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Kidney Week

Abstract: FR-PO639

Mortality and Magnesium Levels in CKD

Session Information

Category: Fluid and Electrolytes

  • 902 Fluid and Electrolytes: Clinical


  • Azem, Rami Mouayad, Cleveland Clinic, Cleveland, Ohio, United States
  • Daou, Remy, Saint Joseph University, Beirut, Lebanon
  • Arrigain, Susana, Cleveland Clinic, Cleveland, Ohio, United States
  • Schold, Jesse D., Cleveland Clinic, Cleveland, Ohio, United States
  • Nakhoul, Georges, Cleveland Clinic Foundation, Cleveland, Ohio, United States

Magnesium disorders are common in Chronic Kidney Disease (CKD) and are typically a consequence of decreased kidney function or use of medications such as diuretics. While hypomagnesemia has been linked with increased mortality, the association between elevated magnesium levels and mortality is not clearly defined. Additionally, associations between magnesium disorders and risk of different types of death have not been reported.


Using our Electronic Health Record-based CKD registry, we identified patients with eGFR 15 to < 60 ml/min/1.73m2 who had magnesium levels within the prior year. We examined associations between magnesium levels and all-cause, cause-specific mortality and progression of CKD while adjusting for demographic factors and comorbidities using Cox models, Competing Risks regression and mixed models.


Out of 10,568 CKD patients, 12.4% (N=1,314) had hypomagnesemia (Mg < 1.7 mmol/L) while 1.9% (N=205) had hypermagnesemia (Mg > 2.6 mmol/L). We observed a U-shaped association between serum magnesium levels and mortality, with both hypomagnesemia (HR=1.14, 95% CI: 1.04, 1.24) and hypermagnesemia (HR=1.23, 95% CI: 1.03, 1.48) having higher all-cause mortality. Our results showed increased subhazard of non-cardiovascular, non-malignancy deaths for hypomagnesemia (SHR=1.29, 95% CI: 1.12, 1.49), but no significant differences in other causes of death. In a sensitivity analysis excluding patients with malignancy, results were similar. Hypomagnesemia was not associated with stronger eGFR decline (P = 0.10).


Hypomagnesemia and hypermagnesemia were both associated with increased mortality. Hypomagnesemia was associated with increased non-cardiovascular, non-malignancy death.