Salerno Fabio R, Akbari Alireza, Lemoine Sandrine, Filler Guido, Scholl Timothy J, McIntyre Christopher W
Department of Medical Biophysics, Western University, London, ON, Canada.
The Lilibeth Caberto Kidney Clinical Research Unit, London Health Sciences Centre, London, ON, Canada.
Clin Kidney J. 2022 Jan 28;15(6):1129-1136. doi: 10.1093/ckj/sfac021. eCollection 2022 Jun.
Sodium-23 magnetic resonance imaging (Na 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.
This was an exploratory, observational study of adult hemodialysis (HD) and peritoneal dialysis (PD) patients. Participants underwent skin [Na] quantification with leg Na MRI at the study's beginning. Outcomes of interest were all-cause mortality and composite all-cause mortality plus major adverse cardiovascular events. 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].
A total of 52 participants (42 HD and 10 PD) underwent the study procedures. The median follow-up was 529 days (interquartile range: 353-602). Increasing skin [Na] quartiles were associated with significantly shorter overall and event-free survival (log-rank χ(1) = 3.926, log-rank χ(1) = 5.685; P for trend <0.05 in both instances). Skin [Na] was associated with all-cause mortality {hazard ratio (HR) 4.013, [95% confidence interval (95% CI) 1.988-8.101]; P < 0.001} and composite events [HR 2.332 (95% CI 1.378-3.945); P < 0.01], independently of age, sex, serum [Na] and albumin. In multiple regression models, dialysate [Na], serum albumin and congestive heart failure were significantly associated with skin [Na] in HD patients ( = 0.62).
Higher skin [Na] was associated with worse clinical outcomes in dialysis patients and may represent a direct therapeutic target.
钠-23磁共振成像（Na MRI）可用于测量皮肤钠浓度（[Na]）。对于需要透析的患者，尚无关于皮肤钠蓄积相关临床结局或钠沉积增加的决定因素的数据。
这是一项针对成年血液透析（HD）和腹膜透析（PD）患者的探索性观察性研究。参与者在研究开始时接受腿部Na MRI对皮肤[Na]进行定量。感兴趣的结局为全因死亡率以及全因死亡率加主要不良心血管事件的复合结局。分层为皮肤[Na]四分位数后，使用Kaplan-Meier生存函数评估累积总生存率和无事件生存率。采用Cox比例风险回归模型来模拟皮肤[Na]与感兴趣结局之间的关联。采用多元线性回归模型来模拟皮肤[Na]的预测因素。
共有52名参与者（42名HD患者和10名PD患者）接受了研究程序。中位随访时间为529天（四分位间距：353 - 602天）。皮肤[Na]四分位数增加与总体生存率和无事件生存率显著缩短相关（对数秩检验χ(1) = 3.926，对数秩检验χ(1) = 5.685；两者趋势P均<0.05）。皮肤[Na]与全因死亡率相关{风险比（HR）4.013，[95%置信区间（95%CI）1.988 - 8.101]；P < 0.001}以及复合事件相关[HR 2.332（95%CI 1.378 - 3.945）；P < 0.01]，独立于年龄、性别、血清[Na]和白蛋白。在多元回归模型中，HD患者的透析液[Na]、血清白蛋白和充血性心力衰竭与皮肤[Na]显著相关（ = 0.62）。
较高的皮肤[Na]与透析患者较差的临床结局相关，可能代表一个直接的治疗靶点。
