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Mitsides N, Alsehli FMS, Mc Hough D, Shalamanova L, Wilkinson F, Alderdice J, Mitra R, Swiecicka A, Brenchley P, Parker GJM, Alexander MY, Mitra S: Salt and Water Retention Is Associated with Microinflammation and Endothelial Injury in Chronic Kidney Disease. Nephron DOI 10.1159/000502011

Endothelial injury and subclinical inflammation (“micro-inflammation”) are both quite common in CKD and their origins are numerous and diverse. Salt and water retention accompanying CKD with expansion of plasma volume and extra-cellular fluid volume is also a common phenomenon.

Mitsides and co-workers examined the association between these parameters in 23 CKD category 5 patients and 11 healthy controls. Uniquely, tissue [Na+] levels were assessed by MRI, fluid expansion by bio-electrical impedance, and inflammation/endothelial injury by a panel of serum biomarkers.

Tissue [Na+] levels were increased in subcutaneous tissue (but not in muscle) and this correlated with fluid volume expansion. Higher subcutaneous tissue [Na+] were also correlated with increased intracellular adhesion molecule (ICAM), lower E-selectin levels. Higher extra-cellular fluid volume levels were associated with higher IL-6 levels. 

While these analyses cannot determine the causal relationship among the measured parameters, they suggest a plausible effect of increased [Na+] retention in CKD and non-osmotic storage in subcutaneous tissue upon inflammation and endothelial injury. The details of this posited relationship require further elucidation, but they heighten interest in [Na+] retention as a factor in the pathogenesis of “uremic” toxicity in advanced CKD. This concept has immediate therapeutic implications that need to be examined in proper randomized clinical trials.

Quoted Karger Article

Salt and Water Retention Is Associated with Microinflammation and Endothelial Injury in Chronic Kidney Disease

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