title: Relationship between serum magnesium levels and cardiovascular events in chronic kidney disease patients.
abstract: BACKGROUND
  Magnesium is an essential ion for all living cells because over 300 enzymes require the presence of magnesium for their catalytic action. To date, no group has evaluated magnesium as a cardiovascular risk factor in chronic kidney disease (CKD) subjects, in which closely interrelated factors and potential confounders such as endothelial dysfunction, insulin resistance (the homeostasis model assessment (HOMA) index) and inflammation (expressed as serum C-reactive protein (CRP) levels) were also considered.
  
  
  METHODS
  Between March 2006 and December 2010, 283 CKD patients were followed up for time-to-event analysis until the occurrence of fatal or nonfatal cardiovascular events. Endothelium-dependent vasodilatation (flow-mediated dilatation; FMD) and endothelium-independent vasodilatation (nitroglycerin-mediated dilatation) of the brachial artery were assessed noninvasively using high-resolution ultrasound.
  
  
  RESULTS
  From the univariate analysis of FMD, it appears that a higher magnesium level is associated with less endothelial dysfunction. When a multivariate analysis was performed, magnesium and estimated glomerular filtration rates (eGFR) maintained a strong positive correlation with FMD, supporting the hypothesis that higher levels of magnesium may protect against endothelial damage. In univariate Cox proportional hazards models, FMD, magnesium, high sensitivity CRP, the HOMA index, eGFR, comorbid diabetes, hypertension, smoking status, systolic blood pressure, serum phosphate and intact parathormone emerged as significant predictors for cardiovascular outcomes. Kaplan-Meier curves showed significantly higher cardiovascular mortality rates in CKD patients whose serum magnesium levels were below 2.05 mg/dl.
  
  
  CONCLUSIONS
  This observational cohort study showed that magnesium may be an independent predictor of future cardiovascular outcomes and is the first study demonstrating such a role in etiologically diagnosed CKD patients, across different stages.
authors.affiliation: Department of Nephrology, Gülhane School of Medicine, Ankara, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Kanbay
authors.forename: Mahmut Ilker
authors.initials: MI
authors.lastname: Yilmaz
authors.forename: Mugurel
authors.initials: M
authors.lastname: Apetrii
authors.forename: Mutlu
authors.initials: M
authors.lastname: Saglam
authors.forename: Halil
authors.initials: H
authors.lastname: Yaman
authors.forename: Hilmi Umut
authors.initials: HU
authors.lastname: Unal
authors.forename: Mahmut
authors.initials: M
authors.lastname: Gok
authors.forename: Kayser
authors.initials: K
authors.lastname: Caglar
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Oguz
authors.forename: Mujdat
authors.initials: M
authors.lastname: Yenicesu
authors.forename: Hakki
authors.initials: H
authors.lastname: Cetinkaya
authors.forename: Tayfun
authors.initials: T
authors.lastname: Eyileten
authors.forename: Cengizhan
authors.initials: C
authors.lastname: Acikel
authors.forename: Abdulgaffar
authors.initials: A
authors.lastname: Vural
authors.forename: Adrian
authors.initials: A
authors.lastname: Covic
mesh_terms: D000328:Adult; D000368:Aged; D002097:C-Reactive Protein / Q000096:biosynthesis; D002318:Cardiovascular Diseases / Q000097:blood* / Q000150:complications; D015331:Cohort Studies; D004730:Endothelium, Vascular / Q000473:pathology; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008274:Magnesium / Q000097:blood*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D016016:Proportional Hazards Models; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000150:complications; D012307:Risk Factors; D014664:Vasodilation
chemical_list: D002097:C-Reactive Protein; D008274:Magnesium