Kidney Week

Abstract: SA-PO865

Lower Serum Magnesium (sMg) Is a Strong Predictor of Left Ventricular Hypertrophy (LVH) and Patterns of LV Remodeling in Patients with CKD Stage 5D

Session Information

• Dialysis: Cardiovascular, BP, Volume
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Kyriazis, Periklis Panos, Baystate Medical Center/University of Massachusetts , Springfield, Massachusetts, United States

Periklis Panos Kyriazis,

• Kalogeropoulos, Charalampos, Attikon University Hospital, Athens, Greece

Charalampos Kalogeropoulos,

• Tsotsorou, Ourania, Attikon University Hospital, Athens, Greece

Ourania Tsotsorou,

• Dermitzaki, Eleftheria-Kleio, University Hospital of Heraklion , Heraklion, Greece

Eleftheria-Kleio Dermitzaki,

• Giannikouris, Ioannis Emmanouel, Medifil SA Hemodialysis Center, Athens, Greece

Ioannis Emmanouel Giannikouris,

• Lygerou, Dimitra, University Hospital of Heraklion , Heraklion, Greece

Dimitra Lygerou,

• Kokkalis, Apostolo, Clinitest E.E Hemodialysis Center, Athens, Greece

Apostolo Kokkalis,

• Bacharaki, Dimitra, Attikon University Hospital, Athens, Greece

Dimitra Bacharaki,

• Vlahakos, Dimitrios V., Attikon University Hospital, Athens, Greece

Dimitrios V. Vlahakos,

Background

To evaluate the prognostic role of sMg on LVH and cardiac geometry in patients with stage 5D CKD

Methods

The study included 127 patients with stage 5D CKD (69 on hemodialysis and 58 on peritoneal dialysis) and a mean age of 62±15 years. Echocardiographic LVH was defined by LV mass index (LVMI) > 95 g/m² in women and > 115 g/m² in men. Based on LVMI and relative wall thickness (RWT), four LV geometric patterns were defined: normal (normal LVMI and RWT), concentric remodeling (normal LVMI and increased RWT>0.42), eccentric LVH (increased LVMI and normal RWT) and concentric LVH (increased LVMI and RWT). sMg and serum Ca (sCa) values were defined as the mean of all predialysis measurements available during the preceding 3 months.

Results

Patients (n=81) with LVH as compared to patients with no LVH (n=46) were older in age (p <0.001), had lower sMg (p<0.001) and higher sCa (p<0.05), malnutrition-inflammation score ( p<0.05), body mass index (p<0.001), pulse pressure (p<0.01), prevalence of diabetes (p<0.05), coronary artery disease (p<0.05) and peripheral vascular disease) (p<0.01). In a multivariate logistic regression analysis adjusted for all factors mentioned above, each increase of sMg by 1 mg/dl was associated with 91% (OR= 0.09, 95% CI: 0.024-0.36; p <0.001) lower odds of having LVH. In a forward stepwise multivariate model (R²= 0.271; p<0.001), sMg emerged a strong independent predictor of LVMI (p<0.01) explaining about 5.7% of its variance.The area under the ROC curve for predicting the development of LVH was 0.696 (p<0.001) and at an optimal sMg cutoff of 2.26 mg/dl the sensitivity and specificity of sMg in predicting the occurrence of LVH were 67.4 % and 66.7 %, respectively. Considering LV geometry, there was a progressive decrease in sMg from the normal group (2.38±0.38 mg/dl) to concentric remodeling group (2.37±0.40 mg/dl), eccentric (2.19±0.30 mg/dl) and then to concentric (2.08±0.36 mg/dl) group (p<0.01 for the trend).

Conclusion

A lower sMg is a major determinant of echocardiographic LVH. Prospective studies may determine whether therapeutic adjustments of sMg can prevent or reduce the risk of LVH in patients with stage 5D CKD