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ORIGINAL ARTICLE
Year : 2017  |  Volume : 17  |  Issue : 1  |  Page : 8-29

Correlations of serum magnesium with dyslipidemia in patients on maintenance hemodialysis


1 Department of Internal Medicine, Faculty of Medicine, Assuit University Hospitals, Assiut University, Assuit, Egypt
2 Department of Clinical Pathology, Faculty of Medicine, Assuit University Hospitals, Assiut University, Assuit, Egypt

Correspondence Address:
Effat A.E. Tony
Department of Internal Medicine, Nephrology Unit, Faculty of Medicine, Assuit University, Assuit, 71515
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-9165.207900

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Background Chronic renal failure (CRF) is defined as a slowly progressive loss of kidney functions resulting in permanent kidney failure. Patients with chronic kidney disease (CKD) are at increased risk not only for end-stage kidney disease but also for cardiovascular (CV) disease. CKD is characterized by specific metabolic abnormalities of plasma lipoproteins (LPs). These abnormalities involve all LP classes and show variations depending on the degree of renal impairment, the etiology of the primary disease, the presence of nephrotic syndrome (NS), and the method of dialysis for patients undergoing renal replacement therapy. High LP-a indicates a coagulant risk for plaque thrombosis. Thus, it predicts risk for early atherosclerosis independently of other cardiac risk factors, including low-density lipoprotein (LDL), in patients with CKD. Dyslipidemia in CKD is associated with increased thickness and stiffness of the large arteries. Thus, strict control of dyslipidemia would be beneficial in preventing CVD, at least during the early stages of CKD. The kidney has a vital role in magnesium (Mg) homeostasis, and, although renal handling of Mg is highly adaptable, this ability deteriorates when renal function declines significantly. Mg homeostasis in humans primarily depends on the balance between intestinal uptake and renal excretion. Mg may be normal or decreased in dialysis patients, which is probably due to decreased dietary intake combined with impaired intestinal absorption. In patients on chronic hemodialysis (HD), the major determinant of Mg balance is concentration of Mg in the dialysate. Thus, in patients with CKD, there may be reduced intake, impaired absorption from the intestine, use of diuretics, and acidosis, which may result in decreased serum Mg, whereas reduced renal excretion may cause accumulation of Mg, resulting in increased serum Mg levels in CRF patients. This prospective study aimed to determine the correlation of serum Mg with dyslipidemia in patients on maintenance HD. Patients and methods This case–control observational prospective study was conducted on 37 end-stage renal failure patients on maintenance HD (age range: 20–70 years; mean age: 47.8±13.9 years; 16 men and 21 women) who were recruited from the Renal and Dialysis Unit, Department of Internal Medicine, Assuit University Hospitals, Egypt, from 2010 to 2012. In addition, 25 apparently healthy persons (age range: 17–70 years; mean age: 42.0±13.25 years; 13 male and 12 female) recruited mainly from among the medical staff and their families who underwent a health examination at Assuit University Hospitals were enrolled in the study as a control group. The study was approved by the ethical committee of the Faculty of Medicine, Assuit University, and written informed consent was obtained from each participant. The underlying causes of CRF were chronic glomerulonephritis, diabetes mellitus, chronic pyelonephritis, obstructive uropathy, analgesic and idiopathic nephropathy, polycystic kidney disease, and lupus nephritis. The duration of HD ranged from 5 to 15 years, with a mean duration of 7.0±2.9 years. The frequency of HD was three sessions per week. The type of dialyzer membrane was polysulfone with bicarbonate dialysate and the dialysate flow rate was 500 ml/min. Blood flow ranged from 250 to 300 ml/min. The Mg concentration in the dialysate fluid was 1 mEq/l. Dialysis adequacy was assessed by measuring urea kinetic modeling (mean urea kinetic modeling: 2.38±0.44). Glomerular filtration rate was estimated by the modified MDRD equation. Patients were excluded if they had been taking diuretics and/or lipid-lowering agents or had acute or chronic infections. All participants were subjected to thorough history taking, full clinical examination, and anthropometric measurements including weight, height, and BMI. Blood samples from both patients and controls were drawn in the morning after an overnight fast of 12–16 h. Peripheral hemogram, liver function, kidney function, lipid profile, LP-a, and serum electrolytes such as Ca, phosphorus (P), and Mg were assessed. An ECG was obtained with measurement of the corrected QT interval (QTc). Transthoracic echocardiography (ECHO) was performed in all studied groups on an interdialytic day in the evaluation phase. M-mode and two-dimensional images as well as spectral pulsed and color flow Doppler recordings were obtained. Results Significant renal dysfunction and lower levels of hemoglobin and platelets with higher mean corpuscular volume (MCV) and mean cell hemoglobin concentration (MCHC) with no statistical difference in the mean level of white blood cells (WBCs) were reported in our studied patients in comparison with controls. Notably, highly statistically significantly lower levels of high-density lipoprotein-cholestrol (HDL-C) with significantly lower levels of LDL-cholesterol (LDL-C) were seen in our HD patients. However, the mean levels of triglycerides (TG) and LP-a were statistically significantly higher, with no statistically significant differences in total cholesterol (TC) levels in the studied patients. The levels of P and Mg were highly statistically significantly higher, with lower Ca levels of no statistical difference, in HD patients. There were no statistically significant differences in the main levels of serum Mg among the studied patients. Lipid metabolism disturbances are frequently present in patients with CRF, representing an important factor in premature atherosclerosis development. The majority of patients with no ST-segment changes had more Mg retention and LP-a retention but with no statistical significance. Nonetheless, none of our patients had prolonged QTc interval in ECG, despite having more Mg retention and LP-a retention with no statistical significance. Left ventricular hypertrophy (LVH) was a striking finding in our patients who had more serum Mg retention and LP-a retention but with no statistical significance. A significant positive correlation between serum Mg level and ST-segment changes in ECG and a significant negative correlation between serum LP-a level and ST-segment changes in ECG were found in our studied patients. Moreover, there were positive correlations of serum Mg levels and LP-a levels with LVH in ECG and ECHO findings in our patients, with no statistical significance. The prolonged QTc interval in ECG had a significant po


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