Tissue sodium accumulation and peripheral insulin sensitivity in maintenance hemodialysis patients.
BACKGROUND
Recent data suggest that sodium (Na+) is stored in the muscle and skin without commensurate water retention in maintenance hemodialysis (MHD) patients. In this study, we hypothesized that excessive Na+accumulation would be associated with abnormalities in peripheral insulin action.


METHODS
Eleven MHD patients and eight controls underwent hyperinsulinemic-euglycemic-euaminoacidemic clamp studies to measure glucose (GDR) and leucine disposal rates (LDR), as well as lower left leg23Na magnetic resonance imaging to measure Na+concentration in the muscle and skin tissue.


RESULTS
The median GDR and LDR levels were lower, and the median muscle Na+concentration was higher in MHD patients compared with controls. No significant difference was found regarding skin Na+concentration between group comparisons. Linear regression revealed inverse relationships between muscle Na+concentration and GDR and LDR in MHD patients, whereas no relationship was observed in controls. There was no association between skin Na+content and GDR or LDR in either MHD patients or controls.


CONCLUSIONS
These data suggest that excessive muscle Na+content might be a determinant of IR in MHD patients, although the causality and mechanisms remain to be proven.
Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN, USA.|CSRD&D, Veterans Administration Tennessee Valley Healthcare System, Nashville, TN, USA.|Vanderbilt Center for Kidney Disease (VCKD), Nashville, TN, USA.
Serpil Muge
SM
Deger
Vanderbilt University Institute of Imaging Science, Nashville, TN, USA.
Ping
P
Wang
Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN, USA.|Vanderbilt Center for Kidney Disease (VCKD), Nashville, TN, USA.
Rachel
R
Fissell
Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN, USA.
Charles D
CD
Ellis
Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN, USA.|CSRD&D, Veterans Administration Tennessee Valley Healthcare System, Nashville, TN, USA.|Vanderbilt Center for Kidney Disease (VCKD), Nashville, TN, USA.
Cindy
C
Booker
Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN, USA.
Feng
F
Sha
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA.
Jennifer L
JL
Morse
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA.
Thomas G
TG
Stewart
Vanderbilt University Institute of Imaging Science, Nashville, TN, USA.
John C
JC
Gore
Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN, USA.|Vanderbilt Center for Kidney Disease (VCKD), Nashville, TN, USA.
Edward D
ED
Siew
Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN, USA.|Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA.
Jens
J
Titze
Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN, USA.|CSRD&D, Veterans Administration Tennessee Valley Healthcare System, Nashville, TN, USA.|Vanderbilt Center for Kidney Disease (VCKD), Nashville, TN, USA.
Talat Alp
TA
Ikizler
D000328:Adult; D015415:Biomarkers; D001786:Blood Glucose; D001823:Body Composition; D005260:Female; D005947:Glucose / Q000378:metabolism; D006801:Humans; D007328:Insulin / Q000097:blood / Q000378:metabolism*; D007333:Insulin Resistance; D007930:Leucine / Q000378:metabolism; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging / Q000378:metabolism; D009928:Organ Specificity; D006435:Renal Dialysis; D012867:Skin / Q000000981:diagnostic imaging / Q000378:metabolism; D012964:Sodium / Q000378:metabolism*
D015415:Biomarkers; D001786:Blood Glucose; D007328:Insulin; D012964:Sodium; D007930:Leucine; D005947:Glucose
Glucose disposal rate; Insulin resistance; Leucine disposal rate; Muscle sodium content