title: Magnetic resonance-determined sodium removal from tissue stores in hemodialysis patients.
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.
authors.affiliation: 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.
authors.forename: Anke
authors.initials: A
authors.lastname: Dahlmann
authors.affiliation: Junior Research Group 2, Interdisciplinary Centre for Clinical Research, Nikolaus-Fiebiger-Centre for Molecular Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Dörfelt
authors.affiliation: Junior Research Group 2, Interdisciplinary Centre for Clinical Research, Nikolaus-Fiebiger-Centre for Molecular Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Eicher
authors.affiliation: Junior Research Group 2, Interdisciplinary Centre for Clinical Research, Nikolaus-Fiebiger-Centre for Molecular Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Linz
authors.affiliation: 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.
authors.forename: Christoph
authors.initials: C
authors.lastname: Kopp
authors.affiliation: Junior Research Group 2, Interdisciplinary Centre for Clinical Research, Nikolaus-Fiebiger-Centre for Molecular Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: Irina
authors.initials: I
authors.lastname: Mössinger
authors.affiliation: Kuratorium für Heimdialyse und Nierentransplantation e.V., Erlangen, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Horn
authors.affiliation: Kuratorium für Heimdialyse und Nierentransplantation e.V., Fürth, Germany.
authors.forename: Beatrix
authors.initials: B
authors.lastname: Büschges-Seraphin
authors.affiliation: Fresenius Medical Care, Bad Homburg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Wabel
authors.affiliation: Department of Radiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Hammon
authors.affiliation: Department of Radiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Cavallaro
authors.affiliation: Department of Nephrology and Hypertension, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: Kai-Uwe
authors.initials: KU
authors.lastname: Eckardt
authors.affiliation: Renal Research Institute, New York, New York, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Kotanko
authors.affiliation: Renal Research Institute, New York, New York, USA.
authors.forename: Nathan W
authors.initials: NW
authors.lastname: Levin
authors.affiliation: Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Johannes
authors.affiliation: Department of Radiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Uder
authors.affiliation: 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.
authors.forename: Friedrich C
authors.initials: FC
authors.lastname: Luft
authors.affiliation: Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine (MDC), Berlin, Germany.
authors.forename: Dominik N
authors.initials: DN
authors.lastname: Müller
authors.affiliation: 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.
authors.forename: Jens M
authors.initials: JM
authors.lastname: Titze
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D015312:Hemodialysis Solutions / Q000032:analysis; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000378:metabolism / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012964:Sodium / Q000302:isolation & purification* / Q000378:metabolism*; D014018:Tissue Distribution; D042582:Vascular Endothelial Growth Factor C / Q000097:blood
chemical_list: D015312:Hemodialysis Solutions; D042582:Vascular Endothelial Growth Factor C; D012964:Sodium
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