electrolyte imbalance in ckd patients

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@ IJTSRD | Available Online @ www ISSN No: 245 Inte R Electrolyt Suraj Ku Dialysis Technologis ABSTRACT The primary function of the kidney i fluid and electrolyte homeostasis. Each d must excrete 1500 ml of water and ingested sodium, potassium, mag phosphate. The kidney also plays a calcium homeostasis. Of the total numb in intensive care 3–25% will develo failure and patients with chronic rena frequently present for surgery. The t renal dysfunction may themselves caus in fluid and electrolyte homeostasis, p use of diuretics and renal replacement of normal renal function may lead to ma fluid and sodium balance. Volume stat will be required in patients with rena because they are at risk of both hypo hypervolaemia. Loss of renal function retention of potassium and magnesium systemic and cardiovascular consequen cardio respiratory compromise and cardiac dysrhythmias. Hypocalcaemia w reduced renal calcitriol production a retention. The identification of fluid a imbalances and the management significant changes are required when tr with renal dysfunction on an intensive who present for anaesthesia. Keywords: calcium, dysfunction, electr fluid, kidney, magnesium, potassium, ren INTRODUCTION Chronic kidney disease (CKD) causes d regulating water homeostasis because glomerular filtration rate (GFR)1. Volum highly prevalent in patients with CKD 30% increase in extracellular fluid can w.ijtsrd.com | Volume – 2 | Issue – 5 | Jul-Aug 56 - 6470 | www.ijtsrd.com | Volum ernational Journal of Trend in Sc Research and Development (IJT International Open Access Journ te Imbalance in CKD Patients umar Singh, Hulsi Sahu, Atul Verma st, Pt. Jawahar Lal Nehru Memorial Medical Col Raipur, Chhattisgarh, India is to maintain day the kidney d any excess gnesium and a key role in ber of patients op acute renal al disease will treatments for se disturbance particularly the therapy. Loss ajor changes in tus assessment al dysfunction ovolaemia and n will lead to m with serious nces including collapse and will result from and phosphate and electrolyte of clinically reating patients e care unit or rolyte, failure, nal, sodium dysfunction in of a reduced me overload is and a 10% to n be detected, even in the absence of overt e homeostasis resulted in hy imbalance and edema. Volu associated with CKD progres disease (CVD) related mo Diuretics are essential in treat pressure control, prevention urine amount regulation However, several studies h outcomes of diuretic usag mortality, and hospitalization i acute kidney injury (AKI), l significant effect on renal r dialysis, or mortality In CKD, diuretic usage in correction o not been thoroughly studied. Sodium imbalance could be usage, particularly in pat ients ability of kidneys to r concentration becomes impa progressing2. Hyponatremia c of fluid overload or a consequ these patients. Various epidem documented an association bet increased mortality from di overload and diuretic usage, s failure (CHF) and liver Recently, Kovesdy et al. disc and higher serum sodium lev higher mortality in patients wi CHF and liver disease22, but degree of diuretic usage were unique disease characteristic sodium imbalance, hyponatrem indicator in patients with CKD study was to determine whethe 2018 Page: 232 me - 2 | Issue 5 cientific TSRD) nal llege, edema2. The disorder in ypertension, electrolyte ume overload has been ssion and cardiovascular orbidity or mortality3. ting fluid balance, blood n of hyperkalemia and in CKD population. have reported negative ge on renal function, in patients with heart. In loop diuretics exert no recovery, the need for , the long-term effect of of volume overload has e secondary to diuretic with CKD, because the regulate dilution and aired as renal disease could be a consequence ence of diuretic usage in miological studies have tween hyponatremia and iseases involving fluid such as congestive heart cirrhosis17,18,19,20,21. covered that both lower vels are associated with ith CKD, independent of t renal outcome and the not reported. Due to the that are susceptible to mia could be prognostic D. Thus, the aim of our er diuretic usage and the

