Serum magnesium concentration and PTH levels. Is long-term chronic hypermagnesemia a risk factor for adynamic bone disease?

The observation that some subjects with low PTH had elevated plasma magnesium (Mg) levels prompted us to analyze in 41 patients on maintenance hemodialysis for 44 +/- 36 months, their serum Mg concentrations, and the relationship between plasma Mg and PTH levels. The mean serum Mg concentration was 2.4 +/- 0.2 mg/dl. Twenty-four out of the 41 subjects (58.5%) had hypermagnesemia (serum Mg above 2.5 mg/dl). Patients were classified into 3 groups according to their PTH level: Group A, low PTH (below 120 pg/ml); group B, adequate PTH (120-250 pg/ml); and group C, high PTH (above 250 pg/ml). There were no differences among groups according to number of subjects, age, sex, time on dialysis, renal disease, serum calcium, phosphorus, bicarbonate, vitamin D or aluminum concentrations. Doses of calcium carbonate and aluminium hydroxide were also similar in all groups. Curiously, although the differences were not statistically significant, the total cumulative intake of calcium and aluminium were less in group A than in the other groups. Interestingly, patients with low PTH had a significantly higher serum Mg concentration than patients with adequate or high PTH (2.8 +/- 0.2 mg/dl vs 2.3 +/- 0.1 mg/dl and 2.2 +/- 0.1 mg/dl, respectively, p < 0.01). Moreover, regression analysis showed a negative linear correlation between serum PTH level and plasma Mg concentration (r = -0.6059, p < 0.001). Based on these findings, chronic hypermagnesemia could have a suppressive effect on PTH secretion, and it could be a risk factor for the development of adynamic bone disease in dialysis patients.