Evidence map›Paper›PMID 42293164›Full record

ReviewCanadian journal of kidney health and disease2026

Effects of Increasing the Concentration of Dialysate Magnesium on Cardiovascular Health: A Narrative Review.

Bryn Tannar, Hareth Al-Hellawi, Jessica M Sontrop, Rey R Acedillo, Ahmed A Al-Jaishi, Sierra Anderson, Amit Bagga, David Berry, Eliot Beaubien, Peter G Blake and 46 more

Abstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Canadian journal of kidney health and disease, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

56 authors.

Bryn TannarLondon Health Sciences Centre and London Health Sciences Centre Research Institute, ON, Canada.ORCID https://orcid.org/0009-0005-4524-6850
Hareth Al-HellawiLondon Health Sciences Centre and London Health Sciences Centre Research Institute, ON, Canada.
Jessica M SontropLondon Health Sciences Centre and London Health Sciences Centre Research Institute, ON, Canada.
Rey R AcedilloThunder Bay Regional Health Sciences Centre, ON, Canada.
Ahmed A Al-JaishiLondon Health Sciences Centre and London Health Sciences Centre Research Institute, ON, Canada.
Sierra AndersonLondon Health Sciences Centre and London Health Sciences Centre Research Institute, ON, Canada.
Amit BaggaDivision of Nephrology, Windsor Regional Hospital, ON, Canada.
David BerrySault Area Hospital, Sault Sainte Marie, ON, Canada.
Eliot BeaubienDivision of Nephrology, Department of Medicine, Peterborough Regional Health Centre, ON, Canada.
Peter G BlakeLondon Health Sciences Centre and London Health Sciences Centre Research Institute, ON, Canada.
Clara BohmSection of Nephrology, Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada.ORCID https://orcid.org/0000-0001-7710-7162
Pierre Antoine BrownDivision of Nephrology, Department of Medicine, University of Ottawa and the Ottawa Hospital, ON, Canada.ORCID https://orcid.org/0000-0002-0283-4530
Joe BuetiSection of Nephrology, Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada.
Christopher T ChanDivision of Nephrology, Toronto General Hospital, ON, Canada.
Brenden CoteLondon Health Sciences Centre and London Health Sciences Centre Research Institute, ON, Canada.
Andrea C CowanLondon Health Sciences Centre and London Health Sciences Centre Research Institute, ON, Canada.ORCID https://orcid.org/0000-0002-9480-969X
Nicole E DayLondon Health Sciences Centre and London Health Sciences Centre Research Institute, ON, Canada.
Varun DevDivision of Nephrology, Humber River Health, Toronto, ON, Canada.
Miten DhruveDivision of Nephrology, Michael Garron Hospital, Toronto East Health Network, ON, Canada.
Laura GregorGrand River Hospital, Kitchener, ON, Canada.
Claire HarrisDivision of Nephrology, Department of Medicine, The University of British Columbia, Vancouver, Canada.
Swapnil HiremathDivision of Nephrology, Department of Medicine, University of Ottawa and the Ottawa Hospital, ON, Canada.ORCID https://orcid.org/0000-0003-0010-3416
Geena JosephDivision of Nephrology, Renfrew Victoria Hospital, ON, Canada.
Srinu KammilaDivision of Nephrology, Department of Medicine, Peterborough Regional Health Centre, ON, Canada.
Mercedeh KiaiiDivision of Nephrology, Department of Medicine, The University of British Columbia, Vancouver, Canada.
Lauren KillinLondon Health Sciences Centre and London Health Sciences Centre Research Institute, ON, Canada.
Eswar Kumar KolusuLondon Health Sciences Centre and London Health Sciences Centre Research Institute, ON, Canada.
Eduardo LacsonDialysis Clinic, Inc., Nashville, TN, USA.
Bin LuoLondon Health Sciences Centre and London Health Sciences Centre Research Institute, ON, Canada.ORCID https://orcid.org/0000-0002-0608-9793
Jennifer M MacRaeDepartment of Medicine, Cumming School of Medicine, University of Calgary, AB, Canada.
Amber O MolnarICES, London, ON, Canada.ORCID https://orcid.org/0000-0003-4549-0202
Bharat NathooDivision of Nephrology, Mackenzie Health, Richmond Hill, ON, Canada.
Matthew J OliverDivision of Nephrology, Department of Medicine, University of Toronto, ON, Canada.
Sanjay PandeyaDivision of Nephrology, Department of Medicine, Halton Healthcare Services, Oakville, ON, Canada.
Malvinder S ParmarDivision of Nephrology, Department of Medicine, Timmins and District Hospital, ON, Canada.ORCID https://orcid.org/0000-0003-3182-0530
David PerkinsTrillium Health Partners, Mississauga, ON, Canada.
Kathleen QuinnDivision of Nephrology, Department of Medicine, Niagara Health System, Saint Catharines, ON, Canada.
Joanna SasalDivision of Nephrology, Department of Medicine, St. Joseph's Health Centre, Unity Health Toronto, ON, Canada.
Nikhil ShahDivision of Nephrology, Department of Medicine, University of Alberta, Edmonton, Canada.
Tanya ShulmanNorth Bay Regional Health Centre, ON, Canada.
Samuel A SilverICES, London, ON, Canada.ORCID https://orcid.org/0000-0002-1843-6131
Anurag SinghDivision of Nephrology, University Hospital of Northern British Columbia, Prince George, Canada.ORCID https://orcid.org/0009-0006-0497-5771
Andrew SteeleLakeridge Health, Whitby, ON, Canada.
Irina St LouisLondon Health Sciences Centre and London Health Sciences Centre Research Institute, ON, Canada.
Navdeep TangriSection of Nephrology, Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada.ORCID https://orcid.org/0000-0002-5075-6370
Robert H TingDepartment of Medicine, Scarborough Health Network, ON, Canada.
Stephanie ThompsonDivision of Nephrology, Department of Medicine, University of Alberta, Edmonton, Canada.ORCID https://orcid.org/0000-0003-3109-6837
Marcello TonelliDepartment of Medicine, Cumming School of Medicine, University of Calgary, AB, Canada.
Hans VorsterCan-SOLVE CKD Network, Vancouver, BC, Canada.
Davinder WadehraDivision of Nephrology, William Osler Health System, Brampton, ON, Canada.
Ron WaldDivision of Nephrology, Department of Medicine, University of Toronto, ON, Canada.
Justin WaltersManitoba Renal Program, St. Boniface Hospital, Winnipeg, MB, Canada.
Shaoyee YaoDivision of Nephrology, Department of Medicine, The University of British Columbia, Vancouver, Canada.
James ZachariasSection of Nephrology, Department of Internal Medicine, Health Sciences Centre, University of Manitoba, Winnipeg, Canada.
Amit X GargLondon Health Sciences Centre and London Health Sciences Centre Research Institute, ON, Canada.ORCID https://orcid.org/0000-0003-3398-3114
Dial-Mag Investigator Writing Committee*

