scholarly journals Baseline Serum Magnesium Level and Its Variability in Maintenance Hemodialysis Patients: Associations with Mortality

2019 ◽  
Vol 44 (2) ◽  
pp. 222-232 ◽  
Author(s):  
Lingping Wu ◽  
Kedan Cai ◽  
Qun Luo ◽  
Lailiang Wang ◽  
Yue Hong
Keyword(s):  
Cardiovascular Mortality ◽  
Cox Regression ◽  
Serum Magnesium ◽  
Magnesium Level ◽  
Maintenance Hemodialysis ◽  
Serum Magnesium Level ◽  
Baseline Serum ◽  
Cox Regression Analysis ◽  
All Cause Mortality ◽  
Group Serum

Background/Aims: The study aimed at investigating the impact of serum magnesium (Mg) baseline level and its variability on mortality in maintenance hemodialysis (MHD) patients. Methods: Eligible patients receiving regular MHD at Ningbo No. 2 Hospital between January 2009 and August 2016 were enrolled and follow-ups were conducted afterwards until death or transplantation. General information, laboratory results, and outcomes of subjects were collected. The relationship between baseline serum Mg level, its coefficient of variation (CV), and all-cause mortality and cardiovascular disease mortality were assessed, respectively. Subjects were divided into groups in 2 manners: by serum Mg level (lower Mg group: serum Mg <1.00 mmol/L, higher Mg group: serum Mg ≥1.00 mmol/L) and by serum Mg CV (high variation group: CV ≥0.149 mmol/L, middle variation group: 0.114 mmol/L ≤ CV < 0.149 mmol/L, and low variation group: CV <0.114 mmol/L). Results: 169 MHD patients were recruited in the study, with mean serum Mg 1.00 ± 0.18 mmol/L, average age 60.20 ± 15.64 years, and median dialysis duration 37.00 (18.30, 77.97) months. During the follow-up, 69 (40.83%) patients died, 24 (34.78%) of which died due to cardiovascular disease. Comparing the two groups, patients in the lower Mg group had a higher all-cause mortality (50.00 vs. 29.33%, p = 0.007). The multivariate Cox regression analysis suggested that lower Mg level was an independent factor for all-cause mortality as well as cardiovascular mortality (HR = 13.268, 95% CI 6.234–28.237, p < 0.001; HR = 12.702, 95% CI 3.737–43.174, p < 0.001, respectively). However, there were no significant statistical differences of all-cause and cardiovascular mortality among these three groups concerning Mg variation. And in the univariate and multivariate Cox regression analysis, serum magnesium CV was not the independent factor for all-cause mortality and cardiovascular mortality. Conclusions: The lower baseline serum magnesium level was associated with all-cause and cardiovascular mortality in MHD patients. However, the variability of magnesium level was not independently associated with the risk of death and further studies need to be conducted.

scholarly journals Serum magnesium and cardiovascular mortality in peritoneal dialysis patients: a 5-year prospective cohort study

2018 ◽  
Vol 120 (4) ◽  
pp. 415-423 ◽  
Author(s):  
Hongjian Ye ◽  
Peiyi Cao ◽  
Xiaodan Zhang ◽  
Jianxiong Lin ◽  
Qunying Guo ◽  
...  
Keyword(s):  
Cohort Study ◽  
Peritoneal Dialysis ◽  
Prospective Cohort Study ◽  
Cardiovascular Mortality ◽  
Prospective Cohort ◽  
Cox Regression ◽  
Serum Magnesium ◽  
Study Endpoint ◽  
Lower Serum ◽  
All Cause Mortality

