Melis Sahinoz1,2, Supisara Tintara3, Serpil Muge Deger4, Aseel Alsouqi5, Rachelle L Crescenzi6, Cindy Mambungu1,2, Andrew Vincz1,2, Olivia Mason7, Heather L Prigmore7, Andrew Guide7, Thomas G Stewart7, David Harrison8, Friedrich C Luft9, Jens Titze10,11,12, T Alp Ikizler1,2,13. 1. Department of Medicine, Division of Nephrology, Vanderbilt University Medical Center Nashville, TN, USA. 2. Veterans Administration, Tennessee Valley Healthcare System, Nashville, TN, USA. 3. Department of Medicine, Beth Israel Deaconess Medical Center, Boston, USA. 4. Department of Medicine, Division of Nephrology, Yildirim Beyazit University, Ankara, Turkey. 5. Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. 6. Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA. 7. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA. 8. Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA. 9. Experimental and Clinical Research Center, Charité Medical Faculty, Berlin, Germany. 10. Programme in Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore, Singapore. 11. Division of Nephrology and Hypertension, University Clinic Erlangen, Erlangen, Germany. 12. Division of Nephrology, Duke University School of Medicine, 2 Genome Court, Durham, NC, USA. 13. Vanderbilt Center for Kidney Disease, Nashville, TN, USA.
Abstract
BACKGROUND: Tissue sodium content in patients on maintenance hemodialysis (MHD) and peritoneal dialysis (PD) were previously explored using 23Sodium magnetic resonance imaging (23NaMRI). Larger studies would provide a better understanding of sodium stores in patients on dialysis as well as the factors influencing this sodium accumulation. METHODS: In this cross-sectional study, we quantified the calf muscle and skin sodium content in 162 subjects (10 PD, 33 MHD patients, and 119 controls) using 23NaMRI. Plasma levels of interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hsCRP) were measured to assess systemic inflammation. Sixty-four subjects had repeat 23NaMRI scans that were analyzed to assess the repeatability of the 23NaMRI measurements. RESULTS: Patients on MHD and PD exhibited significantly higher muscle and skin sodium accumulation compared to controls. African American patients on dialysis exhibited greater muscle and skin sodium content compared to non-African Americans. Multivariable analysis showed that older age was associated with both higher muscle and skin sodium. Male sex was also associated with increased skin sodium deposition. Greater ultrafiltration was associated with lower skin sodium in patients on PD (Spearman's rho=-0.68, P = 0.035). Higher plasma IL-6 and hsCRP levels correlated with increased muscle and skin sodium content in the overall study population. Patients with higher baseline tissue sodium content exhibited greater variability in tissue sodium stores on repeat measurements. CONCLUSIONS: Our findings highlight greater muscle and skin sodium content in dialysis patients compared to controls without kidney disease. Tissue sodium deposition and systemic inflammation seen in dialysis patients might influence one another bidirectionally.
BACKGROUND: Tissue sodium content in patients on maintenance hemodialysis (MHD) and peritoneal dialysis (PD) were previously explored using 23Sodium magnetic resonance imaging (23NaMRI). Larger studies would provide a better understanding of sodium stores in patients on dialysis as well as the factors influencing this sodium accumulation. METHODS: In this cross-sectional study, we quantified the calf muscle and skin sodium content in 162 subjects (10 PD, 33 MHD patients, and 119 controls) using 23NaMRI. Plasma levels of interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hsCRP) were measured to assess systemic inflammation. Sixty-four subjects had repeat 23NaMRI scans that were analyzed to assess the repeatability of the 23NaMRI measurements. RESULTS: Patients on MHD and PD exhibited significantly higher muscle and skin sodium accumulation compared to controls. African American patients on dialysis exhibited greater muscle and skin sodium content compared to non-African Americans. Multivariable analysis showed that older age was associated with both higher muscle and skin sodium. Male sex was also associated with increased skin sodium deposition. Greater ultrafiltration was associated with lower skin sodium in patients on PD (Spearman's rho=-0.68, P = 0.035). Higher plasma IL-6 and hsCRP levels correlated with increased muscle and skin sodium content in the overall study population. Patients with higher baseline tissue sodium content exhibited greater variability in tissue sodium stores on repeat measurements. CONCLUSIONS: Our findings highlight greater muscle and skin sodium content in dialysis patients compared to controls without kidney disease. Tissue sodium deposition and systemic inflammation seen in dialysis patients might influence one another bidirectionally.
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