Reduction of tissue Na(+) accumulation after renal transplantation

INTRODUCTION: Chronic kidney disease (CKD) engenders salt-sensitive hypertension. Whether or not tissue Na(+) accumulation is increased in CKD patients remains uncertain. How tissue Na(+) is affected after renal transplantation has not been assessed. METHODS: We measured tissue Na(+) amount in 31 CKD patients (stage 5) and prospectively evaluated tissue Na(+) content at 3 and 6 months, following living-donor kidney transplantation. Additionally, pre- and post-transplantation data were compared to 31 age- and sex-matched control subjects. (23)Na–magnetic resonance imaging ((23)Na-MRI) was used to quantify muscle and skin Na(+) of the lower leg and water distribution was assessed by bioimpedance spectroscopy. RESULTS: Compared to control subjects, CKD patients showed increased muscle (20.7 ± 5.0 vs. 15.5 ± 1.8 arbitrary units [a.u.], P < 0.001) and skin Na+ content (21.4 ± 7.7 vs. 15.0 ± 2.3 a.u., P < 0.001), whereas plasma Na(+) concentration did not differ between groups. Restoration of kidney function by successful renal transplantation was accompanied by mobilization of tissue Na(+) from muscle (20.7 ± 5.0 vs. 16.8 ± 2.8 a.u., P < 0.001) and skin tissue (21.4 ± 7.7 vs. 16.8 ± 5.2 a.u., P < 0.001). The reduction of tissue Na(+) after transplantation was associated with improved renal function, normalization of blood pressure as well as an increase in lymphatic growth-factor concentration (vascular endothelial growth factor C [VEGF-C] 4.5 ± 1.8 vs. 6.7 ± 2.7 ng/ml, P < 0.01). CONCLUSIONS: Tissue Na+ accumulation in predialysis patients with CKD was almost completely reversed to the level of healthy controls after successful kidney transplantation

Elevated tissue sodium deposition in patients with type 2 diabetes on hemodialysis detected by (23)Na magnetic resonance imaging

Long-term elevated blood sugar levels result in tissue matrix compositional changes in patients with diabetes mellitus type 2 (T2DM). We hypothesized that hemodialysis patients with T2DM might accumulate more tissue sodium than control hemodialysis patients. To test this, (23)Na magnetic resonance imaging ((23)Na MRI) was used to estimate sodium in skin and muscle tissue in hemodialysis patients with or without T2DM. Muscle fat content was estimated by (1)H MRI and tissue sodium content by (23)Na MRI pre- and post-hemodialysis in ten hemodialysis patients with T2DM and in 30 matched control hemodialysis patients. We also assessed body fluid distribution with the Body Composition Monitor. (1)H MRI indicated a tendency to higher muscle fat content in hemodialysis patients with T2DM compared to non-diabetic hemodialysis patients. (23)Na MRI indicated increased sodium content in muscle and skin tissue of hemodialysis patients with T2DM compared to control hemodialysis patients. Multi-frequency bioimpedance was used to estimate extracellular water (ECW), and excess ECW in T2DM hemodialysis patients correlated with HbA1c levels. Sodium mobilization during hemodialysis lowered muscle sodium content post-dialysis to a greater degree in T2DM hemodialysis patients than in control hemodialysis patients. Thus, our findings provide evidence that increased sodium accumulation occurs in hemodialysis patients with T2DM and that impaired serum glucose metabolism is associated with disturbances in tissue sodium and water content

Positionspapier „Schlafmedizin in der Kardiologie“, Update 2021

Various novelties have emerged since the last update of the position paper on sleep medicine in cardiology of the German Cardiac Society in 2014, which is why this revision became necessary. This new version not only includes all new studies available up to the date of printing, including references, updates on pathophysiology, diagnostics, and treatment recommendations but also constitutes outlooks towards novel developments and future scientific projects in this field. This revised position paper provides not only recommendations on diagnostics and treatment for cardiovascular patients with sleep-disordered breathing but also provides an overview of available treatment and evidence. In addition, it provides advice on interactions with comorbidities and in particular includes revised statements on sleep-disordered breathing in patients with coronary artery disease, heart failure, arterial hypertension and atrial fibrillation. Moreover, for the first time this position paper comprises recommendations for telemedicine as an individual novel chapter. This position paper supplies cardiologists as well as all physicians treating patients with cardiovascular diseases options for evidence-based medicine for treatment of the combination of cardiovascular disease in context with the growing attention towards the comorbidity of sleep-disordered breathing. If nothing else, this position paper implicates close interaction with the novel curriculum “sleep medicine” of the German Cardiac Society, facilitating orientation on the newly acquired capabilities through completion of the curriculum to fully handle the diagnostics and treatment of cardiovascular patients with sleep-disordered breathing

Skin sodium is increased in male patients with multiple sclerosis and related animal models.

Novel MRI techniques allow a noninvasive quantification of tissue sodium and reveal the skin as a prominent compartment of sodium storage in health and disease. Since multiple sclerosis (MS) immunopathology is initiated in the periphery and increased sodium concentrations induce proinflammatory immune cells, the skin represents a promising compartment linking high sodium concentrations and MS immunopathology. We used a 7-T sodium MRI (23Na-MRI) and inductively coupled plasma mass spectrometry to investigate the skin sodium content in two mouse models of MS. We additionally performed 3-T 23Na-MRI of calf skin and muscles in 29 male relapsing-remitting MS (RRMS) patients and 29 matched healthy controls. Demographic and clinical information was collected from interviews, and disease activity was assessed by expanded disability status scale scoring. 23Na-MRI and chemical analysis demonstrated a significantly increased sodium content in the skin during experimental autoimmune encephalomyelitis independent of active immunization. In male patients with RRMS, 23Na-MRI demonstrated a higher sodium signal in the area of the skin compared to age- and biological sex-matched healthy controls with higher sodium, predicting future disease activity in cranial MRI. In both studies, the sodium enrichment was specific to the skin, as we found no alterations of sodium signals in the muscle or other tissues. Our data add to the recently identified importance of the skin as a storage compartment of sodium and may further represent an important organ for future investigations on salt as a proinflammatory agent driving autoimmune neuroinflammation such as that in MS

Hypercoagulability causes atrial fibrosis and promotes atrial fibrillation

Nephrolog