Chronic Kidney Diseases Clinical Trial
Official title:
Diurnal Variation in Markers of Mineral and Bone Disease in Chronic Kidney Disease - An Observational Study
The purpose of this study is to examine whether there are diurnal variations in magnesium and other markers related to mineral metabolism in blood from patients with chronic kidney disease (CKD) compared to healthy controls.
CKD is associated with a mortality rate 5-10 times higher than in the general population,
which is driven by a high rate of cardiovascular disease. Several cohort studies have
revealed an association between hypomagnesaemia and increased mortality in patients with CKD
as well as faster progression of CKD. Additionally, studies in cultured vascular smooth
muscle cells (VSMC) and in rodents with CKD have shown that Mg inhibits vascular
calcification.
The exact mechanism behind the inhibitory effect of Mg on vascular calcification is
incompletely understood, but seems to be related to an inhibitory effect on the formation and
precipitation of hydroxyapatite and delayed formation of secondary calciprotein particles,
both of which have been shown to induce calcification of VSMC in vitro. Mg blocks the calcium
(Ca) influx across the cell membrane in the VSMC. Mg has some affinity for the Ca sensing
receptor, which has been shown to be involved in the calcification of VSMC, and might thus
inhibit vascular calcification in a manner similar to other calcimimetics.
Thus, increasing serum Mg has been proposed as a possible treatment to prevent vascular
calcification in CKD. However, any diurnal variation in serum Mg and other markers of mineral
metabolism related to vascular calcification in CKD have not previously been described. This
is relevant as monitoring of treatment with Mg supplementation might potentially be
dangerous, if there are significant diurnal changes in serum Mg. Therefore, we wish to
conduct a prospective controlled clinical trial to investigate any diurnal changes in Mg
other markers of mineral metabolism in healthy controls, patients with predialysis CKD and
patients with end-stage kidney disease (ESKD).
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