Is the magnesium phosphate ratio a predictor of arrhythmia in patients undergoing hemodialysis?

Year 2023, , 128 - 133, 12.01.2023

Ferhat Yurdam , Muhittin Doruk Tatlı

https://doi.org/10.32322/jhsm.1207234

Abstract

Aim: Sudden death due to coronary artery disease, heart failure, arrhythmia or hyperkalemia constitutes the majority of cardiovascular causes in patients with end-stage renal disease. Magnesium plays an important role in many processes that regulate cardiovascular functions such as endothelial function, regulation of vascular tone and myocardial excitability. In addition, hyperphosphatemia is very common in patients with end-stage renal disease and is associated with an increased risk of mortality in hemodialysis patients. Our aim in this study; to determine the role of Mg/PO4 ratio in predicting arrhythmia in patients with end-stage renal disease receiving hemodialysis.
Material and Method: A total of 103 consecutive patients admitted to the cardiology outpatient clinic and receiving hemodialysis for chronic renal failure were included in the study. Between January 2018 and October 2022, patients monitored with 24-hour rhythm holter ECG were recruited. Patients were analyzed by dividing into 2 groups as those with arrhythmia detected in 24-hour rhythm Holter ECG (group 1: 51 patients) and those without (group 2: 52 patients).
Result: The mean age of the patients in the study was significantly higher in group 1 compared to group 2 (66.96±10.27 and 62.21±10.50, p=0.02, respectively). When the 24-hour rhythm Holter ECGs of the patients were examined, the most common arrhythmia was ventricular extrasystole with a rate of 18.4% (n=19), and paroxysmal AF was the second with a rate of 9.7% (n=10). In the univariate regression analysis we performed for arrhythmia predictivity in patients receiving hemodialysis; age (OR: 1.046; 95%CI: 1.005-1.088, p=0.02), LVEF (OR: 0.941; 95%CI: 0.895-0.989, p=0.01), mid-severe MR (OR: 0.553; 95%CI: 0.215-1.424, p=0.22), Na (OR: 1.119; 95%CI: 0.967-1.294, p=0.13), Hemoglobin (OR: 0.872; 95%CI: 0.710-1.069, p=0.18), total cholesterol (OR: 1.006; 95%CI: 0.997-1.016, p=0.19), LDL (OR: 1.012; 95%CI: 0.998-1.026, p=0.10), Mg (OR: 0.117; 95%CI: 0.015- 0.941, p=0.04), PO4 (OR: 1.664; 95%CI: 1.093-2.532, p=0.01), Mg/PO4 ratio (OR: 0.002; 95%CI: 0.000-0.104, p=0.002) detected as arrhythmia predictors. In the multivariate regression analysis, independent predictors for the presence of arrhythmia were determined using 2 different models. In the model 1; age (OR: 0.993; 95%CI: 0.956 1.031, p=0.70), LVEF (OR: 0.955; 95%CI: 0.916-0.994, p=0.026), Mg (OR: 0.136; 95%CI: 0.014-1.308), p=0.08), PO4 (OR: 1.545; 95%CI: 0.989- 2.414, p=0.056) (Table 6). In the model 2; age (OR: 0.988; 95%CI: 0.951-1.026, p=52), LVEF (OR: 0.955; 95%CI: 0.917-0.995, p=0.029), Mg/PO4 ratio (OR: 0.002, 95%CI: 0.000-0.101 p=0.002) was detected independent predictors for the presence of arrhythmia. ROC analysis (Figure) showed that LVEF<54.5%, with 64% sensitivity and 53% specificity ([AUC]: 0.666, 95% CI: 0.560-0.772, p=0.004), Mg/PO4 ratio<0.45, with 64% sensitivity and 65% specificity ([AUC]: 0.674, 95% CI: 0.570-0.778, p=0.002), predicts arrhythmia in hemodialysis patients
Conclusion: In our study, it was concluded that the Mg/P ratio, which can be calculated simply, is a predictor of arrhythmia in hemodialysis patients.

