Sodium Deposition in Soft Tissues of Patients With Kidney Disease

Study Overview
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Brief Summary
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Sodium (Na+) hemostasis is abnormal in CKD patients, and this element can be deposited in the skin, muscle, and skeleton - to cope with long term sodium loading. It is known that sodium stored in this non-osmotically active way, is profoundly inflammatory. Furthermore, inflammation has been associated with several uremic symptoms. The investigators will use novel Na+ MRI imaging to examine the Na+ deposition in the skin, muscle, and skeleton of five groups:1) chronic in-center hemodialysis patients, 2) chronic peritoneal dialysis patients, 3) adult and paediatric patients with CKD stage 1-5 and 4) heart failure patients with and without renal dysfunction 5) sex and age-matched healthy adult and paediatric controls. Additionally, they will investigate the association between sodium deposition in these tissues with uremic symptomatology and biochemical markers of metabolism.

Detailed Description
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Kidneys have a key role in sodium hemostasis through their excretory function. In patients with chronic kidney disease (CKD), kidney function is impaired; thus, suggesting that sodium handling is abnormal in this setting with long-term sodium loading (from oral intake) and lack of adequate urinary excretion. Yet, sodium concentration needs to stay relatively constant to prevent fatal intra-cellular accumulation, which would result in cell injury and death. In hemodialysis patients, at least a part of this extra sodium is non-osmotically active and deposited in the skin, muscle, and skeleton. Furthermore, it has become increasingly recognized that sodium (once accumulated in tissues) is directly pro-inflammatory, affecting the innate immune system by regulating the activity of macrophages in skin. This linkage between sodium and inflammation indicates a potential link between sodium deposition and uremic symptoms experienced by patients. There have been no studies to date examining the sodium deposition in the skin, muscle, and skeleton of patients with different kidney function and renal replacement therapy. This is a pilot study involving a single center recruiting patients from the prevalent maintenance hemodialysis, peritoneal dialysis , CKD stage 1-5, and heart failure populations of London, Ontario, compared to healthy controls. Once recruited, participants will undergo one study visit with the potential of up to two follow-up visits (on a non-dialysis day for hemodialysis patients). Participants will be followed for up to two years after the first study visit. Each session will include symptom questionnaires, the five times sit to stand and 60-second chair stand test (excluding all children), blood pressure and heart rate measurements, blood work (excluding healthy children and adolescents), urine sampling (excluding those on dialysis), an echocardiogram (excluding healthy controls), and an MRI scan of the lower leg detecting sodium content.

Official Title
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Evaluation of Sodium Deposition in Soft Tissues of Patients With Kidney Disease and Its Association With Patient Symptomatology

Conditions
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Haemodialysis Complication

Intervention / Treatment
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* Other: Measuring sodium content


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age greater than or equal to 6 years For patients on maintenance hemodialysis or peritoneal dialysis: more than 3 months duration of therapy For patients with CKD stage 1-5: CKD stage 1-5 and no indications to start dialysis For heart failure patients: with or without renal dysfunction For healthy controls: lack of kidney disease, heart failure, liver cirrhosis, and peripheral edema For subsequent visits (must meet 1 of the below indicators): Change in dialysis prescription Change in renal replacement therapy modality Change in medication Parathyroidectomy Intervention added to or removed from dialysis (i.e. such as but not limited exercise, cooling, and ischemic preconditioning) Exclusion Criteria: Pregnant, breastfeeding or intending pregnancy Unable to give consent or understand written information Contraindication to MRI study

Ages Eligible for Study
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Minimum Age: 6 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Chronic hemodialysis patients<br>Patients on standard in-centre 3 times a week hemodialysis | Other: Measuring sodium content<br>* Sodium MRI measurement of sodium content in the tissues of all participants<br>|
| Peritoneal dialysis patients<br>Patients on peritoneal dialysis | Other: Measuring sodium content<br>* Sodium MRI measurement of sodium content in the tissues of all participants<br>|
| Adult and paediatric patients with CKD stage 1-5<br>Patients with chronic kidney disease stage 1-5 (not dialysis dependent) | Other: Measuring sodium content<br>* Sodium MRI measurement of sodium content in the tissues of all participants<br>|
| Healthy adult and paediatric controls<br>Subjects without kidney disease | Other: Measuring sodium content<br>* Sodium MRI measurement of sodium content in the tissues of all participants<br>|
| Heart failure patients with and without renal dysfunction<br>Heart failure patients (atrial fibrillation etc ...) with and without renal dysfunction | Other: Measuring sodium content<br>* Sodium MRI measurement of sodium content in the tissues of all participants<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Na content in the skin, muscle and skeleton of five cohorts |  | 2 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Inflammatory Marker: CRP levels |  | 2 years | 
| Uremic symptom scores among the different groups |  | 2 years | 
| Liver function markers |  | 2 years | 
| Liver damage markers (liver enzymes) |  | 2 years | 
| cardiac markers (troponin) |  | 2 years | 
| bone markers (ALP, vitamin D levels) |  | 2 years | 
| Uremic toxin levels |  | 3-4 years | 
| Endotoxin levels |  | 5 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Sodium, Soft Tissues