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The primary function of the kidney is to maintain fluid and electrolyte homeostasis. Each day the kidney must excrete 1500 ml of water and any excess ingested sodium, potassium, magnesium and phosphate. The kidney also plays a key role in calcium homeostasis. Of the total number of patients in intensive care 325 will develop acute renal failure and patients with chronic renal disease will frequently present for surgery. The treatments for renal dysfunction may themselves cause disturbance in fluid and electrolyte homeostasis, particularly the use of diuretics and renal replacement therapy. Loss of normal renal function may lead to major changes in fluid and sodium balance. Volume status assessment will be required in patients with renal dysfunction because they are at risk of both hypovolaemia and hypervolaemia. Loss of renal function will lead to retention of potassium and magnesium with serious systemic and cardiovascular consequences including cardio respiratory compromise and collapse and cardiac dysrhythmias. Hypocalcaemia will result from reduced renal calcitriol production and phosphate retention. The identification of fluid and electrolyte imbalances and the management of clinically significant changes are required when treating patients with renal dysfunction on an intensive care unit or who present for anaesthesia. Suraj Kumar Singh | Hulsi Sahu | Atul Verma "Electrolyte Imbalance in CKD Patients" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-2 | Issue-5 , August 2018, URL: https://www.ijtsrd.com/papers/ijtsrd15802.pdf Paper URL: http://www.ijtsrd.com/other-scientific-research-area/other/15802/electrolyte-imbalance-in-ckd-patients/suraj-kumar-singh

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Page 1: Electrolyte Imbalance in CKD Patients

@ IJTSRD | Available Online @ www.ijtsrd.com

ISSN No: 2456

InternationalResearch

Electrolyte Imbalance iSuraj Kumar Singh

Dialysis Technologist

ABSTRACT The primary function of the kidney is to maintain fluid and electrolyte homeostasis. Each day the kidney must excrete 1500 ml of water and any excess ingested sodium, potassium, magnesium and phosphate. The kidney also plays a key role in calcium homeostasis. Of the total number of patients in intensive care 3–25% will develop acute renal failure and patients with chronic renal disease will frequently present for surgery. The treatments for renal dysfunction may themselves cause disturbance in fluid and electrolyte homeostasis, particularly the use of diuretics and renal replacement therapy. Loss of normal renal function may lead to major changes in fluid and sodium balance. Volume status assessment will be required in patients with renal dysfunction because they are at risk of both hypovolaemia and hypervolaemia. Loss of renal function will lead to retention of potassium and magnesium with serious systemic and cardiovascular consequences including cardio respiratory compromise and collapse and cardiac dysrhythmias. Hypocalcaemia will result from reduced renal calcitriol production and phosphate retention. The identification of fluid and electrolyte imbalances and the management of clinically significant changes are required when treating patients with renal dysfunction on an intensive care unit or who present for anaesthesia.

Keywords: calcium, dysfunction, electrolyte, failure, fluid, kidney, magnesium, potassium, renal, sodium

INTRODUCTION Chronic kidney disease (CKD) causes dysfunction in regulating water homeostasis because of a reduced glomerular filtration rate (GFR)1. Volume overload is highly prevalent in patients with CKD and a 10% to 30% increase in extracellular fluid can be detected,

| Available Online @ www.ijtsrd.com | Volume – 2 | Issue – 5 | Jul-Aug

ISSN No: 2456 - 6470 | www.ijtsrd.com | Volume

International Journal of Trend in Scientific Research and Development (IJTSRD)

International Open Access Journal

Electrolyte Imbalance in CKD Patients

Suraj Kumar Singh, Hulsi Sahu, Atul Verma

ialysis Technologist, Pt. Jawahar Lal Nehru Memorial Medical CollegeRaipur, Chhattisgarh, India

