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. 2023 Mar 31;15(7):1710. doi: 10.3390/nu15071710

Table 1.

Characteristics of the studies included in this review are divided into sections relevant to the purpose of this study. Abbreviations: Magnesium (Mg), chronic kidney disease (CKD), Estimated Glomerular Filtration Rate (eGFR), Modification of Diet in Renal Disease Equation (MDRD), Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI).

Authors Year Type of Study Mean Age or Range and Sex Population Date Measures Results
Kanbay et. al. [65] 2012 Observational cohort study.
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    51 years.

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    Stage 3: (29–71 years, Male/Female: 48/53).

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    Stage 4: (31–73 years, Male/Female: 46/40).

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    Stage 5: (28–71 years, Male/Female: 45/51).

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    283 patients (101 in stage 3, 86 in stage 4, and 96 in stage 5). Of the Renal Unit of the Gulhane School of Medicine Medical Center, Ankara, Turkey

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    Between March 2006 and December 2010.

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    The mean follow-up period was 38 months.

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    eGFR was calculated using the MDRD (Modification of Diet in Renal Disease).

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    eGFR was treated as a continuous variable.

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    Strong positive correlation between flow-mediated dilation and Mg values.

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    A higher Mg level is associated with less endothelial dysfunction (p < 0.001).

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    A higher level of Mg may protect against endothelial damage and is associated with better survival.

Wyskida et. al. [66] 2012 Prospective, open-label, cross-sectional clinical study.
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    54.4 ± 14.6 years.

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    58 males and 43 females.

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    Control group: 10 males and 10 females.

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    101 hemodialysis patients and 20 patients with normal kidney function.

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    Katowice, Poland.

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    Between 2011 and 2012.

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    Hemodialysis three times per week for 4 to 5 h (12.7 ± 1.1 h weekly).

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    Carbohydrate dialysate fluid containing: 0.75 mmol/L of Mg and polysulfone or cuprofane dialysis membranes was used.

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    Control group: mean serum Mg concentration was 0.89 ± 0.06 mmol/L.

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    The average serum Mg concentration before hemodialysis was 1.32 ± 0.18 mmol/L, which was 48% higher than in the control group.

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    Hypermagnesemia (≥1.5 mmol/L) was found in 81.2% of hemodialysis patients.

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    With a higher prevalence in males (odds ratio = 1.98 [0.64 to 6.13], p = 23).

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    Strong positive correlation between daily intake of Mg and its serum concentration in hemodialysis patients (r = 0.870, p < 0.001).

Van Laecke et. al. [67] 2013 Retrospective cohort study.
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    57.4 ± 17.3 years

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    56.1% were male.

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    1650 patients (stage 1: 22%; stage 2: 31.7%; stage 3a: 18.1%; stage 3b: 16.2%; stage 4: 10.8%; and stage 5: 1.2%).

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    Outpatient clinic of the nephrology unit of the tertiary university hospital.

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    Between January 2002 and June 2011.

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    A median follow-up of 5.1 years.

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    eGFR was calculated using the abbreviated MDRD (Modification of Diet in Renal Disease).

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    Mg was analyzed as a continuous, based on the lower and upper normal limits of the laboratory (3 groups: <1.8 mg/dL, 1.8–2.2 mg/dL, and >2.2 mg/dL).

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    Low serum Mg levels predict higher mortality in CKD, independent of the initial degree of renal impairment.

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    Mg concentrations were related to the rate of kidney function decline after adjustment for age, sex, diabetes, and hypertension.

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    Low serum Mg predicts a faster decline in kidney function.

Sakaguchi et. al. [58] 2013 Observational cohort study
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    66.0 ± 12.5 years.

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    88,290 (61.9%) were male.

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    142,555 patients in the nationwide registry of patients with End Stage Renal Disease in Japan.

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    Between 2009 and 2010.

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    1-year follow-up of all-cause and cause-specific mortality.

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    The mean serum Mg level was 2.61 (0.52) mg/dl.

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    Lower serum Mg level was a significant and independent predictor of cardiovascular mortality among the chronic hemodialysis population.

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    Lower Mg level was significantly associated with older age, lower albumin, calcium, phosphate, and hemoglobin level, higher C-reactive protein and alkaline phosphate level, increased prevalence of diabetes mellitus, prior history of cardiovascular disease, and hip fracture.

Lacson et. al. [68] 2015 Observational retrospective cohort study.
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    61.7 ± 14.8 years.

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    11, 650 (54.1%) were male.

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    Follow-up analysis: 61.8 ± 14.8 years and 14,799 (53.7%) were male.

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    21,534 patients of Fresenius Medical Care North America outpatient dialysis facilities.

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    Follow-up analysis: n = 27,544 patients.

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    April 2007 through June 2008.

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    1-year follow-up.

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    Hypomagnesemia: Mg < 1.30 mEq/L; low, mid, and high-normal Mg levels: 1.30 to < 1.60, 1.60 to < 1.90, and 1.90 to 2.10 mEq/L, respectively.

