Matthias Hammon1, Susan Grossmann2, Peter Linz2, Hannes Seuss2, Rebecca Hammon3, Daniela Rosenhauer2, Rolf Janka2, Alexander Cavallaro2, Friedrich C Luft4, Jens Titze5, Michael Uder2, Anke Dahlmann6. 1. Department of Radiology, University Hospital Erlangen, Friedrich Alexander Universität (FAU) Erlangen-Nürnberg, Maximiliansplatz 1, 91054 Erlangen, Germany. Electronic address: matthias.hammon@uk-erlangen.de. 2. Department of Radiology, University Hospital Erlangen, Friedrich Alexander Universität (FAU) Erlangen-Nürnberg, Maximiliansplatz 1, 91054 Erlangen, Germany. 3. Department of Neurology, Klinikum Nuremberg, Nuremberg, Germany. 4. Experimental and Clinical Research Center, Charité Medical Faculty and the Max Delbrück Center for Molecular Medicine, Berlin, Germany; Division of Clinical Pharmacology, Vanderbilt University, Nashville, Tennessee. 5. Division of Clinical Pharmacology, Vanderbilt University, Nashville, Tennessee. 6. Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich Alexander Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany.
Abstract
RATIONALE AND OBJECTIVES: Sodium and proton magnetic resonance imaging (23Na/1H-MRI) have shown that muscle and skin can store Na+ without water. In chronic renal failure and in heart failure, Na+ mobilization occurs, but is variable depending on age, dialysis vintage, and other features. Na+ storage depots have not been studied in patients with acute kidney injury (AKI). MATERIALS AND METHODS: We studied 7 patients with AKI (mean age: 51.7 years; range: 25-84) and 14 age-matched and gender-matched healthy controls. All underwent 23Na/1H-MRI at the calf. Patients were studied before and after acute hemodialysis therapy within 5-6 days. The 23Na-MRI produced grayscale images containing Na+ phantoms, which served to quantify Na+ contents. A fat-suppressed inversion recovery sequence was used to quantify H2O content. RESULTS: Plasma Na+ levels did not change. Mean Na+ contents in muscle and skin did not significantly change following four to five cycles of hemodialysis treatment (before therapy: 32.7 ± 6.9 and 44.2 ± 13.5 mmol/L, respectively; after dialysis: 31.7 ± 10.2 and 42.8 ± 11.8 mmol/L, respectively; P > .05). Water content measurements did not differ significantly before and after hemodialysis in muscle and skin (P > .05). Na+ contents in calf muscle and skin of patients before hemodialysis were significantly higher than in healthy subjects (16.6 ± 2.1 and 17.9 ± 3.2) and remained significantly elevated after hemodialysis. CONCLUSIONS: Na+ in muscle and skin accumulates in patients with AKI and, in contrast to patients receiving chronic hemodialysis and those with acute heart failure, is not mobilized with hemodialysis within 5-6 days.
RATIONALE AND OBJECTIVES: Sodium and proton magnetic resonance imaging (23Na/1H-MRI) have shown that muscle and skin can store Na+ without water. In chronic renal failure and in heart failure, Na+ mobilization occurs, but is variable depending on age, dialysis vintage, and other features. Na+ storage depots have not been studied in patients with acute kidney injury (AKI). MATERIALS AND METHODS: We studied 7 patients with AKI (mean age: 51.7 years; range: 25-84) and 14 age-matched and gender-matched healthy controls. All underwent 23Na/1H-MRI at the calf. Patients were studied before and after acute hemodialysis therapy within 5-6 days. The 23Na-MRI produced grayscale images containing Na+ phantoms, which served to quantify Na+ contents. A fat-suppressed inversion recovery sequence was used to quantify H2O content. RESULTS: Plasma Na+ levels did not change. Mean Na+ contents in muscle and skin did not significantly change following four to five cycles of hemodialysis treatment (before therapy: 32.7 ± 6.9 and 44.2 ± 13.5 mmol/L, respectively; after dialysis: 31.7 ± 10.2 and 42.8 ± 11.8 mmol/L, respectively; P > .05). Water content measurements did not differ significantly before and after hemodialysis in muscle and skin (P > .05). Na+ contents in calf muscle and skin of patients before hemodialysis were significantly higher than in healthy subjects (16.6 ± 2.1 and 17.9 ± 3.2) and remained significantly elevated after hemodialysis. CONCLUSIONS: Na+ in muscle and skin accumulates in patients with AKI and, in contrast to patients receiving chronic hemodialysis and those with acute heart failure, is not mobilized with hemodialysis within 5-6 days.
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