The primary function of the kidney is to maintain fluid and electrolyte homeostasis. Each day the kidney must excrete 1500 ml of water and any excess ingested sodium, potassium, magnesium and phosphate. The kidney also plays a key role in

is. Of the total number of patients 25% will develop acute renal

failure and patients with chronic renal disease will frequently present for surgery. The treatments for renal dysfunction may themselves cause disturbance

ctrolyte homeostasis, particularly the use of diuretics and renal replacement therapy. Loss of normal renal function may lead to major changes in fluid and sodium balance. Volume status assessment will be required in patients with renal dysfunction

they are at risk of both hypovolaemia and hypervolaemia. Loss of renal function will lead to retention of potassium and magnesium with serious systemic and cardiovascular consequences including

compromise and collapse and thmias. Hypocalcaemia will result from

reduced renal calcitriol production and phosphate retention. The identification of fluid and electrolyte imbalances and the management of clinically significant changes are required when treating patients

ysfunction on an intensive care unit or

calcium, dysfunction, electrolyte, failure, fluid, kidney, magnesium, potassium, renal, sodium

Chronic kidney disease (CKD) causes dysfunction in regulating water homeostasis because of a reduced

. Volume overload is highly prevalent in patients with CKD and a 10% to 30% increase in extracellular fluid can be detected,

even in the absence of overt edemahomeostasis resulted in hypertension, electrolyte imbalance and edema. Volume overload has been associated with CKD progression and cardiovascular disease (CVD) related morbidity or mortalityDiuretics are essential in treating fluid balance, blood pressure control, prevention of hyperkalemia urine amount regulation in CKD population. However, several studies have reported negative outcomes of diuretic usage on renal function, mortality, and hospitalization in patients with heart. In acute kidney injury (AKI), loop diuretics exert no significant effect on renal recovery, the need for dialysis, or mortality In CKD, the longdiuretic usage in correction of volume overload has not been thoroughly studied. Sodium imbalance could be secondary to diuretic usage, particularly in patients with CKD, because the ability of kidneys to regulate dilution and concentration becomes impaired as renal disease progressing2. Hyponatremia could be a consequence of fluid overload or a consequence of diuretic usage in these patients. Various epidemiological studies have documented an association betweincreased mortality from diseases involving fluid overload and diuretic usage, such as congestive heart failure (CHF) and liver cirrhosisRecently, Kovesdy et al. discovered that both lower and higher serum sodium levels are associated with higher mortality in patients with CKD, independent of CHF and liver disease22, but rendegree of diuretic usage were not reported. Due to the unique disease characteristic that are susceptible to sodium imbalance, hyponatremia could be prognostic indicator in patients with CKD. Thus, the aim of our study was to determine whether diuretic usage and the

2018 Page: 232

6470 | www.ijtsrd.com | Volume - 2 | Issue – 5

Scientific (IJTSRD)

International Open Access Journal

Pt. Jawahar Lal Nehru Memorial Medical College,

even in the absence of overt edema2. The disorder in homeostasis resulted in hypertension, electrolyte

Volume overload has been associated with CKD progression and cardiovascular disease (CVD) related morbidity or mortality3. Diuretics are essential in treating fluid balance, blood pressure control, prevention of hyperkalemia and urine amount regulation in CKD population. However, several studies have reported negative outcomes of diuretic usage on renal function, mortality, and hospitalization in patients with heart. In acute kidney injury (AKI), loop diuretics exert no

icant effect on renal recovery, the need for dialysis, or mortality In CKD, the long-term effect of diuretic usage in correction of volume overload has

Sodium imbalance could be secondary to diuretic ients with CKD, because the

ability of kidneys to regulate dilution and concentration becomes impaired as renal disease

. Hyponatremia could be a consequence of fluid overload or a consequence of diuretic usage in these patients. Various epidemiological studies have documented an association between hyponatremia and increased mortality from diseases involving fluid overload and diuretic usage, such as congestive heart failure (CHF) and liver cirrhosis17,18,19,20,21.

et al. discovered that both lower and higher serum sodium levels are associated with higher mortality in patients with CKD, independent of

