a cross sectional study conducted in 100 CKD patients attending outpatient and inpatient ward of Tagore Medical College and Hospital, Chennai, Tamil Nadu, India. Serum magnesium levels will be measured using Xylidyl blue method. Carotid intimal medial thickness will be measured using Doppler.

Results: In the study 10 patients did not show the sign of any calcification. Among the remaining 90 patients, 42 patients showed calcification and 48 patients showed stenosis. The statistical analysis showed a spearman correlation coefficient value of 0.201 thus showing only a weak association.

Conclusion: The present study showed that only a weak relationship exists between the magnesium level and vascular calcification.


Chronic kidney disease, Haemodialysis patients, Magnesium level, Vascular calcification

Full Text:



Parfrey PS, Foley RN. The clinical epidemiology of cardiac disease in chronic renal failure. J Am Soc Nephrol. 1999;10:1606-15.

Block GA, Klassen PS, Lazarus JM, Ofsthun N, Lowrie EG, Chertow GM. Mineral metabolism, mortality, and morbidity in maintenance hemodialysis. J Am Soc Nephrol. 2004;15:2208-18.

Hunt JL, Fairman R, Mitchell ME. Bone formation in carotid plaques: a clinicopathological study. Stroke. 2002;33:1214-9.

Blacher J, Demuth K, Guerin AP. Influence of biochemical alterations on arterial stiffness in patients with end-stage renal disease. Arterioscler Thromb Vasc Biol. 1998;18:535-41.

Speer MY, Giachelli CM. Regulation of cardiovascular calcification. Cardiovasc Pathol. 2004;13:63-70.

Giachelli CM. The emerging role of phosphate in vascular calcification. Kidney Int. 2009;75:890-97.

Shroff RC, McNair R, Figg N. Dialysis accelerates medial vascular calcification in part by triggering smooth muscle cell apoptosis. Circulation. 2008;118:1748-57.

Temmar M, Liabeuf S, Renard C, et al. Pulse wave velocity and vascular calcification at different stages of chronic kidney disease. J Hypertens. 2010;28:163-9.

Shroff RC, McNair R, Skepper JN. Chronic mineral dysregulation promotes vascular smooth muscle cell adaptation and extracellular matrix calcification. J Am Soc Nephrol. 2010;21:103-12.

El-Abbadi M, Giachelli CM. Mechanisms of vascular calcification. Adv Chronic Kidney Dis. 2007;14:54-66.

Nikolov IG, Mozar A, Drueke TB. Impact of disturbances of calcium and phosphate metabolism on vascular calcification and clinical outcomes in patients with chronic kidney disease. Blood Purif. 2009;27:350-59.

Boskey AL, Posner AS. Effect of magnesium on lipid-induced calcification: an in vitro model for bone mineralization. Cal Tissue Int. 1980;32:139-43.

Inagaki O, Syono T, Nakagawa K, Nishian Y, Takenaka Y, Takamitsu Y. Influence of magnesium deficiency on concentration of calcium in soft tissue of uremic rats. Ren Fail. 1996;18:847-54.

Montezano AC, Zimmerman D, Yusuf H, Burger D, Chignalia AZ, Wadhera V, et al. Vascular smooth muscle cell differentiation to an osteogenic phenotype involves TRPM7 modulation by magnesium. Hypertension. 2010;56:453-62.

Kircelli F, Peter ME, Sevinc Ok E, Celenk FG, Yilmaz M, Steppan S, et al. Magnesium reduces calcification in bovine vascular smooth muscle cells in a dose-dependent manner. Nephrol Dial Transplant. 2012;27:514-21.

Salem S, Bruck H, Bahlmann FH, Peter M, Deetjen PJ, Kretschmer A, et al. Relationship between magnesium and clinical biomarkers on inhibition of vascular calcification. Am J Nephrol. 2012;35:31-9.

Louvet L, Buchel J, Steppan S, Deetjen PJ, Massy ZA. Magnesium prevents phosphate-induced calcification in human aortic vascular smooth muscle cells. Nephrol Dial Transplant. 2013;28:869-78.

Oca MA, Guerrero F, Martinez-Moreno JM, Madueno JA, Herencia C, Peralta A, et al. Magnesium inhibits Wnt/beta-catenin activity and reverses the osteogenic transformation of vascular smooth muscle cells. PLoS One. 2014;9:e89525.

Xu J, Bai Y, Jin J, Zhang J, Zhang S, Cui L, et al. Magnesium modulates the expression levels of calcification-associated factors to inhibit calcification in a time-dependent manner. Exp Ther Med. 2015;9:1028-34.

Li L, Streja E, Rhee CM, Mehrotra R, Soohoo M, Brunelli SM, et al. Hypomagnesemia and mortality in incident hemodialysis patients. Am J Kidney Dis. 2015;66:1047-55.

Fein P, Weiss S, Ramos F, Singh P, Chattopadhyay J, Avram MM. Serum magnesium concentration is a significant predictor of mortality in peritoneal dialysis patients. Adv Perit Dial. 2014;30:90-3.

Ishimura E, Okuno S, Yamakawa T, Inaba M, Nishizawa Y. Serum magnesium concentration is a significant predictor of mortality in maintenance hemodialysis patients. Magnes Res. 2007;20:237-44.

Matias PJ, Azevedo A, Laranjinha I, Navarro D, Mendes M, Ferreira C, et al. Lower serum magnesium is associated with cardiovascular risk factors and mortality in haemodialysis patients. Blood purification. 2014;38(3-4):244-52.

London GM, Guérin AP, Marchais SJ. Arterial media calcification in end-stage renal disease: Impact on all-cause and cardiovascular mortality. Nephrol Dial Transplant. 2003;18:1731-1740.

Markowitz GS, Perazella MA. Acute phosphate nephropathy. Kidney Int. 2009;76:1027-34.

Del Gobbo LC, Imamura F, Wu JH, Oliveira Otto MC, Chiuve SE, Mozaffarian D. Circulating and dietary magnesium and risk of cardiovascular disease: a systematic review and meta-analysis of prospective studies. Am J Clin Nutr. 2013;98(1):160-73.

Nilsson P, Johansson SG, Danielson BG. Magnesium studies in hemodialysis patients before and after treatment with low dialysate magnesium. Nephron. 1984;37:25-29.

Sakaguchi Y, Hamano T, Nakano C. Association between density of coronary artery calcification and serum magnesium levels among patients with chronic kidney disease. PLoS One. 2016;11:e0163673.