AbstractThe aim of this study was to explore the association between serum Mg and cardiovascular mortality in the peritoneal dialysis (PD) population. This prospective cohort study included prevalent PD patients from a single centre. The primary outcome of this study was cardiovascular mortality. Serum Mg was assessed at baseline. A total of 402 patients (57 % male; mean age 49·3±14·9 years) were included. After a median of 49·9 months (interquartile range: 25·9–68·3) of follow-up, sixty-two patients (25·4 %) died of CVD. After adjustment for conventional confounders in multivariate Cox regression models, being in the lower quartile for serum Mg level was independently associated with a higher risk of cardiovascular mortality, with hazards ratios of 2·28 (95 % CI 1·04, 5·01), 1·41 (95 % CI 0·63, 3·16) and 1·62 (95 % CI 0·75, 3·51) for the lowest, second and third quartiles, respectively. A similar trend was observed when all-cause mortality was used as the study endpoint. Further analysis showed that the relationships between lower serum Mg and higher risk of cardiovascular and all-cause mortality were present only in the female subgroup, and not among male patients. The test for interaction indicated that the associations between lower serum Mg and cardiovascular and all-cause mortality differed by sex (P=0·008 andP=0·011, respectively). In conclusion, lower serum Mg was associated with a higher risk of cardiovascular and all-cause mortality in the PD population, especially among female patients.

Comparison of 24-hour and Office Pulse Wave Velocity for Prediction of Mortality in Hemodialysis Patients

2019 ◽  
Vol 49 (4) ◽  
pp. 317-327 ◽  
Author(s):  
Julia Matschkal ◽  
Christopher C. Mayer ◽  
Pantelis A. Sarafidis ◽  
Georg Lorenz ◽  
Matthias C. Braunisch ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Pulse Wave Velocity ◽  
Wave Velocity ◽  
Cardiovascular Mortality ◽  
Pulse Wave ◽  
Cox Regression ◽  
Hemodialysis Patients ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
All Cause Mortality

Background: Mortality in hemodialysis patients still remains unacceptably high. Enhanced arterial stiffness is a known cardiovascular risk factor, and pulse wave velocity (PWV) has proven to be a valid parameter to quantify risk. Recent studies showed controversial results regarding the prognostic significance of PWV for mortality in hemodialysis patients, which may be due to methodological issues, such as assessment of PWV in the office setting (Office-PWV). Method: This study cohort contains patients from the “Risk stratification in end-stage renal disease – the ISAR study,” a multicenter prospective longitudinal observatory cohort study. We examined and compared the predictive value of ambulatory 24-hour PWV (24 h-PWV) and Office-PWV on mortality in a total of 344 hemodialysis patients. The endpoints of the study were all-cause and cardiovascular mortality. Survival analysis included Kaplan-Meier estimates and Cox regression analysis. Results: During a follow-up of 36 months, a total of 89 patients died, 35 patients due to cardiovascular cause. Kaplan-Meier estimates for tertiles of 24 h-PWV and Office-PWV were similarly associated with mortality. In univariate Cox regression analysis, 24 h-PWV and Office-PWV were equivalent predictors for all-cause and cardiovascular mortality. After adjustment for common risk factors, only 24 h-PWV remained solely predictive for all-cause mortality (hazard ratio 2.51 [95% CI 1.31–4.81]; p = 0.004). Conclusions: Comparing both measurements, 24 h-PWV is an independent predictor for all-cause-mortality in hemodialysis patients beyond Office-PWV.

scholarly journals High-Normal Serum Magnesium and Hypermagnesemia Are Associated With Increased 30-Day In-Hospital Mortality: A Retrospective Cohort Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Liao Tan ◽  
Qian Xu ◽  
Chan Li ◽  
Jie Liu ◽  
Ruizheng Shi
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Cox Regression ◽  
Serum Magnesium ◽  
Normal Serum ◽  
Magnesium Level ◽  
Serum Magnesium Level

