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Saudi Journal of Kidney Diseases and Transplantation
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ORIGINAL ARTICLE  
Year : 2012  |  Volume : 23  |  Issue : 1  |  Page : 21-25
Correlation of serum magnesium with dyslipidemia in patients on maintenance hemodialysis


1 Department of Nephro-Urology, Liaquat University of Medical & Health Sciences (LUMHS), Jamshoro, Sindh, Pakistan
2 Department of Medicine, Liaquat University of Medical & Health Sciences (LUMHS), Jamshoro, Sindh, Pakistan
3 Jinnah Postgraduate Medical Centre, Karachi, Sindh, Pakistan

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Date of Web Publication3-Jan-2012
 

   Abstract 

This study was performed to determine the correlation between serum magnesium (Mg) and dyslipidemia in patients on maintenance hemodialysis (MHD). This hospital-based cross-sectional observational study was conducted at the Department of Nephro-Urology, Liaquat University Hospital, Hyderabad, Pakistan, from April 2008 to June 2008. Fifty patients with end-stage kidney disease on MHD treatment (33 males and 17 females) were studied. The mean duration on HD was 7.58 ± 2.05 years, with frequency being two to three sessions/week, and each session lasted for four hours. After obtaining informed written consent, the general information of each patient was recorded on a proforma. After overnight fasting, blood samples was drawn from the arterio-venous fistula for lipid profile, lipoprotein, serum Mg, serum creatinine, blood urea, serum calcium and serum phosphorus. Dyslipidemia was defined as presence of total cholesterol (TC), triglyceride (TG) or low-density lipoprotein (LDL) levels more then 95 th percentile for age and gender or high-density lipoprotein (HDL) levels less then 35 mg/dL. Descriptive and inferential statistical analyses were performed using SPSS version 16.0. The mean age of the study patients was 45.68 ± 13.97 years. There was a significant positive correlation between serum Mg and serum lipoprotein-a (LP-a) (r = 0.40, P < 0.007), serum HDL (r = 0.31, P < 0.01) and serum TG (r = 0.35, P < 0.005). There was no significant correlation between serum Mg and serum LDL-c and serum TC. The serum TG and LP-a levels were significantly increased while HDL-c was significantly lower in MHD patients. The serum TC, LDL-c and very low-density lipoprotein-c were not significantly elevated. We conclude that patients with chronic kidney disease undergoing MHD show positive correlation between serum Mg and serum HDL, LP-a and TG. The abnormalities of lipid metabolism, such as hyper-triglyceridemia, elevated LP-a and low HDL-c, could contribute to atherosclerosis and cardiovascular disease in these patients.

How to cite this article:
Ansari MR, Maheshwari N, Shaikh MA, Laghari MS, Darshana, Lal K, Ahmed K. Correlation of serum magnesium with dyslipidemia in patients on maintenance hemodialysis. Saudi J Kidney Dis Transpl 2012;23:21-5

How to cite this URL:
Ansari MR, Maheshwari N, Shaikh MA, Laghari MS, Darshana, Lal K, Ahmed K. Correlation of serum magnesium with dyslipidemia in patients on maintenance hemodialysis. Saudi J Kidney Dis Transpl [serial online] 2012 [cited 2019 Aug 23];23:21-5. Available from: http://www.sjkdt.org/text.asp?2012/23/1/21/91291

   Introduction Top


Dyslipidemia is highly prevalent in patients on maintenance hemodialysis (MHD), with predominance of the atherogenic triad, i.e. hypertriglyceridemia, elevated very low density lipoprotein (VLDL) and reduced high-density lipoprotein (HDL). [1] The risk factors for coronary heart disease (CHD) in the general population remain predictive of CHD among patients with chronic kidney disease (CKD) as well. [2] Cadiovascular disease is the leading cause of death in patients on MHD, accounting for almost 50% of the deaths. [3] The United States renal data report in 1995 revealed that 42.5% of hemodialysis (HD), 41.7% of peritoneal dialysis and 31.1% of transplant patients die of cardiac and cerebrovascular disease. [2]

The incidence of cardiac death in dialysis and transplant patients has been estimated to be four- to 20-folds higher than in the general population. [4] Hyperlipidemia has been incriminated as a risk factor for atherosclerotic vascular disease in dialyzed patients, [5] and is characterized by hypertriglyceridemia without cholesterol accumulation. Other dyslipidemias consist of decreased HDL cholesterol and elevated serum lipoprotein (LP-a); the low-density lipoprotein (LDL) cholesterol is usually not elevated. [5],[6],[7] LP-a is an independent risk factor for cardiovascular disease. [8],[9] A number of investigators have shown an increase in LP-a in HD patients. Cressman et al have suggested that elevated levels of lipoprotein also correlate with cardiovascular mortality. [9] Elevated serum magnesium (Mg) can be a problem in patients on MHD. Because kidneys are the major route of excretion of Mg from the body, increased serum Mg would be expected in patients with renal insufficiency. [10] 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 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, [11],[12] resulting in increased serum Mg levels in CRF patients. Bone concentration and total body Mg also appear to be increased. [11]

Data have shown a correlation between dyslipidemia and high Mg concentration in patients on HD. [13] Therefore, we designed this study to assess the association between serum Mg and dyslipidemia in patients on end-stage renal disease (ESRD) undergoing MHD.


