ความสัมพันธ์ระหว่างภาวะแมกนีเซียมในเลือดต่ำกับภาวะอัลบูมินรั่วในปัสสาวะในผู้ป่วยโรคไตเรื้อรัง

Jane Pitanupong

doi:10.64960/srimedj.v41i4.270932

Authors

Jane Pitanupong Division of Nephrology, Department of Internal Medicine, Thasala Hospital, Thasala District, Nakhon Si Thammarat Province, Thailand 80160

DOI:

https://doi.org/10.64960/srimedj.v41i4.270932

Keywords:

hypomagnesemia, albuminuria, chronic kidney disease

Abstract

Background and objective: Hypomagnesemia is common in patients with chronic kidney disease (CKD) and may increase cardiovascular risk. Albuminuria is an important marker of CKD severity and is also associated with cardiovascular outcomes. However, evidence regarding the association between hypomagnesemia and albuminuria in CKD remains limited. This study aimed to investigate the association between hypomagnesemia and albuminuria in patients with CKD, and to evaluate the relationship between fractional excretion of magnesium (FEMg) and albuminuria.

Methods: A cross-sectional study was conducted among CKD patients attending the CKD clinic at Thasala Hospital between December 2025 and January 2026. Participants were classified into hypomagnesemia (serum Mg < 1.7 mg/dL) and normomagnesemia groups. Albuminuria was defined as UACR > 30 mg/g. Clinical characteristics and laboratory parameters were compared between groups. Factors associated with hypomagnesemia were assessed using univariate and multivariable analyses. ROC curve analysis was performed to determine the optimal cut-off values of UACR for discriminating hypomagnesemia, and of serum magnesesium and FEMg for discriminating ablumminuria.

Results: A total of 131 patients were included (median age 69 years; 51.9% female). Albuminuria was present in 69 patients (52.7%), and hypomagnesemia was observed in 35 patients (26.7%). In multivariable analysis, albuminuria was independently associated with hypomagnesemia (OR_adj = 3.65, 95% CI 2.46–5.25; p < 0.001). Lower estimated glomerular filtration rate (eGFR) (OR_adj = 1.09, 95% CI 1.02–1.18; p = 0.017) and longer CKD duration (OR_adj = 1.01, 95% CI 1.00–1.02; p = 0.011) were also significantly associated with hypomagnesemia. ROC curve analysis identified an optimal UACR cut-off of 80.0 mg/g for discriminating hypomagnesemia (AUC = 0.857), a serum magnesium cut-off of < 1.60 mg/dL for discriminating albuminuria (AUC = 0.743), and an optimal FEMg cut-off of 8.36% for discriminating albuminuria (AUC = 0.743).

Conclusions: Albuminuria was independently associated with hypomagnesemia in patients with CKD. Lower eGFR and longer CKD duration were also associated with hypomagnesemia.

References

Herzog CA, Asinger RW, Berger AK, Charytan DM, Díez J, Hart RG, et al. Cardiovascular disease in chronic kidney disease. A clinical update from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int 2011;80(6):572-86. doi:10.1038/ki.2011.223.

Maier JA. Low magnesium and atherosclerosis: An evidence-based link. Mol Aspects Med 2003;24 (1-3):137-46. doi:10.1016/S0098-2997(03)00016-2.

Kanbay M, Yilmaz MI, Apetrii M, Saglam M, Yaman H, Unal HU, et al. Relationship between serum magnesium levels and cardiovascular events in chronic kidney disease patients. Am J Nephrol 2012;36(3):228-37. doi:10.1159/000341868.

Pham PC, Pham PM, Pham PA, Pham S, Pham H, Miller JM, et al. Lower serum magnesium levels are associated with more rapid decline of renal function in patients with diabetes mellitus type 2. Clin Nephrol 2005;63(6):429-36. doi:10.5414/CNP63429.

Eker ES, Ataoğlu HE. The relationship between hypomagnesemia and albuminuria in patients with type 2 diabetes mellitus. Clin Endocrinol (Oxf) 2024;101(2):216-22. doi:10.1111/cen.15094.

Lin CC, Liu CS, Li TC, Chen CC, Li CI, Lin WY. Microalbuminuria and the metabolic syndrome and its components in the Chinese population. Eur J Clin Invest 2007;37(10):783-90. doi:10.1111/j.1365-2362.2007.01865.x.

Oka T, Hamano T, Sakaguchi Y, Yamaguchi S, Kubota K, Senda M, et al. Proteinuria-associated renal magnesium wasting leads to hypomagnesemia:A common electrolyte abnormality in chronic kidney disease. Nephrol Dial Transplant 2019;34(7):1154-62. doi:10.1093/ndt/gfy119.

Abdel-Hameed AR, Ahmed MF, Elsantawy AA, Mohammad MB. Prevalence, risk factors and impact of proteinuria-associated hypomagnesemia in chronic kidney disease patients: Cross-sectional study. Egypt J Intern Med 2022;34(1):25. doi:10.1186/s43162-021-00083-8.

Azem R, Daou R, Bassil E, Anvari EM, Taliercio JJ, Arrigain S, et al. Serum magnesium, mortality and disease progression in chronic kidney disease. BMC Nephrol 2020;21(1):49. doi:10.1186/s12882-020-1713-3.

Hughes J, Chiu DYY, Kalra PA, Green D. Prevalence and outcomes of proton pump inhibitor associated hypomagnesemia in chronic kidney disease. PLoS One 2018;13(5):e0197400. doi:10.1371/journal. pone.0197400.

Kharitonova M, Iezhitsa I, Zheltova A, Ozerov A, Spasov A, Skalny A. Comparative angioprotective effects of magnesium compounds. J Trace Elem Med Biol 2015;29:227-34. doi:10.1016/j.jtemb.2014.06.026.

Maier JA, Castiglioni S, Locatelli L, Zocchi M, Mazur A. Magnesium and inflammation: Advances and perspectives. Semin Cell Dev Biol 2021;115:37-44. doi:10.1016/j.semcdb.2020.12.003.

Panta R, Regmi S. Role of magnesium, effects of hypomagnesemia, and benefits of magnesium supplements in cardiovascular and chronic kidney diseases. Cureus 2024;16(7):e64404. doi:10.7759/cureus.64404.

Ahmed F, Mohammed A. Magnesium: The forgotten electrolyte—a review on hypomagnesemia. Med Sci (Basel) 2019;7(4):56. doi:10.3390/medsci7050056.

Ozcelik F, Kactas S, Pence HH, Kurcenli S, Sertoglu E, Toy BE, et al. Fractional excretion of magnesium as an early indicator of renal tubular damage in normotensive diabetic nephropathy. Turk J Biochem 2020;45(5):543-51. doi:10.1515/tjb-2019-0232.

Žeravica R, Ilinčić B, Čabarkapa V, Radosavkić I, Samac J, Nikoletić K, et al. Fractional excretion of magnesium and kidney function parameters in nondiabetic chronic kidney disease. Magnes Res 2018;31(2):57-65. doi:10.1684/mrh.2018.0437.

Tapia H, Mora C, Navarro J. Magnesium in chronic kidney disease. Nefrologia 2007;27(6):674-80.

Sakaguchi Y. The emerging role of magnesium in CKD. Clin Exp Nephrol 2022;26(5):379-84. doi:10.1007/s10157-022-02182-4.

Blaine J, Chonchol M, Levi M. Renal control of calcium, phosphate, and magnesium homeostasis. Clin J Am Soc Nephrol 2015;10(7):1257-72. doi:10.2215/CJN.09750914