Magnesium Management in Renal Impairment

Assessment and Monitoring

Electrolyte abnormalities, including hypomagnesemia, are common in patients with acute kidney injury (AKI), AKI on chronic kidney disease (CKD), or CKD with kidney failure receiving kidney replacement therapy (KRT) and require close monitoring 1
Hypomagnesemia is common during continuous kidney replacement therapy (CKRT), with reported prevalence of 60-65% among critically ill patients 1

Dialysis solutions containing magnesium, along with potassium and phosphate, should be used to prevent electrolyte disorders during KRT 1, 3
Commercial KRT solutions enriched with magnesium, which can be safely used as dialysis and replacement fluids, are recommended to prevent KRT-related hypomagnesemia 3
The onset and exacerbation of hypomagnesemia during CKRT are associated with both depurative mechanisms (diffusive or convective clearance) and chelation of ionized magnesium by citrate when regional citrate anticoagulation is used 1

For patients with Bartter syndrome type 3 who require magnesium supplementation, organic magnesium salts (aspartate, citrate, lactate) are preferred due to their better bioavailability compared to magnesium oxide or hydroxide 4
A reasonable target level for plasma magnesium in Bartter syndrome is >0.6 mmol/L 4
Intravenous supplementation of electrolytes in patients undergoing CKRT is generally not recommended; instead, prevention of KRT-related electrolyte derangements by modulating KRT fluid composition represents a more appropriate therapeutic strategy 3

Magnesium and sulfate salts can lead to hypermagnesemia and should be used cautiously in renal impairment 2