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Subject Area

Internal Medicine

Article Type

Original Study

Abstract

Introduction Vascular calcification is common among end-stage renal disease (ESRD) patients on regular dialysis, either hemodialysis or peritoneal dialysis. Magnesium is suggested to play a role in inhibiting that process. Recently, Mg started to be considered one of the factors that protect against vascular calcification and consequently decrease CVD mortality rate in CKD patients. Many recent studies support that role although the mechanism of that protective effect is not clear. But it is supposed to be a combination of both passive and active mechanisms. The passive one occurs through interference with calcium phosphate deposition and hydroxyapatite inhibition by phosphate binding. While on the other side, it has been noticed that Mg can actively inhibit calcification by preventing VSMCs from transformation into osteogenic phenotype. Aim of work: To assess the relation of serum magnesium level to carotid calcification and stiffness in CKD patients on regular dialysis, either hemodialysis or peritoneal dialysis. Methods: This cross-sectional observational study was held in the Mansoura University Hospital Nephrology and Dialysis Unit in the period from October 2024 to October 2025. This study included 78 cases that were on regular dialysis, either hemodialysis or peritoneal dialysis. All dialysis patients in the unit aged from 18 years to 65 years who were maintained on regular dialysis for more than 3 months. All patients must be able to give consent. Exclusion criteria include a proven history of ischemic events, either stroke or reported coronary artery disease diagnosed by angiography or treated by stenting and coronary artery bypass graft; active infection in the period of study; psychiatric disorders or antipsychotic drug intake; malignancies; severe malnutrition with body  mass index less than 16; weight loss of more than 15% of body weight in the last 6 months; or hypoalbuminemia less than 2.5 gm/dl. Clinical data was collected from all enrolled patients. Venous blood samples were collected immediately before starting the hemodialysis session on the first day of the week for measurement of serum magnesium level. Carotid calcification and stiffness indices were assessed radiologically by ultrasound using B-mode for measuring carotid intima-media thickness (CIMT), carotid arterial strain (CAS), and β-stiffness index. Results: Through all assessed variables, neither magnesium, calcium, nor phosphate levels were correlated significantly with any of the carotid calcification and stiffness indices. Age was positively correlated with CIMT and stiffness index and inversely with CAS, but after regression analysis it remained only as an independent predictor for CIMT. BMI emerged as an independent predictor for CAS in the regression model with an inverse relationship. iPTH showed a positive correlation with CAS and a marginal inverse one with stiffness index after multiple linear regression analysis. Conclusion: In this cross-sectional study of dialysis patients, carotid artery calcification was significantly influenced by age, which emerged as an independent predictor of CIMT. While other factors such as BMI, dialysis duration, and iPTH showed variable associations with carotid stiffness indices. On the other hand, serum magnesium levels were not significantly correlated with CIMT or local carotid stiffness indices. These findings suggest that, despite the growing interest in magnesium as a potential modifiable factor in vascular calcification, its role may be more complex and not adequately reflected by serum measurements alone. The lack of association observed in our study highlights the need for cautious interpretation of serum magnesium as a surrogate marker of vascular health in dialysis populations.

Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.

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