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Can Magnesium Cause Kidney Problems

Prevention And Treatment Of Hypermagnesemia

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Prevention of hypermagnesemia is usually possible. Anticipate hypermagnesemia in patients who are receiving magnesium treatment, especially those with reduced renal function. Initially, withdraw magnesium therapy, which often is enough to correct mild to moderate hypermagnesemia.

In patients with symptomatic hypermagnesemia that is causing cardiac effects or respiratory distress, antagonize the effects by infusing calcium gluconate. Calcium antagonizes the toxic effect of magnesium, and these ions electrically oppose each other at their sites of action. This treatment usually leads to immediate symptomatic improvement. In subjects with frankly impaired ability to excrete magnesium , renal replacement therapy may also be necessary.

Regulation Of Mg Levels

Daily requirement for Mg in adults is estimated to be 816 mmol , values close to the recommended daily allowance . Mg is widely distributed in most human foods such as meat, green vegetables and cereals, except fat.

In an adult body, total Mg is approximately 25 g compared with 1,000 g of calcium .

Approximately one-third of the total Mg in the body is present in the intracellular space, a small amount in the extracellular space, the remainder in bone. Less than 1% of the total body Mg is present in the intravascular compartment . Normal serum Mg concentrations ranges from 0.7 to 1.1 mmol/L , and can be categorized into 3 fractions: ionized , protein-bound and complexed with anions such as phosphate, bicarbonate, citrate or sulphate . Ionized Mg and complexed Mg together form the ultrafilterable fraction of Mg, representing the portion of total plasma Mg that can be removed by the kidneys or dialysis . Serum Mg level may not be a good measure of the total amount of Mg in the body nonetheless, most information comes from the determination of Mg in serum and red blood cells .

Mg balance depends on intestinal uptake, storage in bone and skeletal muscle, and renal excretion .

Magnesium Intake And Impaired Kidney Function

If your kidney function is impaired, as is the case in chronic kidney disease and end-stage renal disease, your body may not be able to rid itself of excess magnesium. This may lead to toxic levels in your body, and can be identified by measuring a serum magnesium level. In some people, the kidney is unable to rid the body of high magnesium levels from supplements or antacids 3. The Food and Nutrition Board’s upper limit for magnesium intake from supplements is 350 milligrams daily.

  • If your kidney function is impaired, as is the case in chronic kidney disease and end-stage renal disease, your body may not be able to rid itself of excess magnesium.
  • In some people, the kidney is unable to rid the body of high magnesium levels from supplements or antacids 3.

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A. Magnesium is essential for muscles, nerves and bones. This mineral helps regulate blood sugar, blood pressure and heart rhythm.

The daily RDA is 420 mg for men and 320 mg for women. American diets are frequently low in magnesium, and commonly prescribed blood-pressure medicines containing diuretics may deplete this mineral.

People with kidney problems are unable to tolerate excess magnesium. They should avoid supplements, laxatives or antacids that contain this mineral. Overdosing on magnesium may overwhelm the system and result in magnesium toxicity. This may be what happened to your father-in-law because of his milk of magnesia habit.

If your wifes kidney function is normal and her physician monitors her magnesium levels, she should be able to tolerate up to 350 mg daily.

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Ascertainment Of Death And Its Causes

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We obtained mortality data from the EHR and through linkage of our registry with the Ohio Department of Health death records. The state death records contain causes of death coded according to the International Classification of Diseases, Tenth Revision . We grouped the underlying causes of death following the National Center for Health Statistics coding system, except for a modification explained here. We classified deaths into three categories: a) deaths from cardiovascular causes, b) deaths from malignancy, and c) deaths from other conditions. We defined cardiovascular deaths as those due to diseases of the heart, essential hypertension, cerebrovascular disease, atherosclerosis, or other diseases of the circulatory system . Patients with death reported in the EHR but not found in Ohio mortality files were included in analyses of all-cause mortality and excluded from cause-specific analyses.

