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LETTER TO EDITOR
Year : 2018  |  Volume : 5  |  Issue : 4  |  Page : 143-144

Serum magnesium concentration a need for revision especially in renal failure


Assistant Professor of Pediatric Nephrology, Pediatric Ward, Sevome Shaban Hospital, Tehran, Iran

Date of Web Publication27-May-2019

Correspondence Address:
Dr. Majid Malaki
Sevome Shaban Hospital, Tehran
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jina.jina_11_18

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How to cite this article:
Malaki M. Serum magnesium concentration a need for revision especially in renal failure. J Integr Nephrol Androl 2018;5:143-4

How to cite this URL:
Malaki M. Serum magnesium concentration a need for revision especially in renal failure. J Integr Nephrol Androl [serial online] 2018 [cited 2019 Sep 19];5:143-4. Available from: http://www.journal-ina.com/text.asp?2018/5/4/143/259158



Dear Editor,

Plasma magnesium concentration is kept within narrow limits. In states of negative magnesium balance, initial losses come from the extracellular space while equilibrium with bone stores does not begin for several weeks. Normal plasma magnesium concentration based on literature is 1.7–2.1 mg/dL (0.7–0.9 mmol, or 1.4–1.8 mEq/L).[1] Half of the total body magnesium is present in soft tissue and another half in bone and 1% is present in the blood. Assessment of total magnesium store is impossible at now and serum magnesium level evaluation cannot show total serum status, magnesium ion measurement has been done in selected centers without approved more beneficial yields. Magnesium has a long biological half-life after oral supplementation and equilibrates slowly in most tissue including serum. It has been shown that at cut-off levels of 1.94 mg/dL and 2.19 mg/dL clinical magnesium deficiency occurred in 10% and 1%, respectively. It was shown that serum magnesium concentration (SMC) lower than 2.1 mg/dL increases the risk of Diabetes mellitus type 2 and levels of 0.85 mmol/L or 2.1 mg/dL can be considered as an reasonable lower limit of SMC.[2] Importance of new definition for hypomagnesemia has been more prominent in special conditions because of hypomagnesemia increase mortality in septic and critically ill patients by mechanisms such as increased need for mechanical ventilation and longer duration of ventilation support, irreversible renal dysfunction. in a study magnesium level of 1.5 mg/dL versus 2 mg/dL increases the risk of bacterial infection.[3] In end-stage renal disease magnesium level below 1.94 mg/dL increase death risk of coronary heart disease up to 33% make that authors were debated about validity of SMC in an accepted reference of 1.7–2.67 mg/dL as a confidential clinical useful reference in clinical affairs; for example the role of magnesium as a protective against vascular calcification in chronic kidney disease is well known and serum magnesium lower than 1.94 mg/dL has been approved that can be associated with increased mortality that obligate clinician to change lower cut off level of SMC as low as 0.8 mmol/L (1.94 mg/dL) but it may not be enough because in patients under hemodialysis after 3 years followed up was shown that serum magnesium under 2.77 mg/dL was associated with higher mortality compared to higher 2.77 mg/dL.[4] Other study goes beyond and shows serum magnesium over 3 mg/dL can decrease soft tissue calcification[5] it can explain why in patients under maintenace hemodialysis normal serum magnesium levels was associated with higher cardiovascular mortality compared to patients with hypermagnesemia.[6]

Conclusion – attention to benefits of magnesium in different diseases can be life saving current reference range of normal serum magnesium is inadequate especially in patients under haemodialysis that it should be changed to as low as 1.94 mg/dL or even more than suggested as lower limit of normal by some because levels up to 2.99 mg/dL has been shown useful for treatment of especial pathological conditions such as tissue calcification.

Acknowledgment

I dedicate this study to my leader Dr. Mohammad Mosadegh God bless his soul.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Drueke TB, Lacour B. Magnesium homeostasis and disorders of magnesium metabolism. In: Feehally J, Floege J, Johnson RJ, editors. Comprehensive Clinical Nephrology. 3rd ed. Philadelphia, PA: Mosby; 2007. p. 136-8.  Back to cited text no. 1
    
2.
Swaminathan R. Magnesium metabolism and its disorders. Clin Biochem Rev 2003;24:47-66.  Back to cited text no. 2
    
3.
Velissaris D, Karamouzos V, Pierrakos C, Aretha D, Karanikolas M. Hypomagnesemia in critically ill sepsis patients. J Clin Med Res 2015;7:911-8.  Back to cited text no. 3
    
4.
Ishimura E, Okuno S, Yamakawa T, Inaba M, Nishizawa Y. Serum magnesium concentration is a significant predictor of mortality in maintenance hemodialysis patients. Magnes Res 2007;20:237-44.  Back to cited text no. 4
    
5.
Massy ZA, Drüeke TB. Magnesium and outcomes in patients with chronic kidney disease: Focus on vascular calcification, atherosclerosis and survival. Clin Kidney J 2012;5:i52-61.  Back to cited text no. 5
    
6.
Yu L, Li H, Wang SX. Serum magnesium and mortality in maintenance hemodialysis patients. Blood Purif 2017;43:31-6.  Back to cited text no. 6
    




 

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