ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005


The Latest on X

Kidney Week

Abstract: TH-PO255

Association Between Magnesium, Erythropoietin Resistance, and Mortality: The Japanese Dialysis Outcome and Practice Pattern Study (J-DOPPS) Study

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis


  • Kato, Sawako, Nagoya Daigaku Daigakuin Igakukei Kenkyuka Igakubu, Nagoya, Aichi, Japan
  • Wang, Jui, Institute for Health Outcomes and Process Evaluation Research, Tokyo, Japan
  • Onishi, Yoshihiro, Institute for Health Outcomes and Process Evaluation Research, Tokyo, Japan
  • Nangaku, Masaomi, Tokyo Daigaku Daigakuin Igakukei Kenkyuka Igakubu, Bunkyo-ku, Tokyo, Japan

Limited data are now available to evaluate the relationship between serum magnesium level, anemia, and mortality in the dialysis population.


Using data from the Japanese Dialysis Outcomes and Practice Patterns Study (J-DOPPS) phases 5 and 6, we analyzed the association between serum magnesium (s-Mg) levels and the erythropoietin resistance index (ERI) as the primary outcome. To estimate the longitudinal relationship, a mixed-effect model was used with ERI at each 4-month period as the dependent variable, quintiles of s-Mg at the previous 4-month period as the independent variable. We also examined the all-cause and cardiovascular disease (CVD)-related deaths as secondary outcomes by Cox regression with quintiles of s-Mg at baseline.


Of the 4776 participants in J-DOPPS, 1650 were included in the analysis. The median of s-Mg at baseline was 2.5 mg/dL. A significant linear association of s-Mg with ERI (p for trend < 0.001) was revealed (Figure). The highest quintile of s-Mg was significantly associated with lower incidence of all-cause mortality (Table) and deaths due to CVD events compared to the middle (reference) quintile.


We observed that lower s-Mg levels subsequently induced higher ERI and that mild higher s-Mg levels predicted good rather than poor outcomes in Japanese hemodialysis patients. Adjustment of s-Mg levels may be proposed as a new strategy at low cost and risk to reduce the risk of premature mortality.

Relationship between the all-cause deaths and serum magnesium.
OutcomeMg quintiles (mg/dL)Incident rate (/100 PYs)Crude analysis HR (95%CI)Adjusted analysis HR (95%CI)
All-cause deathsQ1 ( ≤2.1)5.10.9 (0.6. 1.5)0.6 (0.4. 1.1)
 Q2 (2.2 - 2.3)6.31.2 (0.8. 1.8)1.2 (0.8. 1.8)
 Q3 (2.4 - 2.5)5.4ReferenceReference
 Q4 (2.6 - 2.7)4.10.8 (0.5. 1.2)0.8 (0.5. 1.4)
 Q5 (2.8 ≤ )2.80.8 (0.5. 1.2)0.6 (0.4. 1.0)

Mg, magnesium; Pys, person-years; HR, hazard ratio; CI, confidence interval.


  • Commercial Support – Kyowa Kirin Co, Ltd.