Hypomagnesemia in Type 2 Diabetic Nephropathy
A novel predictor of end-stage renal disease
- Sakaguchi, Yusuke MD
- Shoji, Tatsuya MD; PHD
- Hayashi, Terumasa MD; PHD
- Suzuki, Akira MD; PHD
- Shimizu, Morihiro MD
- Mitsumoto, Kensuke MD
- Kawabata, Hiroaki MD
- Niihata, Kakuya MD
- Okada, Noriyuki MD; PHD
- Isaka, Yoshitaka MD; PHD
- Rakugi, Hiromi MD; PHD
- Tsubakihara, Yoshiharu MD; PHD
OBJECTIVE
There is now growing evidence that magnesium (Mg) deficiency is implicated in type 2 diabetes and its complications. However, it has not been fully elucidated whether hypomagnesemia is a predictor of end-stage renal disease (ESRD) in type 2 diabetic nephropathy.
RESEARCH DESIGN AND METHODS
This retrospective cohort study included 455 chronic kidney disease (CKD) patients (144 with type 2 diabetic nephropathy and 311 with nondiabetic CKD) who were hospitalized at Osaka General Medical Center for a CKD educational program between April 2001 and December 2007. The primary outcome was progression to renal replacement therapy. Participants were categorized based on serum Mg level into Low-Mg (serum Mg level ≤1.8 mg/dL) and High-Mg (serum Mg level >1.8 mg/dL) groups with the previously published normal lower limit chosen as the cutoff point.
RESULTS
Of the subjects with type 2 diabetic nephropathy, 102 progressed to ESRD during follow-up (median, 23 months). A multivariate Cox proportional hazards model showed that after adjustment for various demographic factors and laboratory data, the Low-Mg group had a 2.12-fold higher risk of ESRD than the High-Mg group (95% CI 1.28–3.51; P = 0.004). In contrast, 135 of the nondiabetic CKD subjects progressed to ESRD during follow-up (median, 44 months). No significant difference in outcome was found between the Low- and High-Mg groups of this population (adjusted hazard ratio, 1.15; 95% CI 0.70–1.90; P = 0.57).
CONCLUSIONS
Hypomagnesemia is a novel predictor of ESRD in patients with type 2 diabetic nephropathy.