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Abstract: FR-OR25

Outcomes and Predictors Associated with Skin Sodium Concentration in Dialysis Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Salerno, Fabio R., Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
  • Akbari, Alireza, Robarts Research Institute, London, Ontario, Canada
  • Lemoine, Sandrine, Universite Lyon 1 Faculte de Medecine Lyon-Est, Lyon, Auvergne-Rhône-Alpes , France
  • Filler, Guido, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
  • Scholl, Timothy J., Robarts Research Institute, London, Ontario, Canada
  • McIntyre, Christopher W., Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
Background

Sodium-23 magnetic resonance imaging (23Na MRI) allows the measurement of skin sodium concentration ([Na+]). In patients requiring dialysis no data are available relating to the clinical outcomes associated with skin sodium accumulation or the determinants of increasing deposition.

Methods

This was an exploratory, observational study of adult hemodialysis (HD) and peritoneal dialysis (PD) patients. Participants underwent skin [Na+] quantification with leg 23Na MRI at the study beginning. Outcomes of interest were all-cause mortality and composite all-cause mortality and major cardiovascular adverse events (MACE) and were assessed. Cumulative total and event-free survival were assessed using the Kaplan-Meier survival function after stratification into Skin [Na+] quartiles. Cox proportional hazards regression was used to model the association between Skin [Na+] and outcomes of interest. Multiple linear regression was used to model the predictors of Skin [Na+].

Results

52 participants (42 HD, 10 PD) underwent the study procedures. Median follow-up was 423 days (IQR: 290-550). As shown in Figure 1, increasing Skin [Na+] quartiles were associated with significantly shorter composite event-free survival (log-rank χ2(1) = 4.733, p <0.05). Skin [Na+] was significantly associated with all-cause mortality (univariate HR 1.059, 95% CI: 1.014-1.107; sex-adjusted HR: 1.063, 95% CI: 1.019-1.109) and composite all-cause mortality and MACE (univariate HR 1.054, 95% CI: 1.017-1.092; sex-adjusted HR: 1.055, 95% CI: 1.019-1.093).
In multiple regression models, dialysate [Na+], serum albumin and congestive heart failure were significantly associated with Skin [Na+] in HD patients (R2adj=0.62).

Conclusion

Higher Skin [Na+] was associated with worse clinical outcomes in dialysis patients and may represent a direct therapeutic target.

Kaplan Meier curves for overall survival (A) and event-free survival as a composite of all-cause mortality and major adverse cardiovascular events (B), after skin [Na+] quartile stratification.