Magnesium and Vascular Calcification in Chronic Kidney Disease: Current Insights.
Magnesium and Vascular Calcification in Chronic Kidney Disease: Current Insights.
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慢性肾脏病中镁与血管钙化：最新认识
DOI：
10.3390/ijms25021155
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发表时间：
2024-01-18
影响因子：
5.6
通讯作者：
中科院分区：
文献类型：
--
作者：
镁（Mg）在多种重要的生物过程中起着至关重要的作用。由于肾脏是负责维持血液中镁浓度的主要器官，因此慢性肾病（CKD）患者可能会出现镁紊乱。虽然高镁血症和低镁血症都可能导致不良反应，但与低镁血症相关的后果往往更严重和持久。重要的是，观察性研究表明，低镁血症的CKD患者有更大的血管钙化。血管钙化加速，导致CKD人群的高死亡率。体外和动物研究均表明，镁通过几种潜在机制防止血管钙化，例如抑制羟基磷灰石和致病性钙蛋白颗粒的形成以及限制成骨分化，成骨分化是动脉中膜层中的血管平滑肌细胞转化为骨样细胞的过程。这些临床前发现导致了几项重要的临床试验，这些试验研究了补充镁对CKD患者血管钙化的影响。有趣的是，两项主要的临床研究得出了相互矛盾的结果，导致了平衡状态。本综述概述了我们目前在健康和CKD中对镁的肾脏处理的知识，以及镁可以防止血管钙化的潜在机制。最后，我们评估了临床研究中关于镁补充剂疗效的证据强度，并讨论了未来的研究方向。
Magnesium (Mg) plays crucial roles in multiple essential biological processes. As the kidneys are the primary organ responsible for maintaining the blood concentration of Mg, people with chronic kidney disease (CKD) may develop disturbances in Mg. While both hyper- and hypomagnesemia may lead to adverse effects, the consequences associated with hypomagnesemia are often more severe and lasting. Importantly, observational studies have shown that CKD patients with hypomagnesemia have greater vascular calcification. Vascular calcification is accelerated and contributes to a high mortality rate in the CKD population. Both in vitro and animal studies have demonstrated that Mg protects against vascular calcification via several potential mechanisms, such as inhibiting the formation of both hydroxyapatite and pathogenic calciprotein particles as well as limiting osteogenic differentiation, a process in which vascular smooth muscle cells in the media layer of the arteries transform into bone-like cells. These preclinical findings have led to several important clinical trials that have investigated the effects of Mg supplementation on vascular calcification in people with CKD. Interestingly, two major clinical studies produced contradictory findings, resulting in a state of equipoise. This narrative review provides an overview of our current knowledge in the renal handling of Mg in health and CKD and the underlying mechanisms by which Mg may protect against vascular calcification. Lastly, we evaluate the strength of evidence from clinical studies on the efficacy of Mg supplementation and discuss future research directions.
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