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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.
