Saudi Journal of Kidney Diseases and Transplantation

: 2006  |  Volume : 17  |  Issue : 3  |  Page : 344--350

Correlation of Serum Magnesium with Serum Parathormone Levels in Patients on Regular Hemodialysis

Azar Baradaran1, Hamid Nasri2,  
1 Department of Biochemistry, Center of Research and Reference Laboratory of Iran, Hospital Bu Ali, Shahrekord, Iran
2 Internist and Nephrologist, Shahrekord University of Medical Sciences, Hajar Medical, Educational and Therapeutic Center, (Hemodialysis Department), Shahrekord, Iran

Correspondence Address:
Hamid Nasri
Internist, Nephrologist, Assistant Professor of Shahrekord University of Medical Sciences, Hajar Medical, Educational and Therapeutic Center, (Hemodialysis Department), P.O. Box: 88155-468, Shahrekord


Secondary hyperparathyroidism (SHPT) is a common, important, and treatable complication of end-stage renal disease. This study was conducted to investigate the role of serum magnesium (Mg) in regulating the secretion of parathyroid hormone (PTH) by the parathyroid gland in patients on maintenance hemodialysis (HD). Pre-dialysis serum levels of calcium (Ca), phosphorus (P), Mg, alkaline phosphatase (ALP), intact serum PTH (iPTH), serum 25-hydroxy Vitamin D (25-OH Vit D) and plasma bicarbonate (HCO3) were measured. The Urea Reduction Rate as well as duration and dosage of HD treatment were noted. Our study did not show any significant correlation between serum Mg levels and duration of HD treatment, levels of serum ALP, and plasma HCO3, Ca and P. An inverse correlation, albeit insignificant, was found between the serum Mg levels and iPTH (r=-0.30 p=0.079); also, a significant positive correlation was found between serum Mg levels and serum 25-OH Vit D levels (r= 0.40 p= 0.009). Our findings are in agreement with previous data, which suggest that factors other than serum Mg are more important in the regulation of PTH secretion in HD patients. A positive and strong association between serum Mg with 25-OH Vit D needs to be studied in greater detail.

How to cite this article:
Baradaran A, Nasri H. Correlation of Serum Magnesium with Serum Parathormone Levels in Patients on Regular Hemodialysis.Saudi J Kidney Dis Transpl 2006;17:344-350

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Baradaran A, Nasri H. Correlation of Serum Magnesium with Serum Parathormone Levels in Patients on Regular Hemodialysis. Saudi J Kidney Dis Transpl [serial online] 2006 [cited 2022 May 23 ];17:344-350
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Full Text


Secondary hyperparathyroidism (SHPT) is a common, important, and treatable compli­cation of end-stage renal disease (ESRD).[1],[2]],[3] Hyperphosphatemia, hypocalcemia, decreased expression of calcium and vitamin D receptors, and resistance to the action of parathyroid hor­mone (PTH) are the main causative factors.[3],[4],[5],[6],[7],[8],[9] The fact that many complications of SHPT are poorly reversible in the long-term [10],[11],[12],[13] emphasizes the need for early management of its causative factors. [2] In fact, independent of the factors mentioned above, which regulate parathyroid gland function, it has been believed that serum magnesium (Mg) levels play an important role in regulating the secretion of PTH. [14] It is thought that Mg may be able to modulate PTH secretion in a way similar to calcium (Ca). [15] Since renal excretion is the major route of elimination of Mg from the body, a positive Mg balance would be expected in patients with renal insufficiency. [16] However, the Mg balance may be normal or even decreased in uremic patients. This is probably due to decreased dietary intake combined with impaired intestinal absorption. Impaired absorption of Mg seems to be related to deficient synthesis of the active metabolite of vitamin D by the non­functioning kidney. [16] Following the institution of chronic hemodialysis (HD) treatment, the major determinant of Mg balance is the concentration of Mg in the dialysate. Thus, in patients with chronic renal failure (CRF), although reduced nutritional intake, impaired absorption from the intestine, vomiting, diarrhea, the use of diuretics, and acidosis may result in a negative balance of Mg, as mentioned above, reduced renal excretion may cause accumulation of Mg, [17],[18] resulting in increased Mg concentration in serum and red cells in CRF patients. Bone concentrations and total body Mg also appear to be increased. [17]

Studies have shown that infusion of Mg decreases the secretion of PTH. However, the effect of chronic hyper-magnesemia on PTH levels in dialysis patients is not well established. [19] Uncertainty about the inter­relationship between serum Mg levels, and boyh serum 25-hydroxy vitamin D (25-OH Vit D) levels, and PTH levels in patients on maintenance HD, prompted us to undertake this study.