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    Hypermagnesemia: >2.10 mEq/L.

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    The mid-normal range (1.60 to <1.90 mEq/L) was used as the reference group.

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    The mean serum Mg level was higher overall that the prescribed dialysate mg concentration, with a positive correlation (PC: R = 0.22; p < 0.001).

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    Increasing serum Mg levels were associated with decreasing 1-year mortality risk.

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    Patients with serum Mg levels > 2.10 mEq/L had a survival advantage (HR, 0.89; 95% CI, 0.80–0.95).

Rebholz et. al. [69] 2016 Prospective cohort study.
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    47 years.

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    41% were male.

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    1252 HANDLS study participants (Baltimore, Maryland, USA).

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    August 2004–March 2009.

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    Dietary Mg intake was 116 (96–356) mg/1000 kcal.

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    The mean baseline eGFR in the overall study population was 97 mL/min/1.73 m2.

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    eGFR was calculated using the CKD- EPI equation.

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    Increased probability of rapid deterioration of renal function in association with low dietary intake of Mg (eGFR 100 vs. 94 mL/min /1.73 m2; p < 0.001).

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    Dietary intake of Mg was associated with rapid kidney function decline independent of multiple kidney disease risk factors.

Ferrè et. al. [70] 2017 A multiethnic, population-based, cohort study.
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    30–65 years.

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    47.2% were male.

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    3551 participants from Dallas County, USA.

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    Non- CKD (n = 3245)

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    CKD (n = 306)

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    Between 2007 and 2009.

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    Subjects followed over a median period of 12.3 years.

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    Serum Mg was normally distributed with a mean ± SD value of 2.07 ± 18 mg/dL (0.85 ± 0.07 mM) in the entire cohort, and 2.08 ± 0.19 mg/dL (0.85 ± 0.08 mM) in the CKD and 2.07 ± 0.18 mg/dL (0.85 ± 0.07) in the non-CKD subgroups.

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    eGFR was calculated using the CKD- EPI equation and the MDRD.

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    Low serum Mg levels are independently associated with a higher risk of all-cause death in patients with prevalent early-stage CKD.

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    And is a significant predictor of death in pre-dialysis CKD patients or patients undergoing hemodialysis.

Farhadnejad et. al. [71] 2016 Prospective population-based cohort study.
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    43.3 ± 11.4 years.

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    49.2% were men.

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    1692 patients from 3 medical health centers in Tehran, Iran.

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    Non- CKD: n = 1519; CKD: n = 173.

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    From 2006 to 2008.

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    During a median follow-up of 3.6 years.

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    CKD was defined as eGFR < 60 mL/min//1.73 m2.

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    eGFR was calculated using the abbreviated MDRD (Modification of Diet in Renal Disease).

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    Dietary intakes were collected using a food frequency questionnaire.

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    Higher intakes of Mg (OR: 0.41, 95% CI: 0.22–0.76) were significantly associated with a lower risk of CKD.

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    The protective effect of Mg (estimated average requirement: 581 mg) decreases the risk of CKD by 60%.

Azem et. al. [63] 2020 Observational cohort study.
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    68.7 ± 13.3 years.

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    47% were men.

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    10,568 patients from the Cleveland Clinic CKD registry, USA)

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    From 2005 to December 2014.

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    During a median follow-up of 3.7 years.

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    The mean eGFR of the study population was 46.3 mL/min/1.73 m2.

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    eGFR was calculated using the CKD- EPI equation.

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    Serum Mg was classified based on the normal range into the following categories: <1.7, 1.7–2.6, and >2.6 mg/dL.

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    Mg data obtained within one year prior to the second e

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    GFR < 60 mL/min/1.73 m2 was included.

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    U-shaped association between serum Mg levels and mortality, with both hypomagnesemia and hypermagnesemia (HR = 1.23, 95% CI: 1.03, 1.48).

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    No association between serum Mg levels and the rate of eGFR decline in CKD patients.

Galán Carrillo et. al. [64] 2021 Retrospective observational cohort study.
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    70 ± 13 years.

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    62.9% were male.

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    746 patients with CKD in a nephrology outpatient unit in Spain.

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    CKD grade 3: 45.2%; CKD grade 4: 35.9% (not on dialysis).

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    Between December 2010 and December 2012.

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    Followed up to December 2016.

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    Were followed for a mean of 42.6 months.

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    The mean serum Mg concentration was 2.09 ± 0.33 mg/dL.

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    eGFR was calculated using the CKD-EPI equation.

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    The use of calcitriol (p = 0.029) was associated with higher serum Mg concentration, while calcium supplements (p = 0.038) and proton pump (p = 0.026) inhibitors were associated with lower serum Mg concentration.

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    Loop diuretics demonstrated a statistically significant positive association with serum Mg (p < 0.001).

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    No association was found between serum Mg concentration and initiation of kidney replacement therapy.

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    Patients with hypermagnesemia (Mg > 2.2 mg/dL) had a higher risk of cardiovascular events (p = 0.028).