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J Am Soc Nephrol. 2017 Jun;28(6):1867-1876. doi: 10.1681/ASN.2016060662. Epub 2017 Feb 2.

Skin Sodium Concentration Correlates with Left Ventricular Hypertrophy in CKD.

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Departments of *Nephrology and Hypertension, and
Departments of *Nephrology and Hypertension, and.
Division of Nephrology, Department of Medicine, University of Würzburg, Würzburg, Germany.
Division of Nephrology and Clinical Immunology, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany.
Department of Medical Biometry, Informatics and Epidemiology, University of Bonn, Bonn, Germany; and.
Radiology, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany.
Department of Medicine, Vanderbilt University, Nashville, Tennessee.


The pathogenesis of left ventricular hypertrophy in patients with CKD is incompletely understood. Sodium intake, which is usually assessed by measuring urinary sodium excretion, has been inconsistently linked with left ventricular hypertrophy. However, tissues such as skin and muscle may store sodium. Using 23sodium-magnetic resonance imaging, a technique recently developed for the assessment of tissue sodium content in humans, we determined skin sodium content at the level of the calf in 99 patients with mild to moderate CKD (42 women; median [range] age, 65 [23-78] years). We also assessed total body overhydration (bioimpedance spectroscopy), 24-hour BP, and left ventricular mass (cardiac magnetic resonance imaging). Skin sodium content, but not total body overhydration, correlated with systolic BP (r=0.33, P=0.002). Moreover, skin sodium content correlated more strongly than total body overhydration did with left ventricular mass (r=0.56, P<0.001 versus r=0.35, P<0.001; P<0.01 between the two correlations). Linear regression analysis demonstrated that skin sodium content is a strong explanatory variable for left ventricular mass, unaffected by BP and total body overhydration. In conclusion, we found skin sodium content to be closely linked to left ventricular mass in patients with CKD. Interventions that reduce skin sodium content might improve cardiovascular outcomes in these patients.


blood pressure; kidney diseases; left ventricular hypertrophy; skin; sodium

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