   Patients and Methods Top


This cross-sectional observational study was conducted on 50 ESRD patients undergoing MHD at the Department of Nephro-Urology, Liaquat University Hospital, Hyderabad, Pakistan. There were 33 males and 17 females; their mean duration on HD treatment was 7.58 ± 2.05 years. The duration of each session of HD was four hours, with frequency being two to three times per week. Bicarbonate-containing dialysate was used with a 1.6 m 2 surface area hollow fiber filter polysulfone membrane dialyzer. Patients taking diuretics, lipid-lowering agents and those with acute or chronic infections were excluded from the study. After obtaining informed written consent, the general information for each patient (age, sex, duration and frequency of HD) was recorded on proforma.

After an overnight fasting, blood samples were collected from the arterio-venous fistula before starting dialysis and centrifuged within 20 min of collection for lipid profile analysis, which included total cholesterol (TC), serum triglycerides (TG), HDL cholesterol, LDL cholesterol, VLDL cholesterol and LP-a. Levels of TG, TC, HDL, serum Mg, serum creatinine, blood urea, serum calcium and serum phosphorus were measured using standard methods. LDL cholesterol was calculated by Friedewald's formula. [14] LP-a was measured by enzyme-linked immune assay (ELISA) with immuno-biological laboratories (IBL) kit of Germany. Dyslipidemia was defined as TC, TG or LDL levels more than 95 th percentile for age and gender, or HDL less than 35 mg/dL.


   Statistical Analysis Top


The data were analyzed in statistical program SPSS version 16.0. Frequencies and percentages of categorical parameters were computed on 95% confidence interval. Student's t test was applied for numerical variables of investigations, etc. For correlations, Spearman rho test was used and P-value ≤0.05 was considered as significant.


   Results Top


Fifty patients with ESRD on MHD were studied. The mean age of the study patients was 45.68 ± 13.97 years, their mean duration on HD was 8.04 + 2.24 years, with frequency of twice weekly in 38 (76%) and thrice weekly in 12 patients (24%) [Table 1]A. The mean hemoglobin was 10.45 + 1.47 g/dL, blood urea was 133.84 + 38.7 mg/dL and creatinine was 8.83 + 3.41 mg/dL [Table 1]B.
Table 1:

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In this study, there was a significant positive correlation between serum Mg and serum LP-a (r = 0.40, P < 0.007) [Figure 1]. Significant positive correlation was also observed between serum Mg and serum HDL (r = 0.31, P < 0.01) [Figure 2] as well as serum Mg and serum TG (r = 0.35, P < 0.005) [Figure 3]. There was no significant correlation observed between serum Mg and serum LDL-c or serum TC in this study.
Figure 1: Correlation of serum magnesium with serum lipoprotein-a (r = 0.40, P < 0.007).

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Figure 2: Correlation of serum magnesium with serum high-density lipoprotein (r = 0.31, P < 0.01).

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Figure 3: Correlation of serum magnesium with serum triglycerides (r = 0.35, P < 0.005).

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The serum TG and LP-a levels were significantly elevated while HDL-c was significantly lower in patients on MHD. The serum TC, LDL-c and VLDL-c levels were not significantly elevated. The most common abnormality observed among patients on MHD was low HDL cholesterol followed by increased serum TG and LP-a levels.

The etiology of CKD among the study patients is shown in [Table 2].
Table 2: Etiology of end-stage renal disease in the study patients on maintenance hemodialysis treatment (n=50).

