Study of Serum Magnesium in Chronic Kidney Disease 

Magnesium is the second most abundant cation in the intracellular fluid,after Potassium.It ranks fourth among other cations regarding abundance in the human body.It is essential for substrate formation and plays a role in numerous biological and enzymatic processes in the human body1.Magnesium is not uniformly distributed among tissues of human body. The maximum concentration of magnesium is found in Heart, Kidneys and Brain2 The concentration of serum magnesium is in the range of 1.7-2.4 mg/dl ,of which 30% is protein-bound and another 15% is loosely complexed to phosphate and other anions.

The total body magnesium is around 25gm ,out of which one half is located in bone,only one-half which is insoluble in the mineral phase.

Almost all extraskeletal magnesium is present within cells ,95% of which is bound to proteins and other macromolecules. Only around 1% of body magnesium resides in the ECF. Dietary magnesium content normally range from 140-360mg/day of which 30-40% is absorbed mainly in the jejunum and ileum.

Urinary magnesium excretion normally matches net intestinal absorption and is 100mg/day.Only 20% of filtered magnesium is reabsorbed in the proximal tubule whereas 60% is reclaimed in the cTAL and another 5-10% in the DCT.The major sources of magnesium are green leafy vegetables,meat, cereals and nuts.3,4

The principal organ involved in the regulation of magnesium homeostasis is the kidney.Every day approximately 8 meq is excreted in urine5 Chronic kidney disease (CKD) is a worldwide health problem, affecting millions of people.6 Chronic kidney disease, as defined by the Kidney Disease Improving Global Outcomes (KDIGO) international guidelines, is an abnormality of kidney structure or function that is present for more than 3 months, with implications for health.

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Criteria required to make a diagnosis of CKD include a persistent reduction in eGFR of less than 60 mL/min per 1.73 m2 or 1 or more markers of kidney injury. The kidney has a vital role in magnesium homeostasis: regulation of magnesium excretion is determined by filtration and reabsorption. In individuals with normal renal function, of magnesium are filtered everyday.About 70–80% of plasma magnesium is ultrafilterable, and ~95% of the filtered magnesium load is subject to tubular reabsorption with 5% excreted in urine.

The renal handling of magnesium is highly adaptable, this ability deteriorates when renal function declines significantly. In moderate chronic kidney disease (CKD), increases in the fractional excretion of magnesium largely compensate for the loss of glomerular filtration rate to maintain normal serum magnesium levels. However, in more advanced CKD (as creatinine clearance falls Low serum magnesium levels was shown to be a risk factor for several common metabolic diseases and are associated with vascular calcification and increased cardiovascular mortality in chronic kidney disease patients.11,12,13.On the other hand whereas magnesium supplementation and mild hypermagnesemia might have beneficial effects in CKD patients with regard to calcification and mortality.

Severe hypermagnesaemia is known to cause cardiac conduction defects, neuromuscular effects and muscle weakness when plasma Mg concentration is higher than. The serum magnesium has a dubious credit of being the most unrecognized electrolyte in routine clinical practice. Hence,we set out with an objective of studying serum magnesium levels and its outcomes in Chronic Kidney Disease. This study will be conducted over a period of one year in SILCHAR MEDICAL COLLEGE and HOSPITAL, which is located in Cachar district, Assam and functions as the teaching tertiary referral hospital for the entire Barak Valley,DimaHasao district of Assam and neighboring states like Manipur,Tripura, Mizoram and Meghalaya.