SASH: Sodium Accumulation Study in Haemodialysis
Research type
Research Study
Full title
SASH: Sodium Accumulation Study in Haemodialysis
IRAS ID
306449
Contact name
Nicholas Selby
Contact email
Sponsor organisation
University Hospitals of Derby and Burton NHS Foundation Trust
Clinicaltrials.gov Identifier
Duration of Study in the UK
0 years, 6 months, 2 days
Research summary
Summary of Research
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.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 MRI skin and muscle measures would allow for a method to correlate skin tissue sodium content with detailed cardiovascular and functional assessments.
This study aims to determine the change in skin and muscle sodium content in patients undergoing haemodialysis. Participants will attend one study day on which they will undergo a single dialysis session and two MRI scans (one prior and one following dialysis), in conjunction with clinical data collection (eg. Blood sample).
Summary of Results
The aim of the research study was to look at a new type of MRI scanning that can measure the amount of sodium in different parts of the body. This is very important to patients with kidney disease, as the kidney is the main organ that regulates the amount of sodium in your body. Sodium is important for many important functions, including blood pressure control. We can measure sodium levels in the blood, but this does not tell us how much sodium is present in other areas of your body. Previously, we have not been able to measure this at all. Sodium MRI (Na-MRI) is a new type of MRI scanning that can directly measure sodium in other parts of body such as skin, muscles, and kidneys. We believe that this will help to guide treatment in patients with kidney disease who are on haemodialysis, but we need to perform research studies to prove the benefits.10 participants who had been on haemodialysis for at least 3 months underwent 2 Na-MRI scans of the calf, 1 before and 1 after a haemodialysis session. Skin and muscle sodium MRI measures were collected as well as blood sodium tests for comparison. Blood pressure measures before, during and after dialysis were also recorded.
The primary objective of the study was to determine if it is possible to measure skin and muscle sodium in people receiving treatment with haemodialysis. Secondly, we studied the effect of a single dialysis session on change in skin and muscle sodium content.
Sodium MRI showed a reduction in muscle sodium comparing scans before and after dialysis. Muscle sodium after dialysis strongly correlated with blood pressure after dialysis but not with blood sodium levels. This suggests that muscle sodium concentration is more important for blood pressure control than blood concentrations.REC name
HSC REC A
REC reference
22/NI/0043
Date of REC Opinion
8 Feb 2022
REC opinion
Favourable Opinion