Unraveling the Mechanisms of Magnesium Supplementation in Alleviating Chronic Kidney Disease Complications and Progression: Balancing Risks and Benefits

IF 4.3 3区 材料科学 Q1 ENGINEERING, ELECTRICAL & ELECTRONIC
Majid Sadeghpour, Ali Bejani, Maryam Hosseini Kupaei, Seyed Jafar Amini Majd, Afshin Najafi, Shiva Fakhari, Ali Abdolizadeh, Keivan Mohammadi
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Abstract

Chronic kidney disease (CKD) is a major cause of death and disability worldwide. It is usually diagnosed at early levels because of its slow progression. Treatment should consider CKD complications (such as electrolyte level imbalance, vascular calcification, and bone mineral disorders), as well as the development of CKD itself. Large-scale studies have shown that current treatment guidelines are nearly ineffective and fail to achieve treatment goals. Guidelines have not paid as much attention to magnesium (Mg) as the other electrolytes, while Mg has a significant role in the treatment goals of CKD. Hypomagnesemia is the only electrolyte imbalance that is equally prevalent in all stages of CKD. A lower plasma Mg level in each stage of CKD is associated with a higher risk of CKD progression and cardiac events. Magnesium exerts its effects both directly and via other ions. Mg supplementation increases insulin sensitivity while reducing proteinuria and inflammation. It lowers blood pressure and inhibits vascular calcification primarily because of its effects on calcium and phosphate, respectively. Vitamin D supplementation for low-active vitamin D in CKD patients increases vascular calcification and cardiac events, but magnesium supplementation enhances vitamin D levels and activity without increasing the risk of cardiac events. However, careful attention is required due to the potential threats of hypermagnesemia, particularly in advanced CKD stages. Starting magnesium supplementation early in patients’ treatment plans will result in fewer side effects and more advantages. More original research is needed to determine its optimal dose and serum levels.

揭示镁补充剂缓解慢性肾病并发症和进展的机制:平衡风险与益处
慢性肾脏病(CKD)是全球死亡和残疾的主要原因。由于进展缓慢,通常在早期就能诊断出来。治疗应考虑慢性肾脏病的并发症(如电解质水平失衡、血管钙化和骨矿物质紊乱)以及慢性肾脏病本身的发展。大规模研究表明,目前的治疗指南几乎无效,无法实现治疗目标。指南对镁(Mg)的重视程度不及其他电解质,而镁(Mg)在慢性肾脏病的治疗目标中具有重要作用。低镁血症是唯一一种在慢性肾脏病各个阶段都同样普遍的电解质失衡。在慢性肾脏病的各个阶段,血浆镁水平越低,慢性肾脏病恶化和心脏事件的风险就越高。镁可直接或通过其他离子产生作用。补充镁可提高胰岛素敏感性,同时减少蛋白尿和炎症。镁能降低血压并抑制血管钙化,这主要是因为镁分别对钙和磷酸盐有影响。慢性肾脏病患者补充低活性维生素 D 会增加血管钙化和心脏事件,但补充镁可提高维生素 D 水平和活性,而不会增加心脏事件的风险。然而,由于高镁血症的潜在威胁,尤其是在晚期慢性肾脏病患者中,需要小心谨慎。在患者的治疗计划中尽早开始补充镁元素,可以减少副作用,提高疗效。要确定镁的最佳剂量和血清水平,还需要更多的原创性研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
7.20
自引率
4.30%
发文量
567
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