Magnesium Balance in Chronic Kidney Disease : Mineral Metabolism, Immunosuppressive Therapies and Sodium-Glucose Cotransporter 2 Inhibitors
Lloret, Maria Jesus (Institut de Recerca Sant Pau)
Fayos de Arizón, Leonor (Institut de Recerca Sant Pau)
Massó, Elisabet (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Bover, Jordi (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Valdivielso, José Manuel (Instituto de Salud Carlos III)
Díaz Tocados, Juan Miguel (Instituto de Salud Carlos III)
Domínguez-Coral, Juan Diego (Instituto de Salud Carlos III)
Tinoco Aranda, Adria Patricia (Fundació Puigvert)
Rodríguez Ortiz, María Encarnación (Hospital Universitario Reina Sofía (Còrdova, Espanya))
Universitat Autònoma de Barcelona. Departament de Medicina

Date:	2025
Abstract:	It is now widely recognized that maintaining magnesium (Mg) homeostasis is critical for health, especially in the context of chronic kidney disease (CKD). Patients with CKD commonly develop hyperphosphatemia and secondary hyperparathyroidism, which are controlled by therapies targeting intestinal phosphate absorption and circulating calcium levels or by modulating parathyroid calcium sensing. Notably, Mg supplementation may provide dual benefits by promoting bone formation and maintaining normal mineralization with slightly elevated serum levels. Importantly, low Mg levels are associated with mortality risk in CKD, highlighting the importance of maintaining adequate serum Mg levels in these patients. Particularly, kidney transplant (KT) patients have lower circulating Mg levels, likely due to interactions with immunosuppressive treatments. Sodium-glucose co-transporter 2 (SGLT2) inhibitors have shown survival benefits in CKD and increased serum Mg levels, suggesting that Mg regulation may contribute to these outcomes. Overall, Mg plays a key role in CKD-associated mineral and bone disorders (CKD-MBD). Thus, understanding the mechanisms underlying the alteration of Mg homeostasis in CKD could improve clinical outcomes. This review summarizes the basic and clinical studies demonstrating (1) the key actions of Mg in CKD-MBD, including secondary hyperparathyroidism and bone abnormalities; (2) the distinctive profile of KT patients for Mg homeostasis; and (3) the interaction between commonly used drugs, such as SGLT2 inhibitors or immunosuppressive treatments, and Mg metabolism, providing a broad understanding of both the key role of Mg in the context of CKD and the treatments that should be considered to manage Mg levels in CKD patients.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article de revisió ; recerca ; Versió publicada
Subject:	CKD-MBD ; SLGT2 inhibitors ; Chronic kidney disease ; Magnesium ; Renal transplant patients
Published in:	International journal of molecular sciences, Vol. 26, Num. 12 (June 2025) , art. 5657, ISSN 1422-0067

DOI: 10.3390/ijms26125657
PMID: 40565121

20 p, 1.0 MB

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Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP)
Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut de Recerca Sant Pau
Articles > Research articles
Articles > Published articles