 Patients and Methods

This is a cross-sectional study performed in the HD section of The Hajar Medical Edu­cational and Therapeutic Center of Shahrekord University of Medical Sciences in Shahrekord, Iran. It involved patients with ESRD on regular maintenance HD treatment, using acetate bath dialysate and a polysulfone membrane dialyzer. All patients received treatment with oral active vitamin D 3 (Rocaltrol) and calcium carbonate or sevelamer (Renagel) at various doses, according to the severity of the SHPT. In addition, patients received intravenous (i.v.) iron therapy with iron sucrose (Venofer), administered after each dialysis session, apart from folic acid, L-carnitine, oral vitamin B­complex, and i.v. recombinant human ery­thropoietin (rHuEPO) (Eprex) in appro­priate doses.

Patients with active infection were excluded from the study. The serum calcium (Ca), phos­phorus (P), Mg, and alkaline phosphatase (ALP) levels were measured using standard kits. Intact serum PTH (iPTH) was measured by the RIA method using DSL-8000 of the USA. Serum 25-OH Vit D levels were measured by the ELISA method using DRG of Germany (normal range, 25 to 125 nmol/L). Plasma HCO3 was measured by arterial blood gas. The efficacy of HD was assessed by calculating the urea reduction rate (URR). [20]

For statistical analysis, descriptive data are expressed as mean ± SD. Comparison bet­ween the groups was done using a Student's t-test. Statistical correlations were assessed using a partial correlation test. Statistical analysis was performed separately on the study group as a whole, females, males, diabetics, and non-diabetics. All statistical analyses were performed using SPSS (version 11.5.00). Statistical significance was fixed at a p value [21] On the contrary, Gonella et al. studied 22 uremic patients on chronic HD, using different con­centrations of Mg in the dialysate. After a six-month period, they did not find any significant changes in the serum PTH levels; they concluded that the serum Mg levels do not appreciably influence PTH secretion in uremic patients on regular HD. [22] In a study on 110 HD patients not receiving vitamin D, Navarro et al. demonstrated that serum Mg levels were inversely correlated with PTH levels and that PTH levels were influenced by Mg levels. Navarro concluded that patients with inadequately low PTH levels showed higher serum Mg concentrations, suggesting that chronic hypermagnesemia might decrease PTH secretion and/or synthesis. [19] In another study of 126 patients to determine the patho­genesis of relative hypoparathyroidism (PTH [15] McGonigle et al. studied 20 patients on regular HD therapy to assess the influence of Mg on circulating plasma iPTH levels. Plasma levels of iPTH and 25-OH Vit D were measured before and 10 weeks after the Mg concentration in the dialysate was increased from 0.75 to 1.50 mmol/L. They showed a 36% rise in the mean pre-dialysis plasma Mg concentration and a 23% fall in the mean plasma iPTH concentration. Also, the mean plasma concen­trations of 25-OH Vit D levels decreased, although this was not significant. The authors concluded that a rise in plasma Mg concen­tration reduces the circulating plasma iPTH levels in normo-calcemic, uremic patients with initially both normal and raised plasma PTH levels. [23] In contrast to this study, which implies an inverse correlation between serum Mg and 25-OH Vit D levels, we found a strong positive correlation between serum Mg and 25 OH Vit D levels. This association remained strongly positive in non-diabetic, diabetic, female, and male groups studied individually.

In conclusion, we found a near significant and inverse correlation of serum Mg with serum iPTH levels. Our findings suggest that factors other than serum Mg may be more important in the regulation of PTH secretion. We also found a positive association bet­ween serum Mg with 25-OH Vit D levels, which is in contrast to some earlier studies.


We would like to thank the Research Department at our university, especially Dr. Yussefi, who helped provide the facilities to conduct this study.


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