Association between hypomagnesemia and mortality among dialysis patients: a systematic review and meta-analysis

Lower product of magnesium × potassium is associated with higher mortality in chronic hemodialysis patients: a cohort study

This study aimed to investigate the Mg × K product on the mortality risk of hemodialysis patients with concomitant hypokalemia and lower magnesium levels. This was a prospective observational study of patients in a HD center in southern Taiwan. A total of 444 HD patients were divided into 5 groups by the Mg × K product: group 1, bottom quintile, median Mg × K: 7.87, IQR: 7.03-8.12 (n = 89, age: 64 ± 13 years old); group 2, median Mg × K: 9.37, IQR: 8.97-9.86 (n = 89, age:62 ± 13 years old); group 3, median Mg × K: 10.95, IQR: 10.50-11.26 (n = 89, age:64 ± 13 years old); group 4, median Mg × K: 12.30, IQR: 11.87-12.82 (n = 89, 61 ± 12 years old); and group 5, top quintile, median Mg × K: 14.92, IQR:14.07-16.23 (n = 88, 62 ± 11 years old). The patients were followed up for 2 years to determine the risk of all-cause mortality. Patients with a lower Mg × K product had more comorbidities, malnutrition-inflammation status, and a higher mortality risk. Using multivariable Cox regression analysis, a higher Mg × K [HR, 0.89; 95%CI (0.81-0.98)] was found to be an independent predictor of better survival. HD patients with a lower Mg × K product had more comorbidities, a marked malnutrition-inflammation status, and were associated with long-term mortality. A higher Mg × K value is a favorable survival factor.

Serum oxalate concentration is associated with coronary artery calcification and cardiovascular events in Japanese dialysis patients

Coronary artery calcification (CAC) is associated with cardiovascular disease (CVD). CAC might contain calcium oxalate, and a high serum oxalate (SOx) concentration is associated with cardiovascular mortality in dialysis patients. We assessed the associations between SOx and CAC or CVD events in Japanese hemodialysis patients. This cross-sectional and retrospective cohort study was done in 2011. Seventy-seven hemodialysis patients' Agatston CAC score was measured, and serum samples were collected. SOx concentrations were measured in 2021 by using frozen samples. Also, new-onset CVD events in 2011-2021 were retrospectively recorded. The association between SOx concentration and CAC score ≥ 1000, and new-onset CVD events were examined. Median SOx concentration and CAC score were 266.9 (229.5-318.5) µmol/L and 912.5 (123.7-2944), respectively. CAC score ≥ 1000 was associated with SOx [adjusted odds ratio (OR) 1.01, 95% confidence interval (CI), 1.00-1.02]. The number of new-onset CVD events was significantly higher in patients with SOx ≥ median value [hazard ratio (HR) 2.71, 95% CI 1.26-6.16]. By Cox proportional hazard models, new-onset CVD events was associated with SOx ≥ median value (adjusted HR 2.10, 95% CI 0.90-4.91). SOx was associated with CAC score ≥ 1000 and new-onset CVD events in Japanese hemodialysis patients.

Comparison of Patient Survival According to Erythropoiesis-Stimulating Agent Type of Treatment in Maintenance Hemodialysis Patients

This study aimed to evaluate the difference in patient survival according to the type of erythropoiesis-stimulating agent (ESA) treatment used in the Korean hemodialysis (HD) population. This retrospective study analyzed the laboratory data from a national HD quality assessment program and the claims of Korea. Included participants were divided into three groups according to the type of ESA used during the 6 months of each assessment period as follows: the EP group (n = 38,043, epoetin-α or epoetin-β), the DP group (n = 10,054, darbepoetin-α), and the MR group (2253, continuous erythropoietin receptor activator). The ESA doses in the EP, DP, and MR groups were 6451 ± 3586, 5959 ± 3857, and 3877 ± 2275 unit/week, respectively. The erythropoiesis resistance indexes (ERIs) in the three groups were 10.7 ± 6.7, 9.9 ± 7.6, and 6.3 ± 4.1 IU/kg/g/dL, respectively. Kaplan−Meier curves revealed similar rates of patient survival among the three groups (p = 0.530). A multivariate Cox regression analysis showed that the hazard ratios in the DP group and MR group were 1.00 (p = 0.853) and 0.87 (p < 0.001), respectively, compared to that of the EP group. The hazard ratio in the MR group was 0.87 (p = 0.001) compared to that of the DP group. Our study shows that the MR group had comparable or better patient survival than the EP and DP groups in the multivariate analysis. However, the ESA doses and ERI were considerably different among the three groups. It was difficult to determine whether the better patient survival in the MR group originated from the ESA type, ESA dose, ERI, or other hidden factors.