Background: Magnesium, the fourth most abundant mineral nutrient in our body, plays a critical role in regulating ion channels and energy generation, intracardiac conduction, and myocardial contraction. In this study, we assessed the association of admission serum magnesium level with all-cause in-hospital mortality in critically ill patients with acute myocardial infarction (AMI).Methods: Clinical data were extracted from the eICU Collaborative Research Database (eICU-CRD). Only the data for the first intensive care unit (ICU) admission of each patient were used, and baseline data were extracted within 24 h after ICU admission. Logistic regression, Cox regression, and subgroup analyses were conducted to determine the relationship between admission serum magnesium level and 30-day in-hospital mortality in ICU patients with AMI.Results: A total of 9,005 eligible patients were included. In the logistic regression analysis, serum magnesium at 2.2 to ≤2.4 and &gt;2.4 mg/dl levels were both significant predictors of all-cause in-hospital mortality in AMI patients. Moreover, serum magnesium of 2.2 to ≤2.4 mg/dl showed higher risk of in-hospital mortality than magnesium of &gt;2.4 mg/dl (adjusted odds ratio, 1.63 vs. 1.39). The Cox regression analysis yielded similar results (adjusted hazard ratio, 1.36 vs. 1.25).Conclusions: High-normal serum magnesium and hypermagnesemia may be useful and easier predictors for 30-day in-hospital mortality in critically ill patients with AMI.

scholarly journals Serum Uric Acid Revealed a U-Shaped Relationship With All-Cause Mortality and Cardiovascular Mortality in High Atherosclerosis Risk Patients: The ASSURE Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Yan Cang ◽  
Shaojie Xu ◽  
Jingyin Zhang ◽  
Jingyi Ju ◽  
Zijun Chen ◽  
...  
Keyword(s):  
Uric Acid ◽  
Regression Model ◽  
Serum Uric Acid ◽  
Cardiovascular Mortality ◽  
Cox Regression ◽  
Multicenter Cohort Study ◽  
Male And Female ◽  
Cox Regression Analysis ◽  
All Cause Mortality ◽  
Cvd Mortality

Background: Previous studies have demonstrated an association between hyperuricemia and cardiovascular disease (CVD). The Framingham study confirmed that patients with high atherosclerotic risks (HARs) had worse prognoses. However, after adjusting for confounding factors, the association between serum uric acid (SUA) and all-cause mortality and cardiovascular mortality remains unclear, especially for HAR patients.Objective: The aim of this study was to reveal the relationship of SUA with all-cause and cardiovascular mortality in HAR patients.Methods: This multicenter cohort study enrolled 3,047 participants, and the follow-up was 68.85 ± 11.37 months. Factors related to cardiovascular and all-cause mortality were tested by multivariate Cox regression analysis. Restricted cubic splines (RCSs) with knots were used to explore the shape of the dose–response relationship with SUA and the hazard ratio (HR) of all-cause and CVD mortality. SUA transformed by RCS was added to the Cox regression model as an independent variable, and all-cause and CVD mortality scores were calculated. Survival receiver operating characteristic curves were produced using a regression model predicting the score.Results: SUA demonstrated a “U-shaped” relationship with all-cause and cardiovascular mortality. SUA predicted all-cause and CVD mortality, with cutoff values of values of &gt;370.5 μmol/L for males and &gt;327.65 μmol/L for females and &lt;180.5 μmol/L for males and &lt;165.7 μmol/L for females, respectively. The survival ROC curve indicated that SUA is able to predict all-cause and CVD mortality, with areas under the curve of 0.702 and 0.711, respectively. The HRs of all-cause mortality (male and female) with hyperuricemia and hypouricemia were 2.08 and 2.01 and 2.04 and 1.98, respectively, and the HRs of CVD mortality (male and female) were 2.09 and 1.79, and 2.02 and 1.89, respectively.Conclusion: Abnormal SUA levels were significant and independent risk factors for all-cause and CVD mortality. Hyperuricemia and hypouricemia increased mortality in both males and females. Routine SUA evaluation and intensive management are needed for HAR patients.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03616769.

scholarly journals Association of Soluble Klotho Level with Adverse Outcomes in Patients on Maintenance Hemodialysis

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Li-xia Yu ◽  
Qi-feng Liu ◽  
Jian-hua Feng ◽  
Sha-sha Li ◽  
Xiao-xia Gu ◽  
...  
Keyword(s):  
Cox Regression ◽  
Adverse Outcomes ◽  
Maintenance Hemodialysis ◽  
Strongly Correlated ◽  
Independent Predictive Factor ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
Potential Association ◽  
All Cause Mortality

