Cardiovascular complications are the leading cause of death in patients with
chronic kidney disease (CKD). Abundant experimental evidence suggests a physiological role of
magnesium in cardiovascular function, and clinical evidence suggests a role of the
cation in
cardiovascular disease in the general population. The role of
magnesium in CKD-
mineral and bone disorder, and in particular its impact on cardiovascular morbidity and mortality in patients with CKD, is however not well understood. Experimental studies have shown that
magnesium inhibits
vascular calcification, both by direct effects on the vessel wall and by indirect, systemic effects. Moreover, an increasing number of epidemiologic studies in patients with CKD have shown associations of serum
magnesium levels with intermediate and hard outcomes, including
vascular calcification, cardiovascular events and mortality. Intervention trials in these patients conducted to date have had small sample sizes and have been limited to the study of surrogate parameters, such as arterial stiffness,
vascular calcification and
atherosclerosis. Randomized controlled trials are clearly needed to determine the effects of
magnesium supplementation on hard outcomes in patients with CKD.