Outcomes and Predictors Associated with Skin Sodium Concentration in Dialysis Patients
Bibliographic record
Abstract
Background: Sodium-23 magnetic resonance imaging (23Na MRI) allows the measurement of skin sodium concentration ([Na+]). In patients requiring dialysis no data are available relating to the clinical outcomes associated with skin sodium accumulation or the determinants of increasing deposition. Methods: This was an exploratory, observational study of adult hemodialysis (HD) and peritoneal dialysis (PD) patients. Participants underwent skin [Na+] quantification with leg 23Na MRI at the study beginning. Outcomes of interest were all-cause mortality and composite all-cause mortality and major cardiovascular adverse events (MACE) and were assessed. Cumulative total and event-free survival were assessed using the Kaplan-Meier survival function after stratification into Skin [Na+] quartiles. Cox proportional hazards regression was used to model the association between Skin [Na+] and outcomes of interest. Multiple linear regression was used to model the predictors of Skin [Na+]. Results: 52 participants (42 HD, 10 PD) underwent the study procedures. Median follow-up was 423 days (IQR: 290-550). As shown in Figure 1, increasing Skin [Na+] quartiles were associated with significantly shorter composite event-free survival (log-rank x2(1) = 4.733, p <0.05). Skin [Na+] was significantly associated with all-cause mortality (univariate HR 1.059, 95% CI: 1.014-1.107; sex-adjusted HR: 1.063, 95% CI: 1.019-1.109) and composite all-cause mortality and MACE (univariate HR 1.054, 95% CI: 1.017-1.092; sex-adjusted HR: 1.055, 95% CI: 1.019-1.093). In multiple regression models, dialysate [Na+], serum albumin and congestive heart failure were significantly associated with Skin [Na+] in HD patients (R2adj=0.62). Conclusions: Higher Skin [Na+] was associated with worse clinical outcomes in dialysis patients and may represent a direct therapeutic target.Kaplan Meier curves for overall survival (A) and event-free survival as a composite of all-cause mortality and major adverse cardiovascular events (B), after skin [Na+] quartile stratification.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".