期刊
NEPHROLOGY DIALYSIS TRANSPLANTATION
卷 31, 期 7, 页码 1078-1081出版社
OXFORD UNIV PRESS
DOI: 10.1093/ndt/gfv343
关键词
hemodialysis; hypertension; magnetic resonance imaging; salt; sodium
资金
- German Federal Ministry for Economics and Technology/DLR Forschung unter Weltraumbedingungen [50WB0920]
- Interdisciplinary Centre for Clinical Research (IZKF Junior Research Group)
- NIH [RO1 HL118579-01]
- AHA [14SFRN20770008]
- Vanderbilt CTSA grant from NCATS/NIH [UL1 TR000445]
Sodium balance is achieved within a matter of days and everything that enters should come out; sodium stores are of questionable relevance and sodium accumulation is accompanied by weight gain. Careful balance studies oftentimes conflicted with this view, and long-term studies suggested that total body sodium (TBNa) fluctuates independent of intake or body weight. We recently performed the opposite experiment in that we fixed sodium intake for weeks at three levels of sodium intake and collected all urine made. We found weekly (circaseptan) patterns in sodium excretion that were inversely related to aldosterone and directly related to cortisol. TBNa was not dependent on sodium intake, but instead exhibited far longer (greater than or equal to monthly) infradian rhythms independent of extracellular water, body weight or blood pressure. To discern the mechanisms further, we delved into sodium magnetic resonance imaging (Na-MRI) to identify sodium storage clinically. We found that sodium stores are greater in men than in women, increase with age and are higher in hypertensive than normotensive persons. We have suggestive evidence that these sodium stores can be mobilized, also in dialysis patients. The observations are in accordance with our findings that immune cells regulate a hypertonic interface in the skin interstitium that could serve as a protective barrier. Returning to our balance studies, we found that due to biological variability in 24-h sodium excretion, collecting urine for a day could not separate 12, 9 or 6 g/day sodium intakes with the precision of tossing a coin. Every other daily urine sampling correctly classified a 3-g difference in salt intake less than half the time, making the gold standard 24-h urine collection of little value in predicting salt intake. We suggest that wobbles in expected outcomes can lead to novel clinical insights even with respect to banal salt questions.
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