Magnetic resonance-determined sodium removal from tissue stores in hemodialysis patients.

Anke Dahlmann, Kathrin Dörfelt, Florian Eicher, Peter Linz, Christoph Kopp, Irina Mössinger, Stephan Horn, Beatrix Büschges-Seraphin, Peter Wabel, Matthias Hammon, Alexander Cavallaro, Kai-Uwe Eckardt, Peter Kotanko, Nathan W Levin, Bernd Johannes, Michael Uder, Friedrich C Luft, Dominik N Müller, Jens M Titze

Journal: Kidney international 2016;87(2):434-41

PMID: 25100048

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Abstract

We have previously reported that sodium is stored in skin and muscle. The amounts stored in hemodialysis (HD) patients are unknown. We determined whether (23)Na magnetic resonance imaging (sodium-MRI) allows assessment of tissue sodium and its removal in 24 HD patients and 27 age-matched healthy controls. We also studied 20 HD patients before and shortly after HD with a batch dialysis system with direct measurement of sodium in dialysate and ultrafiltrate. Age was associated with higher tissue sodium content in controls. This increase was paralleled by an age-dependent decrease of circulating levels of vascular endothelial growth factor-C (VEGF-C). Older (>60 years) HD patients showed increased sodium and water in skin and muscle and lower VEGF-C levels compared with age-matched controls. After HD, patients with low VEGF-C levels had significantly higher skin sodium content compared with patients with high VEGF-C levels (low VEGF-C: 2.3 ng/ml and skin sodium: 24.3 mmol/l; high VEGF-C: 4.1 ng/ml and skin sodium: 18.2 mmol/l). Thus, sodium-MRI quantitatively detects sodium stored in skin and muscle in humans and allows studying sodium storage reduction in ESRD patients. Age and VEGF-C-related local tissue-specific clearance mechanisms may determine the efficacy of tissue sodium removal with HD. Prospective trials on the relationship between tissue sodium content and hard end points could provide new insights into sodium homeostasis, and clarify whether increased sodium storage is a cardiovascular risk factor.

Address: 1] Junior Research Group 2, Interdisciplinary Centre for Clinical Research, Nikolaus-Fiebiger-Centre for Molecular Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany [2] Department of Nephrology and Hypertension, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.; Junior Research Group 2, Interdisciplinary Centre for Clinical Research, Nikolaus-Fiebiger-Centre for Molecular Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.; Kuratorium für Heimdialyse und Nierentransplantation e.V., Erlangen, Germany.; Kuratorium für Heimdialyse und Nierentransplantation e.V., Fürth, Germany.; Fresenius Medical Care, Bad Homburg, Germany.; Department of Radiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.; Department of Nephrology and Hypertension, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.; Renal Research Institute, New York, New York, USA.; Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany.; 1] Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine (MDC), Berlin, Germany [2] Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.; Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine (MDC), Berlin, Germany.; 1] Junior Research Group 2, Interdisciplinary Centre for Clinical Research, Nikolaus-Fiebiger-Centre for Molecular Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany [2] Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.

DOI: 10.1038/ki.2014.269

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MeSH Terms: Adult, Age Factors, Aged, Case-Control Studies, Female, Hemodialysis Solutions, Humans, Kidney Failure, Chronic, Magnetic Resonance Imaging, Male, Middle Aged, Renal Dialysis, Sodium, Tissue Distribution, Vascular Endothelial Growth Factor C