Sodium Accumulation Study in Haemodialysis (SASH)
Haemodialysis (HD) sustains life in patients with end-stage kidney disease (ESKD) but is associated with a marked increase in incidence of cardiovascular disease (CVD) and high annual mortality rates. The pathogenesis of CVD in patients on HD is multifactorial and complex but hypertension is thought to be a major contributing factor. Sodium balance is normally regulated by the kidneys in health but has to be achieved by sodium removal during HD for those with ESKD. Recent evidence suggests that accumulation of sodium in the skin and / or muscle may be a critical factor impacting the development of hypertension and CVD in patients with ESKD. Non-invasive methods are therefore required to study tissue sodium accumulation in this context.
It has been proposed that tissue sodium accumulation in skin and/or muscle is a key factor in hypertension. Sodium magnetic resonance imaging (23Na MRI) allows the assessment of skin and muscle sodium storage and will therefore be a valuable tool in elucidating the role of tissue sodium accumulation in the pathogenesis of salt-sensitive hypertension and cardiovascular morbidity and mortality. Moreover, if haemodialysis in patients with end-stage kidney disease (ESKD) results in changes in tissue sodium, the development of 23Na skin and muscle measures would allow for a method to correlate skin tissue sodium content with detailed cardiovascular and functional assessments.
This feasibility study will recruit 10 established haemodialysis patients will undergo a Na MRI scan and skin autofluoresence measurements prior to a dialysis session and then have repeat measures immediately after dialysis. Data will be correlated to biochemical measures as well as skin autofluoresence measurements.