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Abstract: TH-PO1150

A Randomized Trial of Magnesium Oxide for Coronary Artery Calcification in Pre-Dialysis CKD

Session Information

Category: Bone and Mineral Metabolism

  • No subcategory defined

Authors

  • Sakaguchi, Yusuke, Osaka University Graduate School of Medicine, Suita, Japan
  • Hamano, Takayuki, Osaka University Graduate School of Medicine, Suita, Japan
  • Oka, Tatsufumi, Osaka University Graduate School of Medicine, Suita, Japan
  • Yamaguchi, Satoshi, Osaka University Graduate School of Medicine, Suita, Japan
  • Matsui, Isao, Osaka University Graduate School of Medicine, Suita, Japan
  • Hashimoto, Nobuhiro, Osaka University Graduate School of Medicine, Suita, Japan
  • Matsumoto, Ayumi, Osaka University Graduate School of Medicine, Suita, Japan
  • Shimada, Karin, Osaka University Graduate School of Medicine, Suita, Japan
  • Takabatake, Yoshitsugu, Osaka University Graduate School of Medicine, Suita, Japan
  • Takahashi, Atsushi, Osaka University Graduate School of Medicine, Suita, Japan
  • Kaimori, Jun-Ya, Osaka University Graduate School of Medicine, Suita, Japan
  • Horio, Masaru, Osaka University Graduate School of Medicine, Suita, Japan
  • Yamamoto, Ryohei, Osaka University Health Care Center, Toyonaka, Japan
  • Moriyama, Toshiki, Osaka University Health Care Center, Toyonaka, Japan
  • Isaka, Yoshitaka, Osaka University Graduate School of Medicine, Suita, Japan
Background

Although coronary artery calcification (CAC) predicts cardiovascular events among patients with CKD, effective therapeutic strategies for CAC have not yet been established. Animal studies have revealed that magnesium inhibits vascular calcification whereas indoxyl sulfate aggravates it. We explored whether magnesium supplementation or oral carbon adsorbent (AST-120) mitigates the progression of CAC in CKD.

Methods

In this 2-year, open-label, randomized controlled trial with a 2 by 2 factorial design, the efficacy of magnesium oxide and AST-120 for the progression of CAC was separately evaluated. We enrolled stages 3-4 CKD patients with known risk factors of CAC (diabetes mellitus, prior history of cardiovascular disease, hyper-low-density lipoprotein cholesterolemia, or current smoking). These patients were randomly assigned to magnesium oxide or control group and to AST-120 or control group. The primary outcome was a percent change in CAC score (Agatston score).

Results

The study was terminated prematurely after a planned interim analysis of the first 125 enrolled patients, showing that the percent change in CAC score in the magnesium oxide group was lower than that in the control group (median: 11.3% vs 39.5%; P<0.001). The proportion of patients whose annual percent change in CAC score over 15% was significantly lower in the magnesium oxide group (23.9% vs 62.0%; P<0.001). Magnesium supplementation increased serum magnesium levels from 2.0 to 2.3 mg/dL (P<0.001; vs control group) but did not alter serum calcium, phosphate, or parathyroid hormone levels. The progression rate of CAC was not significantly different between patients in the AST-120 and control groups (23.1% and 31.9%, respectively; P=0.57).

Conclusion

Oral magnesium oxide retards the progression of CAC among pre-dialysis CKD patients with a high risk of vascular calcification.