Response to the comment on 'Magnesium and chronic kidney disease'
Respuesta al comentario sobre «Magnesio y enfermedad renal crónica»
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M. de Francisco, Mariano Rodríguez" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Ángel L." "apellidos" => "M. de Francisco" "email" => array:1 [ 0 => "angelmartindefrancisco@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 1 => array:3 [ "nombre" => "Mariano" "apellidos" => "Rodríguez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => " Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla. Universidad de Cantabria, Santander, " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:3 [ "entidad" => " Servicio de Nefrología, Hospital Universitario Reina Sofía, Córdoba, " "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Respuesta al comentario sobre «Magnesio y enfermedad renal crónica»" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "12207_16025_53004_en_t112207.jpg" "Alto" => 313 "Ancho" => 1414 "Tamanyo" => 113936 ] ] "descripcion" => array:1 [ "en" => "Biochemical parameters in peritoneal dialysis patients treated with Ca-Mg" ] ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor:</span></p><p class="elsevierStylePara">The authors reply to our publication on magnesium and chronic kidney disease<span class="elsevierStyleSup">1</span> and provide data on their preliminary experience with 10 peritoneal dialysis patients who received calcium acetate/magnesium carbonate (Osvaren<span class="elsevierStyleSup">®</span>). The median treatment dose during follow-up was 2 pills per day (range 1-3). In two patients, it was necessary to reintroduce another phosphate binder at low doses. During follow-up, they only found one high magnesium value (1.8mmol/l) and none for calcium higher than 10.5mg/dl.</p><p class="elsevierStylePara">Firstly, it is necessary to highlight that the most important factor in serum magnesium concentrations is the concentration in dialysate, which the authors did not report. In our experience in peritoneal dialysis the mean magnesium concentrations with dialysate of 0.25mmol/l and of 0.50mmo/l were 2.04±0.3mg/dl (n: 17 patients) and 2.35±0.3mg/dl (n: 56 patients), respectively.<span class="elsevierStyleSup">2</span> We should bear in mind that, up to concentrations of <4.88mg/dl (<2.0mmol/l), hypermagnesaemia is clinically irrelevant and is associated with beneficial effects.<span class="elsevierStyleSup">1</span> The question that we must answer is whether in peritoneal dialysis patients who receive calcium acetate/magnesium carbonate (Osvaren<span class="elsevierStyleSup">®</span>) these serum magnesium values increase above these figures. In our experience with 12 peritoneal dialysis patients (11 with dialysate of 0.50mmol/l and one with 0.25mmol/l) treated exclusively with calcium acetate/magnesium carbonate (Osvaren<span class="elsevierStyleSup">®</span>) for 6 months, the mean serum magnesium values increased from 2.38±0.33 to 2.63±0.64, with the highest value reached in a patient being 3.5mg/dl (Table 1).</p><p class="elsevierStylePara">In the Calmag study<span class="elsevierStyleSup">3 </span>on haemodialysis patients, the number of calcium acetate/magnesium carbonate pills (Osvaren<span class="elsevierStyleSup">®</span>) required was 7.29±3.026/day, and as such, the dose the authors referred to in their letter (2 pills per day with a range from 1 to 3) is rather low, which may explain why in two patients, it was necessary to reintroduce another phosphate binder. In our haemodialysis studies over six months in real clinical practice (n: 52 patients), the mean CaMg dose required for the reduction of phosphorus (from 6.43±1.93 at baseline to 4.83±1.98mg/dl after six months) was 4.66±1.52 pills without the requirement for any other phosphate binder.<span class="elsevierStyleSup">4</span></p><p class="elsevierStylePara">Therefore, we agree with the authors of this letter that calcium acetate/magnesium carbonate (Osvaren<span class="elsevierStyleSup">®</span>) has an important role as the first step of treatment in peritoneal dialysis and that it is important to carry out more comprehensive studies in peritoneal dialysis patients.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">The authors declare that they have no conflicts of interest related to the contents of this article.</p><p class="elsevierStylePara"><a href="grande/12207_16025_53004_en_t112207.jpg" class="elsevierStyleCrossRefs"><img src="12207_16025_53004_en_t112207.jpg" alt="Biochemical parameters in peritoneal dialysis patients treated with Ca-Mg "></img></a></p><p class="elsevierStylePara">Table 1. Biochemical parameters in peritoneal dialysis patients treated with Ca-Mg </p>" "pdfFichero" => "P1-E562-S4416-A12207-EN.pdf" "tienePdf" => true "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<p class="elsevierStylePara">Respuesta a Domínguez Alpiñariz P.</p> <p class="elsevierStylePara">Comentario en: Nefrologia 2013;33(6):849-50</p> <p class="elsevierStylePara">Nefrologia 2013;33(3):389-99.</p> <p class="elsevierStylePara">PMID: 23640095 [PubMed - in process]</p>" ] "en" => array:1 [ "resumen" => "<p class="elsevierStylePara">Reply to Domínguez Alpiñariz P.</p> <p class="elsevierStylePara">Comment in. Nefrologia 2013;33(6):849-50</p> <p class="elsevierStylePara">Nefrologia 2013;33(3):389-99.</p> <p class="elsevierStylePara">PMID: 23640095 [PubMed - in process]</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "12207_16025_53004_en_t112207.jpg" "Alto" => 313 "Ancho" => 1414 "Tamanyo" => 113936 ] ] "descripcion" => array:1 [ "en" => "Biochemical parameters in peritoneal dialysis patients treated with Ca-Mg" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "de Francisco ALM, Rodríguez M. Magnesio y enfermedad renal crónica. Nefrologia 2013;33(3):389-99. <a href="http://www.ncbi.nlm.nih.gov/pubmed/23640095" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Toyos C, Palomar R, De Francisco ALM, Quintela E, Allende N, Villa C, et al. Factores que influyen en la concentración sérica de magnesio en diálisis peritoneal. XLII Congreso Nacional de la Sociedad Española de Nefrología. VII Iberoamericano. Las Palmas 2012." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "De Francisco ALM, Leidig M, Covic AC, Ketteler M, Benedyk-Lorens E, Mircescu GM, et al. Evaluation of calcium acetate/magnesium carbonate as a phosphate binder compared with sevelamer hydrochloride in haemodialysis patients: a controlled randomized study (CALMAG study) assessing efficacy and tolerability. Nephrol Dial Transplant 2010;25:3707-17. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20530499" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "De Francisco ALM, et al. Effect of calcium acetate/magnesium carbonate in the treatment of hyperphosphatemia in dialysis patients in real clinical practice. One year follow up." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003300000006/v0_201502091623/X2013251413053319/v0_201502091624/en/main.assets" "Apartado" => array:4 [ "identificador" => "35439" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor - Comments on published articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003300000006/v0_201502091623/X2013251413053319/v0_201502091624/en/P1-E562-S4416-A12207-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251413053319?idApp=UINPBA000064" ]
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