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

Abstract

Background and objectives: Serum calcification propensity is a novel functional test that quantifies the functionality of the humeral system of calcification control. Serum calcification propensity is measured by T₅₀, the time taken to convert from primary to secondary calciprotein particle in the serum. Lower T₅₀ represents higher calcification propensity and is associated with higher risk of cardiovascular events and death in patients with ESKD. Increasing magnesium in serum increases T₅₀, 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 T₅₀ in subjects undergoing hemodialysis for ESKD. The primary end point was the value of 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, T₅₀ 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, T₅₀ was 247±69 minutes at baseline and 302±66 minutes at follow-up. The difference in T₅₀ 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 T₅₀ and hence, decreases 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.

Keywords: Bicarbonates; Calcification, Physiologic; Confidence Intervals; Dialysis Solutions; Humerus; Kidney Failure, Chronic; Phosphates; alpha-2-HS-Glycoprotein; calcium; cardiovascular disease; chronic hemodialysis; end stage kidney disease; magnesium; mineral metabolism; parathyroid hormone; randomized controlled trials; renal dialysis.