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Magnesium Hypertension And Endothelial Dysfunction

Magnesium also affects blood pressure and endothelial function. Higher serum magnesium concentration is associated with improved endothelial dysfunction in patients with CKD, demonstrated by increased flow-mediated dilation of the brachial artery . In patients without CKD, serum magnesium is inversely associated with incident hypertension .

Mechanisms from in vitro studies that can explain the association between magnesium and blood pressure include effects of magnesium on contractility of vascular smooth muscle cells in the arterial wall, and effects of magnesium on endothelial function, thereby influencing vasodilation and vasoconstriction. In vascular smooth muscle cells, magnesium inhibits the influx of calcium via L-type calcium channels, which reduces vascular tone . At the endothelial level, acetylcholine-induced vasodilatation is magnesium-dependent and enhanced by increased magnesium concentrations in vitro .

In animal studies, a magnesium-deficient diet in Wistar rats induced an increase of blood pressure compared to rats on a normal magnesium diet . In rats with hypertension induced by administration of a mineralocorticoid in combination with salt loading , dietary magnesium supplementation decreased blood pressure . These findings, therefore, are in line with the above-described mechanisms on both endothelial cells and vascular smooth muscle cells.

Thedrugs And Supplements That Should Cause Concern

The following drugs andsupplements can affect kidney function:

1. NSAIDS

NSAIDs are very effectivemedications for multiple medical problems. But taking NSAIDS can affectthe kidneys, and can cause damage, especially if youre also takingdiuretics or ACE inhibitors.

NSAIDS include over-the-counterpainkillers like aspirin , ibuprofen , and naproxen .

They also includeprescription drugs like:

  • Naproxen sodium .
  • Naproxen/esomeprazole .
  • Diclofenac .

Using these medications withcaffeine can further harm your kidneys. When taking these medications, be sureto check regularly with your doctor if you have impaired kidney function.

2. Antibiotics

Certain antibiotics areremoved from the body through the kidneys, so taking them can put extra strainon your kidneys. Penicillin, cephalosporins and sulfonamides in particular canbe harmful to your kidneys.

Long-term antibiotic use caninjure your kidneys, even if youre otherwise healthy. And for people whosekidneys arent functioning at 100% to begin with, antibiotics can build up inthe body and cause damage.

Despite this, its importantto keep in mind that antibiotics can be safely used if needed as long as thedose is adjusted for your bodys level of kidney function.

3. Dietary supplements

Certain herbs or nutritionalsupplements are associated with kidney injury, even among healthy people. Withsuch a wide variety of supplements available, the best way to know if asupplement is safe is to ask your doctor to review all the ingredients.

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Are Magnesium Supplements Safe

Magnesium is one of the seven major minerals that the body needs in relatively large amounts . But too much of one major mineral can lead to a deficiency in another, and excessive magnesium can in turn cause a deficiency in calcium. Few people overdose on minerals from food. However, it is possible to get too much magnesium from supplements or laxatives.

People with kidney problems are more likely to experience an overdose of magnesium. Symptoms of toxic magnesium levels can range from upset stomach and diarrhea, to more serious symptoms of vomiting, confusion, slowed heart rate and dangerously low blood pressure. Severe magnesium overdoses can lead to problems breathing, coma, irregular heartbeat and even death.

Magnesium supplements can interact with several drugs. Taking magnesium too close to a dose of some antibiotics, including ciprofloxacin and moxifloxacin, may interfere with how the body absorbs the medicine. Similarly, magnesium can interfere with some osteoporosis drugs if the doses are taken too close together. Magnesium can also interfere with some thyroid medications. Magnesium can worsen side effects of some blood pressure medications, and increase the potency of some diabetes medicines.

Inflammation And Oxidative Stress

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Inflammation and oxidative stress have both been identified as being involved in both the development and progression of CKD . Low magnesium is associated with an increase in oxidative stress and increased production of inflammatory molecules.

