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Clinical Research
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Intracellular Phosphate and ATP Depletion Measured by Magnetic Resonance Spectroscopy in Patients Receiving Maintenance Hemodialysis

Guillaume Chazot, Sandrine Lemoine, Gabriel Kocevar, Emilie Kalbacher, Dominique Sappey-Marinier, Olivier Rouvière and Laurent Juillard
JASN January 2021, 32 (1) 229-237; DOI: https://doi.org/10.1681/ASN.2020050716
Guillaume Chazot
1Service de néphrologie et d’exploration fonctionnelle rénale, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
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Sandrine Lemoine
1Service de néphrologie et d’exploration fonctionnelle rénale, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
2CARMEN U1060 Institut National de la Santé et de la Recherche Médicale (Cardiovascular Metabolisme Nutrition), Université de Lyon, Université Claude Bernard, INSA de Lyon, Bron, France
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Gabriel Kocevar
3CREATIS (Centre de Recherche et d'Applications en Traitement de l'Image et du Signal) Unité Mixte de Recherche 5220 Centre National de la Recherche Scientifique and U1206 Institut National de la Santé et de la Recherche Médicale, Université de Lyon, Université Claude Bernard, INSA (Institut National Des Sciences Appliquées) de Lyon, Villeurbanne, France
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Emilie Kalbacher
1Service de néphrologie et d’exploration fonctionnelle rénale, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
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Dominique Sappey-Marinier
3CREATIS (Centre de Recherche et d'Applications en Traitement de l'Image et du Signal) Unité Mixte de Recherche 5220 Centre National de la Recherche Scientifique and U1206 Institut National de la Santé et de la Recherche Médicale, Université de Lyon, Université Claude Bernard, INSA (Institut National Des Sciences Appliquées) de Lyon, Villeurbanne, France
4CERMEP-Imagerie du vivant (Centre d'Etude et de Recherche Médicale par Emission de Positons), Université de Lyon, Bron, France
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Olivier Rouvière
5Service de radiologie, Hôpital Édouard-Herriot, Hospices Civils de Lyon, Lyon, France
6Labtau U1032 Institut National de la Santé et de la Recherche Médicale, Université de Lyon, Université Claude Bernard, Villeurbanne, France
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Laurent Juillard
1Service de néphrologie et d’exploration fonctionnelle rénale, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
2CARMEN U1060 Institut National de la Santé et de la Recherche Médicale (Cardiovascular Metabolisme Nutrition), Université de Lyon, Université Claude Bernard, INSA de Lyon, Bron, France
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Significance Statement

The origin of most of the phosphate removed during hemodialysis has been uncertain. In this pilot study, the authors used phosphorus (31P) magnetic resonance spectroscopy to quantify intracellular inorganic phosphate (Pi), phosphocreatine, and ATP kinetics in 11 patients with ESKD during a 4-hour hemodialysis treatment. They found a decreased concentration of both intracellular Pi and ATP, confirming that Pi is, at least partially, released by the intracellular compartment. This finding raises the possibility that excessive dialytic removal of phosphate might adversely affect the intracellular availability of high-energy phosphates and ultimately, cellular metabolism.

Abstract

Background The precise origin of phosphate that is removed during hemodialysis remains unclear; only a minority comes from the extracellular space. One possibility is that the remaining phosphate originates from the intracellular compartment, but there have been no available data from direct assessment of intracellular phosphate in patients undergoing hemodialysis.

Methods We used phosphorus magnetic resonance spectroscopy to quantify intracellular inorganic phosphate (Pi), phosphocreatine (PCr), and βATP. In our pilot, single-center, prospective study, 11 patients with ESKD underwent phosphorus (31P) magnetic resonance spectroscopy examination during a 4-hour hemodialysis treatment. Spectra were acquired every 152 seconds during the hemodialysis session. The primary outcome was a change in the PCr-Pi ratio during the session.

Results During the first hour of hemodialysis, mean phosphatemia decreased significantly (−41%; P<0.001); thereafter, it decreased more slowly until the end of the session. We found a significant increase in the PCr-Pi ratio (+23%; P=0.001) during dialysis, indicating a reduction in intracellular Pi concentration. The PCr-βATP ratio increased significantly (+31%; P=0.001) over a similar time period, indicating a reduction in βATP. The change of the PCr-βATP ratio was significantly correlated to the change of depurated Pi.

Conclusions Phosphorus magnetic resonance spectroscopy examination of patients with ESKD during hemodialysis treatment confirmed that depurated Pi originates from the intracellular compartment. This finding raises the possibility that excessive dialytic depuration of phosphate might adversely affect the intracellular availability of high-energy phosphates and ultimately, cellular metabolism. Further studies are needed to investigate the relationship between objective and subjective effects of hemodialysis and decreases of intracellular Pi and βATP content.

Clinical Trial registry name and registration number Intracellular Phosphate Concentration Evolution During Hemodialysis by MR Spectroscopy (CIPHEMO), NCT03119818

  • chronic hemodialysis
  • hyperphosphatemia
  • cell transfer
  • Copyright © 2021 by the American Society of Nephrology
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Journal of the American Society of Nephrology: 32 (1)
Journal of the American Society of Nephrology
Vol. 32, Issue 1
January 2021
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Intracellular Phosphate and ATP Depletion Measured by Magnetic Resonance Spectroscopy in Patients Receiving Maintenance Hemodialysis
Guillaume Chazot, Sandrine Lemoine, Gabriel Kocevar, Emilie Kalbacher, Dominique Sappey-Marinier, Olivier Rouvière, Laurent Juillard
JASN Jan 2021, 32 (1) 229-237; DOI: 10.1681/ASN.2020050716

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Intracellular Phosphate and ATP Depletion Measured by Magnetic Resonance Spectroscopy in Patients Receiving Maintenance Hemodialysis
Guillaume Chazot, Sandrine Lemoine, Gabriel Kocevar, Emilie Kalbacher, Dominique Sappey-Marinier, Olivier Rouvière, Laurent Juillard
JASN Jan 2021, 32 (1) 229-237; DOI: 10.1681/ASN.2020050716
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Keywords

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  • hyperphosphatemia
  • cell transfer

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