Schneider Markus P, Raff Ulrike, Kopp Christoph, Scheppach Johannes B, Toncar Sebastian, Wanner Christoph, Schlieper Georg, Saritas Turgay, Floege Jürgen, Schmid Matthias, Birukov Anna, Dahlmann Anke, Linz Peter, Janka Rolf, Uder Michael, Schmieder Roland E, Titze Jens M, Eckardt Kai-Uwe
Departments of *Nephrology and Hypertension, and
Departments of *Nephrology and Hypertension, and.
J Am Soc Nephrol. 2017 Jun;28(6):1867-1876. doi: 10.1681/ASN.2016060662. Epub 2017 Feb 2.
The pathogenesis of left ventricular hypertrophy in patients with CKD is incompletely understood. Sodium intake, which is usually assessed by measuring urinary sodium excretion, has been inconsistently linked with left ventricular hypertrophy. However, tissues such as skin and muscle may store sodium. Using sodium-magnetic resonance imaging, a technique recently developed for the assessment of tissue sodium content in humans, we determined skin sodium content at the level of the calf in 99 patients with mild to moderate CKD (42 women; median [range] age, 65 [23-78] years). We also assessed total body overhydration (bioimpedance spectroscopy), 24-hour BP, and left ventricular mass (cardiac magnetic resonance imaging). Skin sodium content, but not total body overhydration, correlated with systolic BP (=0.33, =0.002). Moreover, skin sodium content correlated more strongly than total body overhydration did with left ventricular mass (=0.56, <0.001 versus =0.35, <0.001; <0.01 between the two correlations). Linear regression analysis demonstrated that skin sodium content is a strong explanatory variable for left ventricular mass, unaffected by BP and total body overhydration. In conclusion, we found skin sodium content to be closely linked to left ventricular mass in patients with CKD. Interventions that reduce skin sodium content might improve cardiovascular outcomes in these patients.
慢性肾脏病（CKD）患者左心室肥厚的发病机制尚未完全明确。通常通过测量尿钠排泄来评估的钠摄入量与左心室肥厚之间的关联并不一致。然而，皮肤和肌肉等组织可能会储存钠。我们使用钠磁共振成像（一种最近开发的用于评估人体组织钠含量的技术），测定了99例轻至中度CKD患者（42名女性；年龄中位数[范围]为65[23 - 78]岁）小腿水平的皮肤钠含量。我们还评估了全身水过多情况（生物电阻抗光谱法）、24小时血压以及左心室质量（心脏磁共振成像）。皮肤钠含量而非全身水过多情况与收缩压相关（=0.33，=0.002）。此外，与全身水过多情况相比，皮肤钠含量与左心室质量的相关性更强（=0.56，<0.001对比=0.35，<0.001；两种相关性之间<0.01）。线性回归分析表明，皮肤钠含量是左心室质量的一个强有力的解释变量，不受血压和全身水过多情况的影响。总之，我们发现CKD患者的皮肤钠含量与左心室质量密切相关。降低皮肤钠含量的干预措施可能会改善这些患者的心血管结局。