Background. The predictive value of soluble Klotho (sKlotho) for adverse outcomes in patients on maintenance hemodialysis (MHD) is controversial. In this study, we aimed to clarify the potential association of sKlotho levels with adverse outcomes in this patient population. Materials. A total of 211 patients on MHD were identified and stratified according to the median sKlotho level. Patients were followed up for adverse outcomes including cardiovascular (CV) morbidity and all-cause mortality. Results. During the 36-month follow-up, 75 patients [51 CV events (including 16 CV deaths) and 40 deaths] experienced adverse outcomes. After stratification according to median sKlotho level, patients with a lower sKlotho level had a greater risk of CV events (38.2% vs. 19.5%, p = 0.006 ), all-cause mortality (28.4% vs. 11.6%, p = 0.003 ), and combined adverse outcomes (51.0% vs. 24.2%, p < 0.001 ). Similar observations were made from analyses using Kaplan-Meier survival curves. Cox regression analysis showed that a low sKlotho level was strongly correlated with CV morbidity [1.942 (1.030–3.661), p = 0.040 )], all-cause mortality [2.073 (1.023–4.203), p = 0.043 ], and combined adverse outcomes [1.818 (1.092–3.026), p = 0.021 ] in fully adjusted models. Conclusions. The sKlotho level was an independent predictive factor of adverse outcomes including CV morbidity and mortality in patients on MHD.

scholarly journals Lower serum bilirubin is a risk factor for cardiovascular mortality in maintenance hemodialysis patients: a retrospective cohort study

2021 ◽  
Author(s):  
Yu Chen ◽  
Peilei Zhao ◽  
Weifeng Fan ◽  
Hongmei Li ◽  
Xiaojing Zhong ◽  
...  
Keyword(s):  
Cardiovascular Mortality ◽  
Serum Bilirubin ◽  
Cox Regression ◽  
Cardiovascular Death ◽  
Hemodialysis Patients ◽  
Cox Proportional Hazards Model ◽  
Maintenance Hemodialysis ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
Maintenance Hemodialysis Patients

Abstract Background: Although recent studies showed serum bilirubin, an endogenous antioxidant, is protective against cardiovascular diseases, cancer, and diabetic complications, less information is available its association with cardiovascular mortality in hemodialysis patients. This study aimed to investigate the relationship between serum bilirubin and the cardiovascular mortality in maintenance hemodialysis patients.Methods: This retrospective study included 284 chronic hemodialysis patients who started hemodialysis between January 01, 2003, and May 30, 2019. The endpoint was cardiovascular death and all-cause death. A Cox proportional hazards model was used to evaluate the risk factors for cardiovascular death in the maintenance hemodialysis. The cardiovascular mortality was evaluated by Kaplan-Meier analysis.Results: Up to 2019, the median follow-up time was 53 months. In Kaplan–Meier analysis curves, the risk of cardiovascular death in the patients with serum indirect bilirubin (IBIL) levels＜3.0 μmol/L was significantly higher than those with serum IBIL levels≥3.0 μmol/L(p =0.045). In multivariate Cox regression analysis, the risk of cardiovascular mortality in patients with serum IBIL levels ≥3.0 μmol/L was 0.556 times the risk in patients with serum IBIL levels＜3.0 μmol/L (Hazard ratio=0.556, 95% confidence interval 0.334~0.926, p =0.024). However, there was no significant association between serum IBIL and all-cause mortality (p =0.269). Conclusions: Our findings suggest that low serum IBIL level is independently associated with high risk of cardiovascular death in maintenance hemodialysis patients.

