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Abstract: PO1084

Time Course of Tissue Sodium Flux in Maintenance Hemodialysis (MHD) Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Fang, Hsin-Yu, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States
  • Perez, Luis M., University of Illinois at Urbana-Champaign, Urbana, Illinois, United States
  • Larsen, Ryan J., University of Illinois at Urbana-Champaign, Urbana, Illinois, United States
  • Shankar, Deepa H., University of Illinois at Urbana-Champaign, Urbana, Illinois, United States
  • Ikizler, Talat Alp, Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Wilund, Kenneth Robert, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States
Background

Recent 23Na-MRI studies show that sodium can accumulate in tissues. MHD patients have higher tissue sodium concentration ([Na+]) than healthy counterparts, while tissue [Na+] can be partially reduced during hemodialysis (HD). This study aimed to evaluate the magnitude of tissue [Na+] removed during HD and the time-course for its recalibration.

Methods

Seven HD patients (57% male; 60±12 yr; BMI: 36±10 kg/m2; spKt/V: 1.4±.32; dialysate [Na+]: 136±1.90 mEq/L; UFR: 7.2±1.4 mL/kg/hr; thrice-weekly HD) had sequential 23Na-MRI scans (3T system) over 3 consecutive days, including 2 HD days and the non-HD day in between, at 4 time points: pre-first HD (T1), post-first HD (T2), 24 hours post-first HD (T3), and pre-second HD (T4). [Na+] of the medial (MG) and lateral (LG) gastrocnemius, soleus (Sol), tibialis anterior (TA), and the whole lower leg (WL) were quantified from MRI images. Plasma [Na+] was also assessed at T1, T2, and T4 by colorimetric enzymatic assays (Piccolo). Repeated measures ANOVA and the nonparametric Friedman test were used to test the differences in tissue and plasma [Na+] over time.

Results

Tissue [Na+] was reduced at the end of HD (T2) compared to baseline (T1) in the WL (P=.006), MG (P=.043), LG (P=.006), Sol (P=.029), and TA (P=.006), (Figure 1A-E). For the WL and all 4 examined muscles, tissue [Na+] at both T3 and T4 did not differ from baseline (all P>.05), indicating that tissue [Na+] returned to the baseline within 24 hours after last HD. In contrast, plasma [Na+] did not change over time (P=.067; Figure1F).

Conclusion

We found that tissue [Na+] was reduced by HD but returned to baseline levels within 24 hours that remained stable until next pre-HD. More studies are needed to determine the mechanisms for these shifts, and whether lifestyle or pharmaceutical interventions can inhibit tissue [Na+] accumulation or enhance its removal.

Funding

  • Private Foundation Support