Risk Factors for Pulmonary Hypertension and survival in Hemodialysis Patients: Are We Overlooking Serum Magnesium?

Introduction: Pulmonary hypertension (PH) is a major complication in patients undergoing maintenance hemodialysis (MHD), significantly elevating the risk of cardiovascular events and mortality, and severely impairing quality of life. Methods: In this single-center retrospective study, 1,077 MHD patients were enrolled. PH was diagnosed via echocardiography, and relevant clinical data were collected. Results: The prevalence of PH was 33.8% (364 cases). Nonlinear regression analysis indicated a significant inverse correlation between serum magnesium levels and PH. Notably, the risk of PH increased substantially when serum magnesium fell below 0.98 mmol/L. After adjusting for confounders (age, hemoglobin, serum phosphorus, NT-proBNP, left ventricular ejection fraction, extracellular water ratio, and pleural effusion), patients in the high-magnesium group (≥0.98 mmol/L) exhibited a 49.9% lower risk of PH (P=0.026). Survival analysis further confirmed that hypomagnesemia was associated with a 65% and 89% increase in mortality risk among non-PH and PH patients, respectively. Conclusion: This study provides the evidence that hypomagnesemia is an independent risk factor for PH in MHD patients and is closely associated with adverse clinical outcomes. Management of hypomagnesemia is particularly crucial in MHD patients with PH.