End-Stage Renal Disease (ESRD) Clinical Trial
Official title:
Intracellular Phosphate and Adenosine Triphosphate (ATP) Concentration Evolution by Magnetic Resonance (MR) Spectroscopy in Patients During Hemodialysis
End-stage renal disease is associated with hyperphosphatemia due to a decrease of renal
phosphate excretion. This hyperphosphatemia is associated with an increase of cardiovascular
risk and mortality. Thus, three therapeutic options have been developed: dietary restriction,
administration of phosphate binders and phosphorus clearance by hemodialysis (HD).
During a standard HD session, around 600 to 700mg phosphate is removed from the plasma,
whereas it contains only 90 mg inorganic phosphate (Pi); 85% of phosphate is stored in bones
and teeth in hydroxyapatite form, 14% is stored in the intracellular space (90% organic
phosphate and 10% Pi), and 1% remains in the extracellular space.
Currently, the source of Pi cleared during HD remains to be determined. Phosphorus (31P)
magnetic resonance spectroscopy allows reliable, dynamic and non-invasive measurements of
phosphate intracellular concentration. The investigator's team recently published data
obtained in anephric pigs, suggesting that phosphate intracellular concentration increases
during a HD session. In parallel, we showed that ATP intracellular concentration decreased.
These results suggest that the source of Pi cleared during HD could be located inside the
cell.
In this study, investigators will measure intracellular phosphate and ATP concentrations and
intracellular potential of hydrogen (pH) evolution during hemodialysis in 12 patients
suffering from end-stage renal disease by MR spectroscopy.
If these results were confirmed in humans, it could explain, at least in part, HD intolerance
in some patients and would lead to modify therapeutic approaches of hyperphosphatemia, for
example, by modifying HD sessions time.
n/a
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