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Purpose of review: Cardiovascular disease (CVD) accounts for nearly half of deaths among people receiving maintenance hemodialysis. Observational and interventional data suggest that higher serum magnesium, achieved through higher dialysate magnesium concentrations or oral supplementation, may improve cardiovascular outcomes and survival. This review synthesizes current evidence and provides context for an ongoing cluster-randomized trial that is testing whether a center-wide dialysate magnesium concentration of 0.75 mmol/L, versus ≤0.50 mmol/L, delivered as a policy and sustained for up to four years, reduces the risk of major cardiovascular-related hospitalizations. Sources of information: Peer-reviewed articles. Methods: We searched MEDLINE and EMBASE for observational and interventional studies evaluating serum or dialysate magnesium concentrations and cardiovascular outcomes in patients with chronic kidney disease and/or kidney failure. We appraised the methodological quality of interventional trials. This review is divided into four sections: (1) epidemiological associations between serum magnesium concentrations and CVD outcomes, (2) the impact of a higher concentration of dialysate magnesium on CVD outcomes, (3) the impact of oral magnesium supplementation on CVD outcomes, and (4) ongoing trials. Key findings: Twenty studies, including 10 randomized controlled trials, were reviewed. Systematic reviews and meta-analyses show that hypomagnesemia is associated with higher risks of cardiovascular events and all-cause mortality in hemodialysis. Interventional studies indicate that higher dialysate magnesium concentrations or oral supplementation can improve surrogate markers of vascular health, including less vascular calcification and stiffness. Higher dialysate concentrations may also lower cardiovascular mortality. Given encouraging but predominantly surrogate-based evidence, adequately powered randomized trials are warranted. Limitations: Most trials were small, single-center, and of short duration. They relied on surrogate endpoints, and there was heterogeneity in interventions and outcome measures.

Indexed as

cardiovascular diseasecardiovascular mortalitychronic kidney diseasedialysate magnesiumhemodialysis

Identifiers

PMID42293164
PMCPMC13254138

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.