The impact of low serum and dialysate magnesium levels on clinical outcomes in peritoneal dialysis patients: a literature review.

Historically, concerns about hypermagnesemia led to the reduction of dialysate magnesium (dMg) concentrations to below 0.75 mmol/L, effectively minimizing related adverse events. However, findings in recent years indicate that hypomagnesemia, defined as serum magnesium (sMg) levels below 0.7 mmol/L, has become more prevalent and a greater concern among dialysis patients, and has been associated with severe clinical outcomes, including vascular calcification and elevated mortality rates. Despite its significance, hypomagnesemia is often overlooked in clinical practice. This review highlights the critical importance of sMg levels in patients undergoing peritoneal dialysis (PD), particularly focusing on hypomagnesemia and hypermagnesemia. While causality has not been definitively established, evidence from the literature suggests that sMg levels should be monitored regularly and that increasing dMg concentrations from 0.25 to 0.5 or 0.75 mmol/L may help prevent hypomagnesemia, alongside nutritional management. Considering the impact of dMg on serum magnesium levels, and acknowledging the variability in reported outcomes, careful selection and individualization of dMg concentrations have the potential to impact clinical outcomes in PD patients.