Tissue sodium concentrations in chronic kidney disease and dialysis patients by lower leg sodium-23 magnetic resonance imaging

2020 ◽  
Author(s):  
Elena Qirjazi ◽  
Fabio R Salerno ◽  
Alireza Akbari ◽  
Lisa Hur ◽  
Jarrin Penny ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Chronic Kidney Disease ◽  
Magnetic Resonance ◽  
Kidney Disease ◽  
Negative Correlation ◽  
Lower Leg ◽  
Resonance Imaging ◽  
Clinical Biomarkers ◽  
Tissue Sodium ◽  
23Na Mri

Abstract Background Sodium-23 magnetic resonance imaging (23Na MRI) allows direct measurement of tissue sodium concentrations. Current knowledge of skin, muscle and bone sodium concentrations in chronic kidney disease (CKD) and renal replacement therapy patients is limited. In this study we measured the tissue sodium concentrations in CKD, hemodialysis (HD) and peritoneal dialysis (PD) patients with 23Na MRI of the lower leg and explored their correlations with established clinical biomarkers. Methods Ten healthy controls, 12 CKD Stages 3–5, 13 HD and 10 PD patients underwent proton and 23Na MRI of the leg. The skin, soleus and tibia were segmented manually and tissue sodium concentrations were measured. Plasma and serum samples were collected from each subject and analyzed for routine clinical biomarkers. Tissue sodium concentrations were compared between groups and correlations with blood-based biomarkers were explored. Results Tissue sodium concentrations in the skin, soleus and tibia were higher in HD and PD patients compared with controls. Serum albumin showed a strong, negative correlation with soleus sodium concentrations in HD patients (r = −0.81, P < 0.01). Estimated glomerular filtration rate showed a negative correlation with tissue sodium concentrations (soleus: r = −0.58, P < 0.01; tibia: r = −0.53, P = 0.01) in merged control–CKD patients. Hemoglobin was negatively correlated with tissue sodium concentrations in CKD (soleus: r = −0.65, P = 0.02; tibia: r = −0.73, P < 0.01) and HD (skin: r = −0.60, P = 0.04; tibia: r = −0.76, P < 0.01). Conclusion Tissue sodium concentrations, measured by 23Na MRI, increase in HD and PD patients and may be associated with adverse metabolic effects in CKD and dialysis.

scholarly journals Tissue Sodium Storage in Patients With Heart Failure: A New Therapeutic Target?

2021 ◽  
Vol 14 (11) ◽  
Author(s):  
Sandrine Lemoine ◽  
Fabio R. Salerno ◽  
Alireza Akbari ◽  
Robert S. McKelvie ◽  
Christopher W. McIntyre
Keyword(s):  
Magnetic Resonance Imaging ◽  
Chronic Kidney Disease ◽  
Glomerular Filtration Rate ◽  
Magnetic Resonance ◽  
Kidney Disease ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Sodium Content ◽  
Resonance Imaging ◽  
Tissue Sodium

Background: Preclinical data suggest sodium deposited (without water) in tissues may lead to aberrant remodeling and systemic inflammation, independently of fluid overload in patients with heart failure (HF). Tissue salt storage can be measured noninvasively and quantitatively with 23 Na-magnetic resonance imaging. We aimed to investigate the possibility that patients with HF complicated by renal dysfunction are subject to higher tissue sodium concentration exposure than patients with chronic kidney disease alone. Methods: We conducted an exploratory study including 18 patients with HF, 34 hemodialysis patients (with no meaningful renal clearance of sodium), and 31 patients with chronic kidney disease, with glomerular filtration rate matched to the patients with HF. Every patient underwent 23 Na-magnetic resonance imaging of the calf, to quantify tissue sodium and allow comparison among the 3 patient groups. Results: There were no differences in age, sex, and body mass index between groups. Median (interquartile range) skin sodium content in HF (31 [23–37] mmol/L) was very high and indistinguishable from skin sodium content in hemodialysis patients (30 [22–35] mmol/L), P =0.6. Patients with HF exhibited significantly higher skin sodium content than matched estimated glomerular filtration rate chronic kidney disease patients (22 [19–26] mmol/L), P =0.005. Median muscle sodium content in patients with HF was significantly higher than in patients with chronic kidney disease, P =0.002. There was no relationship with estimated glomerular filtration rate in patients with HF. We report a significant correlation between skin sodium and urinary sodium ( P =0.04) but no correlation with muscle sodium. Patients who were assessed as being volume depleted (sodium excretion fraction <1%) had lower skin sodium content than patients with sodium excretion fraction >1% ( P =0.03). Conclusions: We have demonstrated that patients with HF characteristically have very high levels of skin sodium storage, comparable to well-characterized extreme levels seen in patients with end-stage kidney disease requiring hemodialysis. 23 Na-magnetic resonance imaging may allow precision medicine in the management of this challenging group of patients with HF. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03004547.

scholarly journals Quantitative assessment of renal structural and functional changes in chronic kidney disease using multi-parametric magnetic resonance imaging

2019 ◽  
Vol 35 (6) ◽  
pp. 955-964 ◽  
Author(s):  
Charlotte E Buchanan ◽  
Huda Mahmoud ◽  
Eleanor F Cox ◽  
Thomas McCulloch ◽  
Benjamin L Prestwich ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Chronic Kidney Disease ◽  
Blood Flow ◽  
Magnetic Resonance ◽  
Kidney Disease ◽  
Renal Artery ◽  
Response To Therapy ◽  
Resonance Imaging ◽  
Artery Flow ◽  
Cortical Perfusion

Abstract Background Multi-parametric magnetic resonance imaging (MRI) provides the potential for a more comprehensive non-invasive assessment of organ structure and function than individual MRI measures, but has not previously been comprehensively evaluated in chronic kidney disease (CKD). Methods We performed multi-parametric renal MRI in persons with CKD (n = 22, 61 ± 24 years) who had a renal biopsy and measured glomerular filtration rate (mGFR), and matched healthy volunteers (HV) (n = 22, 61 ± 25 years). Longitudinal relaxation time (T1), diffusion-weighted imaging, renal blood flow (phase contrast MRI), cortical perfusion (arterial spin labelling) and blood-oxygen-level-dependent relaxation rate (R2*) were evaluated. Results MRI evidenced excellent reproducibility in CKD (coefficient of variation &lt;10%). Significant differences between CKD and HVs included cortical and corticomedullary difference (CMD) in T1, cortical and medullary apparent diffusion coefficient (ADC), renal artery blood flow and cortical perfusion. MRI measures correlated with kidney function in a combined CKD and HV analysis: estimated GFR correlated with cortical T1 (r = −0.68), T1 CMD (r = −0.62), cortical (r = 0.54) and medullary ADC (r = 0.49), renal artery flow (r = 0.78) and cortical perfusion (r = 0.81); log urine protein to creatinine ratio (UPCR) correlated with cortical T1 (r = 0.61), T1 CMD (r = 0.61), cortical (r = −0.45) and medullary ADC (r = −0.49), renal artery flow (r = −0.72) and cortical perfusion (r = −0.58). MRI measures (cortical T1 and ADC, T1 and ADC CMD, cortical perfusion) differed between low/high interstitial fibrosis groups at 30–40% fibrosis threshold. Conclusion Comprehensive multi-parametric MRI is reproducible and correlates well with available measures of renal function and pathology. Larger longitudinal studies are warranted to evaluate its potential to stratify prognosis and response to therapy in CKD.

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