Magnesium Oxide Use in CKD Patients Linked to Increased Cardiovascular and Renal Risks, Suggests Study
Taiwan: In a large cohort study, the use of magnesium oxide (MgO) in patients with chronic kidney disease (CKD) was associated with a higher risk of adverse outcomes, including acute kidney injury (AKI), acute kidney disease (AKD), progression to end-stage renal disease (ESRD), arrhythmias, and myocardial infarction. The magnitude of these risks was notably greater in patients with more advanced stages of CKD.
These findings emphasize the need for careful risk–benefit assessment and close clinical monitoring when prescribing MgO in this vulnerable, high-risk population.
The study in the International Journal of Medical Sciences by Po-Jen Hsiao and colleagues from Tri-Service General Hospital, Taipei, raises safety concerns about magnesium oxide use in chronic kidney disease (CKD). Magnesium balance is frequently disrupted in CKD, and serum levels reflect only a small fraction of total body stores, limiting accurate assessment. Both low and high magnesium levels have been linked to adverse cardiovascular outcomes, prompting caution in the routine use of MgO for conditions like constipation and dyspepsia.
To investigate this, the researchers analyzed data from the Taipei Medical University Clinical Research Database, including non-dialysis CKD patients from 1998 to 2021. Medication adherence was assessed using the medication possession ratio. The study evaluated multiple outcomes, including acute kidney injury (AKI), acute kidney disease (AKD), AKI-related hospitalization, progression to end-stage renal disease requiring dialysis, cardiac arrhythmias, heart failure with pulmonary edema, and myocardial infarction, while adjusting for baseline comorbidities and concurrent medications.
The researchers reported the following findings:
- The study included 6,105 magnesium oxide (MgO) users and 10,143 non-users in the initial analysis.
- After adjusting for baseline characteristics, a matched cohort was created to minimize bias.
- MgO use was consistently linked to a higher risk of adverse renal and cardiovascular outcomes in both unmatched and matched analyses.
- In the matched cohort, significantly increased risks were observed for acute kidney injury, acute kidney disease, end-stage renal disease, cardiac arrhythmias, and myocardial infarction.
- Similar risk patterns were seen in patients receiving ACE inhibitors or angiotensin receptor blockers, as well as those enrolled in pre-ESRD care programs.
- A dose-response relationship was identified, with higher MgO exposure associated with greater risks of adverse outcomes.
- Advancing stages of CKD further increased the risk, particularly in patients with stage 4 and stage 5 disease.
- The findings indicate that both higher MgO use and greater disease severity contribute to worse clinical outcomes.
The authors note that the observational design limits causal conclusions. Serum magnesium data were incomplete and may not accurately represent total body stores. Residual confounding and indication bias are also possible, as patients receiving MgO may differ in factors such as nutritional status or underlying gastrointestinal conditions.
Overall, the findings underscore the need for individualized treatment in CKD. Although MgO is widely used, particularly in East Asia, its risks should be carefully weighed—especially in patients with advanced CKD or cardiovascular comorbidities. Safer alternatives like polyethylene glycol or lactulose may be preferred in high-risk groups, with close monitoring and tailored therapy essential to optimize outcomes.
Reference:
Hsiao, P.J., Tsou, L.L.A., Yang, C.C., Huang, L.Y., Wang, R.L., Chan, J.S., Wu, K.L., Kao, Y.H., Chou, C.L. (2026). Magnesium Oxide Use and Clinical Outcomes in CKD Patients: Evidence from a Nationwide Population-Based Cohort Study in Taiwan. International Journal of Medical Sciences, 23(4), 1519-1534. https://doi.org/10.7150/ijms.125059.
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