Magnesium has been shown to fight inflammation, lowering inflammatory markers in the body. Magnesium is also a cofactor of several antioxidant enzymes in the body, for example, glutathione, one of the bodys primary antioxidants, needs magnesium for its production.

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Why Magnesium Is Important

Magnesium works together with other electrolytes, such as calcium, potassium, and sodium. Electrolytes are found in cells, body fluids, tissues, and bones and are essential because they:

  • Balance water in the body
  • Balance the body’s acid/base levels
  • Move nutrients in and out of cells
  • Move wastes out of cells
  • Ensure nerves, muscles, the heart, and the brain work properly

When magnesium levels drop, the kidneys will regulate how much magnesium they eliminate through urination. Urine production will slow down or stop in an attempt to reserve magnesium. This is a problem because the body does not excrete the waste that builds up, damaging the kidneys and other organs.

Vascular Calcification: In Vitro Evidence And Potential Pathogenic Mechanisms

The process of vascular calcification may start early during the course of CKD, prior to the start of dialysis, and worsens progressively, often in an accelerated fashion compared with the general population . Disturbances in mineral and bone metabolism appear to play a major role in the pathogenesis and rapid progression of vascular calcification . However, it is notable that compared with calcium and phosphate, the role of magnesium in this pathologic process has been the subject of few studies.

Calcium phosphate deposition, mainly in the form of carbonate and hydroxyapatite, respectively , which also are the mineral compounds of bone, is the hallmark of vascular calcification and can occur in the blood vessels, myocardium and cardiac valves . A recent in vitro investigation of the role of calcium phosphate deposition in VSMC calcification suggests that calcium phosphate deposition is initially a passive phenomenon, which then triggers the aforementioned osteogenic changes, resulting in the formation of more organized apatite crystal ultrastructures .

Potential mechanisms of the inhibitory effects of magnesium in the calcification process are shown in .

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Magnesium In Dialysis Patients

In the normal population, total and ionized serum magnesium concentrations usually lie between 0.65 and 1.05 mmol/L and 0.45 and 0.74 mmol/L, respectively. In HD and PD patients, both total and ionized magnesium concentrations are often slightly elevated above the normal range and have been shown to be dependent on residual renal function , on pharmacological or dietary intake and on dialytic elimination . Mild hypermagnesaemia has been described when using a magnesium dialysate concentration of 0.75 mmol/L in both PD and HD patients, while the results when a lower dialysate concentration was used were not as consistent .

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Take this medication by mouth as directed by your doctor, usually once daily before a meal. This medication may also be given through a tube into the stomach . Dosage and length of treatment are based on your medical condition and response to treatment. In children, the dosage is also based on weight.

Prilosec OTC is a 14-day regimen that can be used up to three times a year, but not more often than every 4 months. If you need to use Prilosec OTC for more than the three indicated 14-day courses of treatment, consult with your doctor.

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Addiction Alcoholism And Magnesium Depletion

In cases of addiction or alcoholism, low intake and absorption can cause magnesium deficiency. Complications such as liver disease, vomiting and diarrhea reduce body levels of magnesium, and treatment of addiction may in fact further complicate issues when withdrawal is experienced. In some cases, intravenous magnesium replacement is warranted during severe alcohol withdrawal. 14

Linus Pauling Institute Recommendation

The Linus Pauling Institute supports the latest RDA for magnesium intake . Despite magnesium being plentiful in foods, it is considered a shortfall nutrient . Following the Linus Pauling Institute recommendation to take a daily multivitamin/mineral supplement might ensure an intake of at least 100 mg/day of magnesium. Few multivitamin/mineral supplements contain more than 100 mg of magnesium due to its bulk. Eating a varied diet that provides green vegetables, whole grains, and nuts daily should provide the rest of an individual’s magnesium requirement.