Keywords

Arrhythmia, hemodialysis, predictivity, Holter ECG

References

• US Renal Data System. USRDS 2018 Annual Data Report: Atlas of End-Stage Renal Disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2018.
• Nakai S, Iseki K, Itami N, et al. Overview of regular dialysis treatment in Japan (as of 31 December 2009). Ther Apher Dial 2012; 16: 11–53.
• de Jager DJ, Grootendorst DC, Jager KJ et al. Cardiovascular and noncardiovascular mortality among patients starting dialysis. JAMA 2009; 302: 1782–89.
• Foley RN, Parfrey PS, Sarnak MJ. Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis 1998; 32: 112-19.
• Stenvinkel P, Carrero JJ, Axelsson J et al. Emerging biomarkers for evaluating cardiovascular risk in the chronic kidney disease patient: how do new pieces fit into the uremic puzzle? Clin J Am Soc Nephrol 2008; 3: 505–21.
• Chazan JA. Sudden death in patients with chronic renal failure on hemodialys. Dialysis transplant 1987; 16: 447-48.
• Lörincz I, Zilahi Z, Kun C, Matyus J, Kakuk G. ECG abnormalities in hemodialysis. Am Heart J 1997; 134: 1138-40.
• Volpe SL. Magnesium, the metabolic syndrome, insulin resistance, and type 2 diabetes mellitus. Crit Rev Food Sci Nutr 2008; 48: 293–300.
• Kolte D, Vijayaraghavan K, Khera S, et al. Role of magnesium in cardiovascular diseases. Cardiol Rev 2014; 22: 182–92.
• Liao F, Folsom AR, Brancati FL. Is low magnesium concentration a risk factor for coronary heart disease? The Atherosclerosis Risk in Communities (ARIC) Study. Am Heart J 1998; 136: 480–90.
• Zhang W, Iso H, Ohira T et al. Associations of dietary magnesium intake with mortality from cardiovascular disease: the JACC study. Atherosclerosis 2012; 221: 587–95.
• Larsson SC, Orsini N, Wolk A. Dietary magnesium intake and risk of stroke: a meta-analysis of prospective studies. Am J Clin Nutr 2012; 95: 362–6.
• Tonelli M, Sacks F, Pfeffer M, et al. Cholesterol and Recurrent Events Trial Investigators. Relation between serum phosphate level and cardiovascular event rate in people with coronary disease. Circulation 2005; 112: 2627-33.
• Ganesh SK, Stack AG, Levin NW, et al. Association of elevated serum PO4, Ca x PO4 product, and parathyroid hormone with cardiac mortality risk in chronic hemodialysis patients. J Am Soc Nephrol 2001; 12: 2131–8.
• Lu W, Xie Y, Zhang Y, et al. Low Serum Magnesium as a Predictive Factor of Major Adverse Cardiac and Cerebrovascular Events in Maintenance Hemodialysis Patients. Research Square; 2022. Doi: 10.21203/rs.3.rs-1991980/v1
• Strobl FF, Kuhlin B, Stahl R, et al. Intracranial arterial calcifications as a prognostic factor for subsequent major adverse cardiovascular events (MACE). Radiol Med (Torino) 2018; 123: 456–62.
• Sakaguchi Y, Hamano T, Nakano C, et al. Association between density of coronary artery calcification and serum magnesium levels among patients with chronic kidney disease. PloS One 2016; 11: e0163673.
• Leenders NHJ, Bos C, Hoekstra T, Schurgers LJ, Vervloet MG, Hoenderop JGJ. Dietary magnesium supplementation inhibits abdominal vascular calcification in an experimental animal model of chronic kidney disease. Nephrol Dial Transplant Off Publ Eur Dial Transpl Assoc - Eur Ren Assoc 2022; 37: 1049–58.
• Ozturk N, Olgar Y, Aslan M, Ozdemir S. Effects of magnesium supplementation on electrophysiological remodeling of cardiac myocytes in L-NAME induced hypertensive rats. J Bioenerg Biomembr 2016; 48: 425–36.
• Petrović J, Labudović-Borović M, Vorrink SU, Lauschke VM, Pejušković B, Pešić V. Magnesium enhances cardiomyocyte proliferation and suppresses cardiac fibrosis induced by chronic ACTH exposure in rats. Magnes Res 2021; 34: 74–83.
• de Roij van Zuijdewijn CL, Grooteman MP, Bots ML, et al. Serum magnesium and sudden death in European hemodialysis patients. PLoS One 2015; 10: e0143104.
• Lacson E Jr, Wang W, Ma L, et al. Serum magnesium and mortality in hemodialysis patients in the United States: a cohort study. Am J Kidney Dis 2015; 66: 1056–66.
• Li L, Streja E, Rhee CM, et al. Hypomagnesemia and mortality in incident hemodialysis patients. Am J Kidney Dis 2015; 66: 1047–55.
• Kis M, Senoz M, Guzel T. The relationship between good collateral development and magnesium/phosphate ratios in chronic total occlusion. Acta Medica Nicomedia 2022; 5: 126-30.
• Soydan E, Akın M. Koroner arter hastalığında magnezyum/fosfat oranı ile endotel fonksiyonları arasındaki ilişki: Bir prospektif çalışma. Ege Tıp Derg 2021; 60: 76-82.
• Chipperfield B, Chipperfield JR. Relation of myocardial metal concentration to water hardness and death rates from ischemic heart disease. Lancet 1973; 2: 709-12.
• Rogiers P, Vermeier W, Kesteloot H, Stroobandt R. Effect of the infusion of magnesium sulfate during atria1 pacing on ECG intervals, serum electrolytes, and blood pressure. Am Heart J 1989: 117: 1278-83.
• DiCarlo LA, Morady F, de Buitleir M, Krol RB, Schurig L, Annesley TM. Effect of magnesium sulfate on cardiac conduction and refractoriness in humans. JACC 1986; 7: 1356-62.
• Schwartz A, Gurman GM, Cohen G, et al. Association between hypophosphatemia and cardiac arrhythmias in the early stages of sepsis. European journal of internal medicine 2002; 13: 434-438.
• Adam, W, Nagu, T, Mutagaywa R, Kisanga O. Intradialytic arrhythmias among patients with end stage renal disease on maintenance hemodialysis at Muhimbili National Hospital. Doi: https: //doi.org/10.21203/rs.3.rs-150987/v1
• Sforzini S, Redaelli B, Latini R, Vincenti A, Mingardi G. Ventricular arrhythmias and four-year mortality in 288 haemodialysis patients. Gruppo Emodialisi e Patologie Cardiovascular. Lancet 1992; 289: 212–3.
• Seliger SL, Gillen DL, Tirschwell D, Wasse H, Kestenbaum BR, Stehman-Breen CO. Risk factors for incident stroke among patients with end-stage renal disease. J Am Soc Nephrol 2003; 14: 2623–31.
• Zimmermann AJ, Bossard M, Aeschbacher S, et al. Effects of sinus rhythm maintenance on left heart function after electrical cardioversion of atrial fibrillation: implications for tachycardia-induced cardiomyopathyy. Canadian J Cardiol 2015; 31: 36–43.
• Schliamser JE, Kadish AH, Subacius, H, Shalaby A, Schaechter A, Levine J, et al. Significance of follow-up left ventricular ejection fraction measurements in the Defibrillators in Non-Ischemic Cardiomyopathy Treatment Evaluation trial (DEFINITE). Heart rhythm 2013; 10: 838-46.