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LETTER TO EDITOR
Year : 2019  |  Volume : 6  |  Issue : 2  |  Page : 17-18

Hypomagnesemia: Hidden key of life and primary event for hypovitaminosis D and hypoalbuminemia in hemodialysis


Department of Pediatric Nephrology, Sevome Shaban Hospital, Tehran, Iran

Date of Submission25-Nov-2018
Date of Decision08-Dec-2018
Date of Acceptance20-Nov-2019
Date of Web Publication26-Feb-2021

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


DOI: 10.4103/jina.jina_18_18

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How to cite this article:
Malaki M. Hypomagnesemia: Hidden key of life and primary event for hypovitaminosis D and hypoalbuminemia in hemodialysis. J Integr Nephrol Androl 2019;6:17-8

How to cite this URL:
Malaki M. Hypomagnesemia: Hidden key of life and primary event for hypovitaminosis D and hypoalbuminemia in hemodialysis. J Integr Nephrol Androl [serial online] 2019 [cited 2021 Dec 4];6:17-8. Available from: http://www.journal-ina.com/text.asp?2019/6/2/17/310183



Dear Editor,

Zieve et al., in 1977, found in severe magnesium (Mg) deficiency protein synthesis in many tissues reduced, and DNA synthesis increased, The increase in splenic DNA synthesis in the presence of depressed protein synthesis may be an early stage in a lymphoproliferative process leading ultimately to neoplasia.[1] The interaction of Mg and Vitamin D is well known; Mg is a cofactor for binding, transport, and conversion process of Vitamin D in the liver and renal organ. Studies show high Mg intake was associated with reduced risk of Vitamin D deficit or insufficiency. Plasma Mg levels of 0.79–0.76 mmol/L (1.9–1.8 mg/dL) have been classified as inadequate and levels <0.76 mmol/L as deficient.[2]

The aim of this study is to determine the serum Mg level in three categories of Vitamin D deficiency (<20ng/mL), insufficiency (20-30 ng/mL), and sufficiency (>30ng/mL) groups [Table 1]. Mg less than 1.9 mg/dL considered as hypomagnesemia, and this study shows the prevalence of hypomagnesemia in Vitamin D deficiency, insufficiency, and sufficiency was 35%, 20%, and 3%. Comparison of the laboratory test was done by t-independent test in patients with Mg levels higher and lower/equal than 1.9 mg/dL, and the results show higher fasting blood sugar and lower phosphor, Vitamin D, blood urea nitrogen and albumin in cases with hypomagnesemia (=1.9 mg/dL) [Table 2].
Table 1: Laboratory tests in different vitamine D levels

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Table 2: Comparison of parameters in different Magnesium levels

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Hypomagnesemia is relatively common in the general population ranging from 2.5% to 15% because of inadequate Mg intake, increased gastrointestinal or renal loss, or redistribution from extracellular to intracellular space.[3] Mg can improve Vitamin D metabolism, PTH response and reverse the resistance to Vitamin D treatment. Improvement in Mg status leads to an increase in Vitamin D binding protein synthesis and, in turn, an elevated transport of Vitamin D3 to the liver and 25 (OH)-D to the kidney.[2] Vitamin D can help Mg balance by enhancing absorption and increasing the urinary Mg excretion.[4]

This study shows serum albumin and serum vitamine D can be effected by serum Mg level while more deeply drop of serum Mg level leads to decrease serum phosphor and serum level and increase blood sugar. Part of these may be related to the primary role of Mg in Vitamin D regulation and metabolism and its important role for protein synthesis in many tissues.


  Conclusion Top


This study shows Mg level lower than 1.9 mg/dL is associated with diverse metabolic derangement in hemodialysis patients, hypovitaminosis D occur in 70% (deficient: 54% and insufficient 16%) and Hypomagnesemia (<1.9 meq/dL) was seen in 16%. Hypomagnesemia may be a primary event that accelerates hypovitaminosis D, hypoalbuminemia, that ultimately lead to hypophosphatemia and higher fasting blood sugar in profound deficiency. In all dialysis paying attention to Mg level as a cardiovascular, metabolism, and cognition regulator is necessary, especially in low Vitamin D level situations.

Acknowledgment

I dedicate this study to the soul of Dr. Mohammad Mosadegh, God bless his soul.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Zieve FJ, Freude KA, Zieve L. Effects of magnesium deficiency on protein and nucleic acid synthesis in vivo. J Nutr 1977;107:2178-88.  Back to cited text no. 1
    
2.
Deng X, Song Y, Manson JE, Signorello LB, Zhang SM, Shrubsole MJ, et al. Magnesium, vitamin D status and mortality: Results from US National Health and Nutrition Examination Survey (NHANES) 2001 to 2006 and NHANES III. BMC Med 2013;11:187.  Back to cited text no. 2
    
3.
Ayuk J, Gittoes NJ. How should hypomagnesaemia be investigated and treated? Clin Endocrinol (Oxf) 2011;75:743-6.  Back to cited text no. 3
    
4.
Hardwick LL, Jones MR, Brautbar N, Lee DB. Magnesium absorption: mechanisms and the influence of vitamin D, calcium and phosphate. J Nutr 1991;121:13-23.  Back to cited text no. 4
    



 
 
    Tables

  [Table 1], [Table 2]



 

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