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   Discussion Top


In our study, there was a positive correlation between serum Mg and serum LP-a, serum HDL and serum TG levels. Thus, elevated serum Mg levels may be associated with dyslipidemia in patients on MHD. There was no significant correlation between serum Mg and serum LDL-c and TC. The pattern of dyslipidemia in our study patients showed hyper-triglyceridemia, elevated LP-a and reduced HDL-c. These lipid abnormalities are well-recognized risk factors of atherosclerotic vascular disease in HD patients [5] and, thus, there is strong need to focus on underlying causes and treatment of the hyperlipidemia. Hamid Nasri et al found a positive correlation between serum Mg and LP-a and also between serum Mg with TG level. [12] We also found a similar positive correlation between serum Mg and serum LP-a, serum TG and serum HDL; there was no correlation with cholesterol. In contrast to this study, Robles et al in a study on 25 patients on HD found a significant positive correlation between serum Mg levels and TC and a nearly significant correlation between serum Mg and serum TG. [13]

Uremia might cause elevation of LP-a in patients on HD by affecting its metabolism. The kidneys play a role in the metabolism of LP-a, and damage to kidney causes elevation of its levels. [14] Magnesium may affect the metabo-lism of TG and HDL in liver and kidneys, and it may be involved in enzymes responsible for lipoprotein synthesis, but these factors are not clearly understood and further large studies are needed in this regard.

Our results indicate that patients with CKD undergoing MHD show significant dyslipidemia. As a first means of controlling hyperlipidemia, body weight normalization, dietary modification, regular exercise and education about diet should be applied. Statins can be used safely in patients with CKD with careful monitoring. The association of dyslipidemia with serum Mg levels is not clearly understood, and further large clinical studies are needed to understand this association better.

 
   References Top

1.Pennell P, Leclercq B, Delahunty MI, Walters BA. The utility of non-HDL in managing dyslipidemia of stage 5 chronic kidney diseases. Clin Nephrol 2006;66(5):336-47.  Back to cited text no. 1
    
2.Soubassi LP, Papadakis ED, Theodoropoulos IK, et al. Incidence and risk factors of coronary artery disease in patients on chronic hemodialysis. Int Artif Organs 2007;30(3):253-7.  Back to cited text no. 2
    
3.Al Wakeel JS, Mitwalli AH, Al Mohaya S, et al. Morbidity and mortality in ESRD patients on dialysis. Saudi J Kidney Dis Transpl 2002;13 (4):473-7.  Back to cited text no. 3
    
4.Manske CL, Kasiske BL. Lipid abnormalities after renal transplantation. In: Keane WF, Stein JH, JH, eds. Lipids and renal disease. Contemporary Issues in Nephrology, Churchill Livingstone, New York, 1991;37-61.  Back to cited text no. 4
    
5.Keane WF, Oda H. Lipid abnormalities in end stage renal disease Nephrol Dial Transplant 1998;13(suppl 1):45-9.  Back to cited text no. 5
    
6.De Gomez NT, Giammona AM, Touceda LA, Raimondi C. Lipid abnormalities in chronic renal failure Patients undergoing hemodialysis. Medicina (Buenos Aires) 2001;61:142-6.  Back to cited text no. 6
    
7.Quashing T, Krane V, Metzger T, Warner C. Abnormalities in Uremia lipoprotein metabolism and its impact on cardiovascular disease. Am J Kidney Dis 2001;l38 (suppl 1):514-S9.  Back to cited text no. 7
    
8.Kronenberg F, Kathrein H, Ko¨nig P, et al. Apolipoprotein(a) phenotypes predict the risk for carotid atherosclerosis in patients with end-stage renal disease. Arterioscler Thromb 1994; 14: 1405-11.  Back to cited text no. 8
    
9.Cressman MD, Heyka RJ, Paganini EP, et al. Lipoprotein (a) is an independent risk factor for cardiovascular disease in hemodialysis patients. Circulation 1992;86:475-82.  Back to cited text no. 9
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10.Mountokalakis TD. Magnesium metabolism in chronic renal failure. Magnes Res 1990;3(2): 121-7.  Back to cited text no. 10
    
11.Lindeman RD. Chronic renal failure and magnesium metabolism. Magnesium 1986;5(5-6): 293-300.  Back to cited text no. 11
    
12.Nasir H, Baradaran A. Correlation of serum magnesium with dyslipedemia in maintenance hemodialysis patients. Acta Medica (Hradec Kralove) 2004;47(4):263-5.  Back to cited text no. 12
    
13.Robles NR, Escola JM, Albarran L, Espada R, Cruz A. Correlation of serum magnesium and serum lipid levels in hemodialysis patients. Dial Transplant 1998;27(10):644-8.  Back to cited text no. 13
    
14.Friedwald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma without use of preparative ultracentrifuge. Clin Chem 1972; 18:499-502.  Back to cited text no. 14
    

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Correspondence Address:
Muhammad Rafique Ansari
Assistant Professor, Department of Nephro-Urology, Liaquat University of Medical & Health Sciences (LUMHS), Jamshoro, Sindh
Pakistan
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PMID: 22237213

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    Figures

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    Tables

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    Abstract
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