Magnesium and Dialysis: The Neglected Cation

Am J Kidney Dis. 2015 Sep;66(3):523-31. doi: 10.1053/j.ajkd.2015.01.029. Epub 2015 Apr 9.


Disorders of magnesium homeostasis are very common in dialysis patients but have received scant attention. In this review, we address measurement of plasma magnesium, magnesium balance and the factors that affect magnesium flux during dialysis, the prevalence of hypo- and hypermagnesemia in dialysis patients, and the potential clinical significance of hypo- and hypermagnesemia in dialysis patients. Many factors can affect plasma magnesium concentration, including diet, nutritional status (including plasma albumin level), medications (such as proton pump inhibitors), and dialysis prescription. Further interventional studies to determine the effect of normalization of plasma magnesium concentration on clinical outcomes are needed. At the present time, we recommend that predialysis plasma magnesium be measured on a regular basis, with the dialysate magnesium concentration adjusted to maintain plasma magnesium concentration within the normal range.

Keywords: Gibbs-Donnan effect; Magnesium; dialysis; hemodialysis; hypermagnesemia; hypomagnesemia; peritoneal dialysis; proton pump inhibitors; review.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Animals
  • Diabetic Nephropathies / therapy
  • Hemodialysis Solutions / chemistry
  • Homeostasis / drug effects
  • Homeostasis / physiology*
  • Humans
  • Infusions, Intravenous
  • Intestinal Absorption / physiology
  • Kidney Failure, Chronic / metabolism*
  • Kidney Failure, Chronic / therapy
  • Magnesium / blood
  • Magnesium / metabolism
  • Magnesium / physiology*
  • Magnesium Sulfate / administration & dosage
  • Male
  • Middle Aged
  • Nutritional Status
  • Peritoneal Dialysis
  • Proton Pump Inhibitors / pharmacology
  • Renal Dialysis*
  • Torsades de Pointes / drug therapy
  • Torsades de Pointes / etiology


  • Hemodialysis Solutions
  • Proton Pump Inhibitors
  • Magnesium Sulfate
  • Magnesium