Older adults

Older adults are less likely than younger adults to consume enough magnesium to meet their needs and should therefore take care to eat magnesium-rich foods in addition to taking a multivitamin/mineral supplement daily . Since older adults are also more likely to have impaired kidney function, they should avoid taking more than 350 mg/day of supplemental magnesium without medical consultation .

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What Is Magnesium Overdose

Magnesium overdose is an excess of magnesium in the body. Magnesium is an essential mineral that helps muscles function and maintain energy. In the absence of kidney disease, your body naturally removes excess magnesium. A magnesium overdose, also called magnesium toxicity or hypermagnesemia, generally occurs when magnesium is ingested in large quantities in the form of a supplement, either as a pill or a liquid. It is very rare to experience a magnesium overdose by consuming foods that have naturally occurring magnesium in them, such as fruits and vegetables or nuts and whole grains.

Magnesium is commonly found in over-the-counter medications. It is often used as a laxative, so after taking a magnesium-based laxative can be a mild symptom of magnesium overdose. Antacids also contain magnesium. A mild magnesium overdose is usually accompanied by temporary diarrhea and nausea.

People who have impaired kidney function are at the greatest risk for magnesium overdose. Even a moderate magnesium overdose may cause a drop in blood pressure in those with . Other possible serious symptoms include difficulty breathing, muscle , and mental confusion. Serious cases of magnesium overdose may cause .

Seek immediate medical care for serious symptoms of a magnesium overdose, including severe abdominal, pelvic, or chest pain or pressure confusion or loss of consciousness for even a brief moment rapid heart rate and .

Magnesium And Survival Of Haemodialysis Patients: Observational Studies

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The potential relationship between serum magnesium levels and survival has been investigated in 515 ESRD patients undergoing intermittent haemodialysis treatment . During a mean follow-up of 51 months, 103 patients died . When analysing the results according to the patients baseline serum magnesium levels, mortality rates were significantly higher in the group with lower baseline magnesium levels than in the group with higher baseline magnesium levels . It is important to note, at this point, that serum magnesium concentration at baseline correlated strongly with concentrations 1 year later . Multivariate Cox proportional hazard analysis showed that serum magnesium levels were a significant and independent predictor of overall mortality after adjustment for confounding factors such as patients age, sex, duration of haemodialysis and presence of diabetes. Lower serum magnesium concentration was also a significant and independent predictor of death owing to non-cardiovascular causes , but not for death from cardiovascular causes . The authors concluded that it might be worthwhile considering a higher dietary intake of magnesium and/or an adjustment of dialysate magnesium concentrations.

Magnesium and survival in haemodialysis patients:

  • Patients with slightly elevated serum magnesium concentrations may have a survival advantage.

  • Low serum magnesium concentrations may be independent predictors of death.

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Magnesium And Diabetes Inflammation And Lipid Profile

Magnesium may also influence the cardiovascular system via metabolic and inflammatory effects. Magnesium intake is inversely associated with incident type 2 diabetes mellitus in the general population, as was shown in a large meta-analysis of prospective cohort studies . Lower serum magnesium concentrations have been associated with development of pre-diabetes in participants with normal baseline glucose concentrations derived from a population-based cohort . Randomized controlled trials showed that dietary magnesium supplementation reduces plasma glucose concentrations in patients with pre-diabetes and hypomagnesemia , and improves insulin sensitivity, fasting glucose concentrations, and HbA1c concentrations in patients with type 2 diabetes mellitus .

Besides patients with diabetes, a cross-sectional analysis in patients with CKD showed that serum magnesium concentration also is inversely associated with C-reactive protein concentrations, as a reflection of low-grade inflammation . Magnesium supplementation decreases CRP concentration, as was shown in a meta-analysis of randomized controlled trials in non-CKD populations .

The mentioned metabolic and inflammatory effects may provide an additional link between lower magnesium concentrations and cardiovascular complications. An extensive overview of these effects is beyond the scope of this review.

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