scholarly journals Electrolyte and Acid-Base Disorders in Chronic Kidney Disease and End-Stage Kidney Failure

2017 ◽  
Vol 43 (1-3) ◽  
pp. 179-188 ◽  
Author(s):  
Tsering Dhondup ◽  
Qi Qian
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Patient Outcomes ◽  
Treatment Strategies ◽  
Disease Process ◽  
Pharmacological Therapy ◽  
Diagnosis And Treatment ◽  
Acid Base Balance ◽  
Acid Base ◽  
End Stage

The kidneys play a pivotal role in the regulation of electrolyte and acid-base balance. With progressive loss of kidney function, derangements in electrolytes and acid-base inevitably occur and contribute to poor patient outcomes. As chronic kidney disease (CKD) has become a worldwide epidemic, medical providers are increasingly confronted with such problems. Adequate diagnosis and treatment will minimize complications and can potentially be lifesaving. In this review, we discuss the current understanding of the disease process, clinical presentation, diagnosis and treatment strategies, integrating up-to-date knowledge in the field. Although electrolyte and acid-base derangements are significant causes of morbidity and mortality in CKD and end-stage renal disease patients, they can be effectively managed through a timely institution of combined preventive measures and pharmacological therapy. Exciting advances and several upcoming outcome trials will provide further information to guide treatment and improve patient outcomes.

Serum Sodium Levels and Patient Outcomes in an Ambulatory Clinic-Based Chronic Kidney Disease Cohort

2015 ◽  
Vol 41 (3) ◽  
pp. 200-209 ◽  
Author(s):  
Sang-Woong Han ◽  
Anca Tilea ◽  
Brenda W. Gillespie ◽  
Fredric O. Finkelstein ◽  
Margaret A. Kiser ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Patient Outcomes ◽  
Serum Sodium ◽  
Risk Of Mortality ◽  
Ambulatory Patients ◽  
Lower Egfr ◽  
Stage Renal Disease ◽  
End Stage ◽  
Improve Patient

Background: Chronic kidney disease (CKD) patients are prone to both hypo- and hypernatremia. Little has been published on the epidemiology of hypo- and hypernatremia in ambulatory patients with non-dialysis CKD. Methods: Data collected in two contemporaneous CKD cohort studies, the Renal Research Institute (RRI)-CKD study (n = 834) and the Study of Treatment of Renal Insufficiency: Data and Evaluation (STRIDE) (n = 1,348) were combined and analyzed to study the association between serum sodium (Na+) and clinical outcomes. Results: Baseline estimated glomerular filtration rate (eGFR) and Na+ were 26 ± 11 ml/min/1.73 m2 and 140.2 ± 3.4 mEq/l, respectively. The prevalence of Na+ ≤135 mEq/l and ≥144 mEq/l was 6 and 16%, respectively. Higher baseline Na+ was significantly associated with male sex, older age, systolic blood pressure, BMI, serum albumin, presence of heart failure, and lower eGFR. The risk of end-stage renal disease (ESRD) was marginally significantly higher among patients with Na+ ≤135 mEq/l, compared with 140< Na+ <144 mEq/l (referent), in time-dependent models (adjusted hazard ratio, HR = 1.52, p = 0.06). Mortality risk was significantly greater at 135< Na+ ≤140 mEq/l (adjusted HR = 1.68, p = 0.02) and Na+ ≥144 mEq/l (adjusted HR = 2.01, p = 0.01). Conclusion: CKD patients with Na+ ≤135 mEq/l were at a higher risk for progression to ESRD, whereas both lower and higher Na+ levels were associated with a higher risk of mortality. While caring for CKD patients, greater attention to serum sodium levels by clinicians is warranted and could potentially help improve patient outcomes.

scholarly journals CHRONIC KIDNEY DISEASE AND ARRHYTHMIAS: CONCLUSIONS FROM A KIDNEY DISEASE: IMPROVING GLOBAL OUTCOMES (KDIGO) CONTROVERSIES CONFERENCE

2019 ◽  
Vol 23 (2) ◽  
pp. 18-40
Author(s):  
Peter J. Blankestijn ◽  
Juan-Jesus Carrero ◽  
Catherine M. Clase ◽  
Rajat Deo ◽  
Charles A. Herzog ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Ventricular Arrhythmias ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Heart Rhythm ◽  
Heart Rhythm Disorders ◽  
Key Issues ◽  
End Stage ◽  
Supraventricular Tachycardias

Patients with chronic kidney disease (CKD) are predisposed to heart rhythm disorders, including atrial fibrillation (AF)/atrial flutter, supraventricular tachycardias, ventricular arrhythmias, and sudden cardiac death (SCD). While treatment options, including drug, device, and procedural therapies, are available, their use in the setting of CKD is complex and limited. Patients with CKD and end-stage kidney disease have historically been under-represented or excluded from randomized trials of arrhythmia treatment strategies, 1 although this situation is changing. Cardiovascular society consensus documents have recently identified evidence gaps for treating patients with CKD and heart rhythm disorders. To identify key issues relevant to the optimal prevention, management, and treatment of arrhythmias and their complications in patients with kidney disease, Kidney Disease: Improving Global Outcomes (KDIGO) convened an international, multidisciplinary Controversies Conference in Berlin, Germany, titled CKD and Arrhythmias in October 2016.

scholarly journals ACID-BASE BALANCE IN HYPERTENSIVE PATIENTS WITH CHRONIC KIDNEY DISEASE: INFLUENCE OF DIABETES

2021 ◽  
Vol 39 (Supplement 1) ◽  
pp. e298
Author(s):  
Giuseppe Mule’ ◽  
Caterina Carollo ◽  
Alessandra Sorce ◽  
Marta Giambrone ◽  
Alida Ferrara ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Acid Base Balance ◽  
Acid Base ◽  
Hypertensive Patients ◽  
Base Balance

scholarly journals Diagnostic utility of different models used to assess the acid–base balance in cats with chronic kidney disease

