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Abstract: PO1050

Effects of Dialysate Magnesium Concentrations on Mortality: Results from the MONDO Initiative

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • von Gersdorff, Gero D., University Hospital, Cologne, Cologne, Germany
  • Rascher, Katherine G., University Hospital, Cologne, Cologne, Germany
  • Guinsburg, Adrian M., Fresenius Medical Care AG und Co KGaA, Buenos Aires, Argentina
  • Raimann, Jochen G., Renal Research Institute, New York, New York, United States
  • Ye, Xiaoling, Renal Research Institute, New York, New York, United States
  • Kotanko, Peter, Renal Research Institute, New York, New York, United States
Background

Dialysate magnesium (DMg) is known to be positively associated with serum Mg levels in hemodialysis (HD) patients (pts). We aimed to study the associations between different DMg levels and mortality in HD pts.

Methods

We conducted a retrospective cohort study to examined the associations of different DMg levels (1.0, 1.5, or 2.0 mEq/L) and all-cause mortality. In-center HD pts treated in KfH and MONDO with constant DMg levels during their first year of observation were studied. The primary outcome variable was a 1-year mortality risk. In a second step, we used 1:1 propensity score matching (based on age, gender, catheter, and vintage) to create 4 matching groups: 1)DMg 1.0 versus 1.5 mEq/L (KfH and MONDO), 2)DMg 1.5 versus 2.0 mEq/L (only KfH), 3)1.0 versus 2.0 mEq/L (only KfH). The associations between different DMg levels and mortality after matching were evaluated by Cox proportional hazards models, Kaplan Meier survival curves, and the Log Rank test, respectively.

Results

We studied 32,117 pts from KfH [69 years, 64% males, 42% diabetics, 48% catheter; DMg 1.0: 31,460 (98%), DMg 1.5: 395 (1%) and DMg 2.0: 262 (1%)]; 15,211 pts from MONDO [57 years, 58% males, 41% diabetics, 24% catheter; DMg 0.75: 2,481 (16%), DMg 1.0: 12,508 (82%) and DMg 1.5: 222 (1%)]. Propensity score-matching created 4 well-balanced cohorts with DMg of 1.0 v.s. 1.5(KfH and MONDO), DMg 1.5 v.s. 2.0 and 1.0 v.s. 2.0 (KfH), respectively. Survival analysis show that DMg 1.5 is not statistically associated with survival benefits compared to 1.0 in both data sets (Table 1, Figure 1 a, d). In addition, compared to both DMg 1.0 and 1.5, we do not observe a survival benefit of DMg 2.0 in KfH’s data (Table 1, Figure 1b, c).

Conclusion

Increased DMg was not associated with a survival benefit in either the KfH or MONDO datasets. One of the limitations is the lack of detailed dialysate information. Further studies directly addressing the association between serum Mg and DMg are needed to further delineate the complex relationship between DMg and patient outcomes.