P0215EXCESSIVE TISSUE SODIUM STORAGE IN PATIENTS WITH NON-DIALYSIS DEPENDENT CARDIO-RENAL SYNDROME IS COMPARABLE TO HEMODIALYSIS PATIENTS

Abstract

Abstract Background and Aims Both CKD and heart failure (HF) are characterized by a propensity to retain sodium. Renal dysfunction worsens the progression of heart failure and is associated with worse outcomes. This may be a result of synergistic aggravation of sodium retention by the two conditions. We aimed to compare tissue Na storage in skin and muscle between cardiorenal (CR) patients and patients with a range of renal dysfunction, including those requiring hemodialysis (HD). Method Proton and 23Na images of the lower limb were acquired on a 3T MRI. We studied 9 CR patients, 7 matched CKD 2-5 patients (without HF) and 31 established HD patients. Regions of interest including skin and soleus were drawn on images to provide a quantitative sodium measurement and these tissue concentrations compared between groups. Blood samples were drawn at each scan in all patients. Spot urine samples were collected for CR patients. Results For CR patients, mean age was 66 ± 8 years, 78% of male, mean estimated glomerular filtration rate (eGFR) was 52 ± 18 mL/min/1.73m2, urea was 11 ± 6 mmol/L. For HD patients, mean age was 66 ± 8.7 years, 68% of male and mean dialysis vintage was 38 ± 37 months for HD patients. Mean age was 63 ± 8, 71 % of male, eGFR 45 ± 29 mL/min/1.73m2 for CKD patients. CR patients displayed an increased amount of salt in skin (32.5 ± 13 mmol/L) and muscle (26 ±4 mmol/L) with levels significantly higher than that seen in GFR matched controls (without HF) and comparable to HD patients (31 ±12 and 28 ± 6 mmol/L p=0.9 and p=0.3 respectively) without meaningful residual renal function. Conclusion The combination of HF and CKD is associated with intense tissue Na storage; resulting in tissue Na accumulation in CR patients (with reasonably well-preserved renal function) similar to CKD patients requiring HD.