2020 ◽  
Vol 68 (2) ◽  
pp. 169-176
Author(s):  
Piotr Sławuta ◽  
Agnieszka Sikorska-Kopyłowicz ◽  
Grzegorz Sapikowski
Keyword(s):  
Chronic Kidney Disease ◽  
Metabolic Acidosis ◽  
Kidney Disease ◽  
Anion Gap ◽  
Control Group ◽  
Acid Base Balance ◽  
Acid Base ◽  
Classic Model ◽  
Arterial Blood ◽  
Base Balance

AbstractMetabolic acidosis is diagnosed based on the concentration of bicarbonate ions and partial pressure of carbon dioxide in arterial blood, although acid–base balance (ABB) disorders may also be diagnosed based on the serum ion concentrations in order to determine the values of strong ion difference (SID), anion gap (AG), corrected anion gap (AGcorr) and chloride/sodium ratio (Cl−/Na+). The aim of this study was to assess and compare the classic model, the value of the AG, AGcorr, and Cl−/Na+ in the diagnosis of ABB disorders in cats with chronic kidney disease (CKD). The study group consisted of 80 cats with CKD, divided into four groups based on the guidelines of the International Renal Interest Society (IRIS). The control group (C) included 20 healthy cats. Metabolic acidosis – diagnosed based on the classic model (Hendersson–Hasselbalch equation) – was found in IRIS group IV. AG, AGcorr, SID calculated for IRIS groups II, III and IV were lower than in group C, while the value of AGdiff and Cl−/Na+ in those groups was higher than in group C. We can conclude that ABB analysis using the classic model enabled the detection of ABB disorders in cats in stage IV CKD. However, the analysis of the AG, AGcorr and Cl−/Na+ values enabled the diagnosis of acid–base balance disorders in cats with IRIS stage II, III and IV CKD.

scholarly journals Multiple brown tumors—Forgotten pathology in times of calcimimetics: A case report and literature review

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110393
Author(s):  
José Carlos De La Flor Merino ◽  
Pablo Justo ◽  
Juan J. Domínguez ◽  
Ana Gómez-Berrocal ◽  
Antonio E. Seva ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Secondary Hyperparathyroidism ◽  
Pharmacological Therapy ◽  
Mineral And Bone Disorder ◽  
Tertiary Hyperparathyroidism ◽  
Bone Disorder ◽  
Brown Tumors ◽  
Stage Renal Disease ◽  
End Stage

Multiple brown tumors represent a rare variant of osteitis fibrosa cystica. Brown tumors are associated with primary, secondary, or tertiary hyperparathyroidism. Brown tumors have been reported in patients with chronic kidney disease resulting in mineral and bone disorders. Chronic kidney disease resulting in mineral and bone disorder is a result of increased osteoclast activity and excessive production of parathormone due to parathyroid gland hyperactivity. Brown tumors are frequently overlooked in patients with end-stage renal disease since calcimimetics and vitamin D analogs were introduced as pharmacological therapy for secondary hyperparathyroidism. We present a case of a 79 year-old pre-dialysis woman, with multiple brown tumors secondary to a parathyroid adenoma despite being treated with cinacalcet for secondary hyperparathyroidism. In addition, we review the corresponding literature.

Acid-Base and Electrolyte Managements in Chronic Kidney Disease and End-Stage Renal Disease: Case-Based Discussion

2018 ◽  
Vol 45 (1-3) ◽  
pp. 179-186 ◽  
Author(s):  
Jing Lin ◽  
Zhen Cheng ◽  
Xiaoqiang Ding ◽  
Qi Qian
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Treatment Options ◽  
Management Plan ◽  
Acid Base ◽  
Body Of Knowledge ◽  
Current State ◽  
Disease Case ◽  
Stage Renal Disease ◽  
End Stage

Acid-base and electrolyte alterations are common in patients with chronic kidney disease (CKD) and end-stage kidney failure (ESRD). The alterations become more complex as CKD advances to ESRD, leading to morbidity and mortality. Three cases are presented illustrating some key prototypic features in CKD and ESRD. Each is accompanied by discussion of pathophysiology, diagnosis, and treatment options. Newer investigational results are integrated into the existing body of knowledge. Although rigorous assessment of various dialysis prescriptions is scanty, in its current state, instituting a well thought-out, multi-pronged management plan to minimize CKD/ESRD and dialysis-related electrolyte and acid-base disruptions is appropriate. There is a pressing need for prospective interventional trials in the future.

The effect of sodium zirconium cyclosilicate on acid-base balance in chronic kidney disease

2021 ◽  
Author(s):  
Daisuke Mori ◽  
Yuta Namiki ◽  
Ayaka Sugimachi ◽  
Manabu Kado ◽  
Shinjiro Tamai ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Acid Base Balance ◽  
Acid Base ◽  
Sodium Zirconium ◽  
Base Balance ◽  
Sodium Zirconium Cyclosilicate

A rare case of primary hyperaldosteronism associated with chronic kidney disease-difficulties in diagnosis and treatment

2019 ◽  
Author(s):  
Letiţia Leuştean ◽  
Ginuţa Marcela Bălineanu ◽  
Cosmina Rimbu ◽  
Anamaria Hrişcă ◽  
Voroneanu Elena Luminiţa ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Rare Case ◽  
Primary Hyperaldosteronism ◽  
Diagnosis And Treatment
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