CKD and Low Magnesium: Pay Attention

Lynda Szczech, MD


February 06, 2013

In This Article


Why is this important? Multiple recent studies demonstrate an increased risk for atrial fibrillation among persons with CKD and end-stage renal disease.[2,3,4,5] Unfortunately, little is known about the best way to treat persons with concurrent CKD and atrial fibrillation, given the increased risk of bleeding associated with anticoagulants and antiplatelet agents and the limited inclusion of persons with CKD in trials that test how atrial fibrillation rate should be controlled.

As our awareness of the increasing burden of atrial fibrillation in the CKD population grows, perhaps we should shed the "laissez-faire" attitude regarding magnesium that has changed little over the last 20 years. The association demonstrated here between magnesium and atrial fibrillation is still a considerable way from being able to establish a cause-and-effect relationship whereby we can conclude that treating hypomagnesemia decreases the risk for atrial fibrillation. However, given the very difficult situation that we find ourselves in with respect to the limited evidence, the alternative of waiting for atrial fibrillation to occur and treating may be more problematic than attempted prevention. Clearly, significant additional research is needed to understand if magnesium levels correlate with risk for atrial fibrillation among those with CKD and if treatment of the low magnesium can safely decrease this risk. Until then, this treatment may be considered a potential therapeutic pathway with relatively limited downsides.