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What is the Dial-Mag Trial?

The Dial-Mag Trial, a pragmatic clinical trial, focuses on evaluating the effect on patient health of a higher vs. lower concentration of magnesium (Mg) in the dialysate used in hemodialysis.

Taking place in hemodialysis units across Canada, Dial-Mag uses the innovative approach of embedding interventions into routine care to answer questions that are highly relevant to patients, families, clinicians, dialysis providers and policymakers.

Dial-Mag Research Question

In outpatients receiving maintenance hemodialysis, what is the effect of a higher vs. lower dialysate magnesium concentration (0.75 mmol/L vs. ≤0.5 mmol/L) over 4 years on all-cause mortality?
The Dial-Mag Trial will also look at secondary outcomes of the effect of a higher vs. lower dialysate magnesium concentration (0.75 mmol/L vs. ≤0.5 mmol/L) over 4 years on muscle cramps, fractures, cardiovascular-related mortality, and cardiovascular-related hospitalization.

Periodic table chemical symbol for magnesium, the letters "Mg" in green, in a green lined box, with the words "Magnesium, 24.305" under the letters.

Why Magnesium?

Magnesium is a necessary mineral for the health and function of the heart, kidneys and other organs. However, many patients on hemodialysis live with low levels of magnesium, raising their risk of death, cardiovascular disease, muscle cramps, and fractures. There could be many causes for these low levels of magnesium. This includes poor diet, medication interference, and the dialysis procedure itself, which leaches small amounts of magnesium from the blood.

One way to make sure that dialysis patients are getting enough magnesium is to increase its concentration in the dialysate. In Canada, dialysate manufacturers prepare fluid with magnesium (Mg) in concentrations of 0.38, 0.5, or 0.75 mmol/L. All three concentrations are routinely distributed to Canadian hemodialysis centres. The centres use them in dialysis, though there is no consensus on what dialysate magnesium concentration is best.

Trial Timeline

Trial Timeline infographic consisting of connected colour circles with icon images in the circles. The circles are laid out horizontally and connected by a line. The first circle on the left is purple with a magnifying glass icon in it. Above the first circle is "Spring/Fall 2021" and below it is "Start of Pre-Intervention, Baseline muscle cramp data collection." The second circle from the left is pink and has an icon image of three dots connected by lines in it. Above the second circle reads "Winter 2021" and below the circle reads "Randomization, Provide dialysis units with allocated Mg concentration." The third circle, is orange and has an icon of a running man in it. Above the third circle reads "Spring 2022" and below it reads "Start of Intervention, Dialysis units begin using allocated Mg concentration." The fourth circle, is yellow and has an icon showing a running man hitting a finish line. Above this circle reads "Spring 2026" and below it reads "End of Intervention." The fifth is green and has a magnifying glass icon. Above it reads "September 2027" and below "Data Analysis. The sixth and final circle is black with a paper icon in it. Above reads "Fall 2028" and below reads "Final Report."

If you have any questions or would like to contact us, please email dialmagcanada@lhsc.on.ca

The team derived the information used on this website from our own research and other reliable sources. For a full list of the sources used to create this website, please check out our References Page.