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Abstract: SA-PO309

Does Sodium Magnetic Resonance Imaging Help for Initiation of Incremental Dialysis?

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Lemoine, Sandrine, Universite de Lyon, Lyon, Auvergne-Rhône-Alpes , France
  • Akbari, Alireza, Lawson Health Research Institute, London, Ontario, Canada
  • Penny, Jarrin D., Lawson Health Research Institute, London, Ontario, Canada
  • McIntyre, Christopher W., Lawson Health Research Institute, London, Ontario, Canada

Incremental HD (twice a week) can be proposed to some patients who had a significant residual renal function (RRF) when hemodialysis (HD) is initiated. However renal urea clearance is a very limited tool to assess the totality of crucial functions of the kidney, such as ability of the kidney to control salt and water excretion. We hypothesized that corticomedullary gradient (CMG) measurement with 23NaMRI could provide a new tool to select HD patients potentially suitable for incremental dialysis.


We conducted a prospective observational study to better characterize CMG in HD patient with 23NaMRI. We performed CMG measurment with 23NaMRI in fasting patients. All MR experiments were carried out on a GE MR750 3T (GE Healthcare, WI). A custom-built two-loop (18cm in diameter) butterfly radiofrequency surface coil tuned for 23Na frequency (33.786 MHz) was used to acquire renal 23Na images. We compared CMG in healthy controls (n=15) and HD patients (n=10) with or without conventionally assessed RRF.


For healthy controls, median (IQR) age was 50 (32-60), years old, 46% men, eGFR 103 (84-108) mL/min/1.73m2, urinary osmolarity (osmU) 786 (587-938) osm/L. For HD patients, median(IQR) age was 50 (32-60) years old, 40 % men, urinary osmolarity (osmU) 313 (193-317) osm/L, 40% with residual renal function (RRF).
Corticomedullary gradient for controls (1,53 (1,47-1,61)), was significantly different to HD 1,32 (1,24-1,36) (p=0.001). There was a significant correlation between osmolarity and CMG (r=0.92, p<0.001). We were able to see a difference in salt repartition between HD patient with RRF and control. Anuric HD patients had lost medullary sodium entirely. Figure 1 shows difference in corticomedullary pictures (A) control; (B) HD patients with RRF; (C) HD patients with no RRF


We showed that is possible to assess corticomedullary gradient in HD patients. Additional study is justified to explore the ability to the 23NaMRI to discriminate patients who might benefit best from an incremental dialysis approach.