As stated, Keto analogues must be converted to a form that is stable; calcium, magnesium, sodium, and lots of others are possible. Calcium was the choice in the 1970’s and 1980’s. However, as of 2019 new options came to the market using magnesium to replace calcium or a blend of calcium and magnesium to reduce intake of both.
Everything for kidney patients is tricky and related at the same time, and magnesium is no different. Stage 5 patients may not be able to regulate magnesium levels and may need to be on a low-magnesium diet. However, stage 3 and 4 patients normally have no problem regulating magnesium.
The following are excerpts from studies on magnesium relating to kidney patients:
“Oral magnesium supplementation may be an option for treatment and prevention of vascular calcification resulting in the reduction of cardiovascular events in CKD patients.”
“Our findings suggest that magnesium may inhibit vascular calcification in dialysis patients.”
“Magnesium probably retards arterial calcification in hemodialysis patients.”
“Elevated serum magnesium levels >2.10 mEq/L were associated with better survival rates than low serum magnesium below 1.30 mEq/L.”
“Lower magnesium levels result in a greater risk of cardiovascular mortality and hospitalization, as well as accelerated progression of renal disease.”
“Low magnesium levels were independently associated with all cause death in patients with prevalent CKD.”
“Hypomagnesemia (low magnesium levels) significantly increases the risk of mortality in CKD and dialysis populations. Physicians should be aware of this association.”
“Preliminary evidence suggests that insulin sensitivity, hyperglycemia, diabetes, left ventricle hypertrophy, and dyslipidemia may be improved with magnesium intake.”
“Magnesium carbonate was generally well tolerated in this selected patient population and was effective in controlling serum phosphorus while reducing elemental calcium intake.”
“Serum magnesium levels may be used as nutritional markers in dialysis patients because they correlated with albumin levels.”
*All studies are listed in “Stopping Kidney Disease” chapter 30.
Let’s break these down to a list of possible benefits from magnesium intake for CKD and dialysis patients.
- Increase survival rates
- Reduce /slow vascular calcification
- Reduce cardiovascular events (heart attacks)
- Slow kidney disease progression
- Improve insulin sensitivity
- Improve blood sugar (hyperglycemia)
- Improve serum albumin levels (a strong mortality indicator)
- Lower blood pressure
- Improve muscle quality
- Lower phosphorus levels as effective as calcium-based phosphorus binders.
- Works as a phosphorus binder
Almost all of the data on magnesium and kidney disease is from 2010 forward.
The amount of data is growing each year, but is not as well-documented as calcium overload or the risks of high glycemic foods.
|Amino acids||0 mg expected|
|Calcium based keto analogues||0 mg (calcium 1,200 mg)|
|Albutrix S3||360 mg (calcium free)|
|Albutrix S4||190 mg|
|Albutrix S5||0 mg (magnesium free)|
As you can see today, we have choices based on our current stage of kidney disease and our current blood tests. As a reference, the recommended daily amount of magnesium is 420 mg.
One other issue for us to consider as patients: calcium and magnesium compete for absorption when taken together. This reduces the intake of both minerals, which may be an advantage for some patients. Some research also suggests that taking magnesium at the same time as calcium reduces intake of both. This may increase overall safety. This is the rationale behind Albutrix S4.
What does this research mean to us as patients?
If you are stage three/four or your GFR is higher than 20 then magnesium-based keto analogues are a better choice than products that are high in calcium. I will say it again that calcium based keto analogues are restricted for patients with a GFR under 20 in over 20 countries.
If you are stage 5, you will need to base your decision on your doctor’s advice and your current blood tests. You may or may not be able to take supplemental magnesium.
The good news is that your magnesium and calcium levels are easily tested when you have your normal blood tests. You may have to ask for magnesium in some cases. Getting your blood tested is the best way to avoid guessing.
Magnesium-based keto analogues give us a less risky option and modern option compared to high-dose calcium keto analogues or high nitrogen amino acids. Unlike calcium-based keto analogues, magnesium-based keto analogues are not restricted for use by any country. Magnesium-based or a blend of magnesium- and calcium-based keto analogues represent a much safer option for stage 3 and stage 4 patients.
We can debate the amount of magnesium each patient can take safely based on current kidney function. However, there is no debate on the benefits of magnesium over supplemental calcium intake in dialysis and kidney disease patients. One is helpful and one may be harmful over the long term.