Serum Uric Acid Showed U-shaped Relationship with All-Cause Mortality and Cardiovascular Mortality in High Atherosclerosis Risk Patients: ASSURE Study

2020 ◽  
Author(s):  
Yan Cang ◽  
Shaojie Xu ◽  
Jinying Zhang ◽  
Zijun Chen ◽  
Keke Wang ◽  
...  
Keyword(s):  
Uric Acid ◽  
Serum Uric Acid ◽  
Cardiovascular Mortality ◽  
Cox Regression ◽  
Rank Test ◽  
Cardiac Events ◽  
Cox Regression Analysis ◽  
All Cause Mortality ◽  
Risk Patients ◽  
Restricted Cubic Splines

Abstract Background: Previous studys have demonstrated association between hyperuricemia and cardiovascular disease (CVD), and Framingham study has confirmed patients with high atherosclerotic risk (HAR) had worse prognosis. But after controlling other traditional atherosclerotic risks, the association between serum uric acid (SUA) and all-cause mortality, cardiovascular mortality remains controversial, especially in HAR patients.Objective: The aim of study was to reveal the relationship with SUA and all-cause mortality, cardiovascular mortality in HAR patients.Methods: The multi-center cohort study comprised 3,640 participants (1927male, 1713 female),whose mean age was 60.2±10.4 years andmean follow-uptimewere 68.85±11.37 months. Factors related to cardiovascular mortality and all-cause mortality, major adverse cardiac events in-hospital during follow-up were tested by multivariate Cox regression analysis and log-rank test. Restricted cubic splines with knots were used to explore theshape of dose-response relationship with SUA levels and Hazard risk (HR) of all-cause and CVD mortality.Results：The study showed SUA presented U-shaped relationship with all-cause and cardiovascular mortality. HR of all-cause mortality with hyperuricemia and hypouricemia was 2.11, 95% CI(1.61-3.07), and 2.05, 95% CI(1.35-2.90), respectively. HR of Cardiovascular mortality was 2.42, 95% CI (1.61-3.12), and 1.95, 95% CI(1.29-2.90), respectively. Conclusion：Abnormal SUA levels maybe significant and independent risk factors for all-cause and cardiovascular mortality. Routine SUA evaluation and intensive management are pressing needed, especially in HAR patients.

scholarly journals Association between Serum Magnesium and Erythropoietin Responsiveness in Hemodialysis Patients: A Cross-Sectional Study

2019 ◽  
Vol 44 (3) ◽  
pp. 354-361 ◽  
Author(s):  
Ling Yu ◽  
Jinghong Song ◽  
Xiangxue Lu ◽  
Yuan Zu ◽  
Han Li ◽  
...  
Keyword(s):  
Protective Factor ◽  
Serum Magnesium ◽  
Laboratory Data ◽  
Resistance Index ◽  
Magnesium Level ◽  
Multivariate Logistic Regression Model ◽  
Maintenance Hemodialysis ◽  
Serum Magnesium Level ◽  
Group A ◽  
Group B

Background/Aims: As shown in the China Health and Nutrition Survey, serum magnesium is associated with anemia. However, the roles of magnesium in anemia and erythropoietin (EPO) responsiveness remain unclear in maintenance hemodialysis (MHD) patients. This study aims to investigate the level of serum magnesium and its relationship with EPO responsiveness in MHD patients. Methods: A total of 307 MHD patients were recruited for this survey. Laboratory data and anthropometrics were collected. EPO responsiveness was evaluated by the erythropoietin resistance index (ERI). The subjects were divided into 3 groups according to serum magnesium concentrations (group A, the lowest tertile; group B, the middle tertiles; and group C, the highest tertile). Multivariate logistic regressions were conducted to evaluate the factors that may be associated with EPO responsiveness. Results: The mean serum magnesium level was significantly higher than normal levels in MHD patients, while no hypomagnesemia was observed. A multivariate logistic regression model revealed that high-sensitivity C-reactive protein, intact parathyroid hormone, serum albumin, and magnesium levels were correlated with a high ERI. The OR of a high ERI was found to be 2.57 (95% CI 1.330–4.975, p = 0.005) for group A and 1.66 (95% CI 0.878––3.140, p > 0.05) for group B compared with the OR for group C. Conclusion: Serum magnesium levels were higher than normal levels in MHD patients. A high serum magnesium level was correlated with good EPO responsiveness and was therefore suggested to be a protective factor for EPO hyporesponsiveness.

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