, but renal outcome and the degree of diuretic usage were not reported. Due to the unique disease characteristic that are susceptible to sodium imbalance, hyponatremia could be prognostic indicator in patients with CKD. Thus, the aim of our

hether diuretic usage and the

Page 2: Electrolyte Imbalance in CKD Patients

International Journal of Trend in Scientific Research and Development (IJTSRD) ISSN: 2456-6470

@ IJTSRD | Available Online @ www.ijtsrd.com | Volume – 2 | Issue – 5 | Jul-Aug 2018 Page: 233

related hyponatremia are associated with fluid imbalance and are predictive of adverse clinical outcomes, including renal outcomes, in patients with CKD. AIMS AND OBJECTIVES: To determine the prevalence of malnutrition

among CKD patient on hemodialysis. To determine the impact of demographic

socioeconomic factors on malnutrition indicators. To determine the prevalence of

chronic kidney disease complications. To evaluate the diet & fluid

compliance among hemodialysis patients. And to clarify the correlation between dietary

intake and malnutrition among hemodialysis patients.

MATERIALS AND METHODS Location of the study The hospital based study was carried out at the hemodialysis unit of DR. B. R. A. Memorial Hospital Raipur , with the purpose to observe and undertake the protocol followed in the hospital to assess the nutritional status of the patients visiting for hemodialysis and different wards for the treatment of chief complaints and associated co morbidities. SAMPLE SIZE:- A convenient sample of 50 adult hemodialysis patients from both sexes was selected for the study. STUDY SETTING The study was conducted at the hemodialysis unit at Al-Shifa hospital, in Gaza strip, which is considered the dialysis center in Dr. B. R. A. Memorial hospital raipur with 4 machines and more than 100 patients. STUDY POPULATION All hemodialysis patients from both gender diagnosed as an ESRD on hemodialysis for more than six months. Eligibility Criteria 1 Inclusion criteria:- Patients with ESRD from both gender aged 19-59

years. On regular hemodialysis for at least six months or

more.

2 Exclusion criteria:- Patients with other types of acute illness, such as

pneumonia, acute myocardial infarction or septicemia.

Patients with depression. Patients <19 and >59 years old. Patients on hemodialysis for <6 months. Collection of data Demographic and socioeconomic data Data regarding socioeconomic status like occupation, marital status, education, family type, family size and monthly family income was collected by interviewing the subjects. Questionnaire interview Face to face structured interviews was used to collect data from individuals. Most questions are one of two types: the multiple choice question which offers several fixed alternatives and yes or no question which offers a dichotomous choice. The interviewer explained to all individuals the importance, aim and purpose of the research study. Also all questions were ideally asked in the same way during the data collection to achieve a high degree of validity and reliability. Diet and fluid compliance data Also, the following data concerning diet and fluid compliance was collected from patients files and by using questionnaire interview: using of diet regimen, fluid intake, average weight change between hemodialysis sessions (kg) in the last two months ...etc.

Figure: Showing Distribution of the study

population by serum potassium level

Page 3: Electrolyte Imbalance in CKD Patients

International Journal of Trend in Scientific Research and Development (IJTSRD) ISSN: 2456-6470

@ IJTSRD | Available Online @ www.ijtsrd.com | Volume – 2 | Issue – 5 | Jul-Aug 2018 Page: 234

Table 5: Distribution of the study population by biochemical indicators of CKD associated bone disease

Variable patient Frequency (50)

Percentage (100%)

Total calcium (mg/dL)

Normal (8.4-9.5 mg/dL) Hypocalcemia Males hypocalcemia Females hypocalcemia

14 36 23 13

28.0 72.0 46.0 26.0

M±SD = (7.83±1.05 mg/dL) Phosphorous (mg/dL)

Normal (3.5-5.5 mg/dL) Hyperphosphatemia Hypophosphatemia Males hypophosphatemia Females hypophosphatemia

14 0 36 20 16

28.0 72.0 40.0 32.0

M±SD= (3.16±0.73 mg/dL)

Figure: Showing Biochemical indicators of CKD- associated bone disease( Hypophosphatemia and

Hypocalcemia)

Table 7: Distribution of the study population by blood pressure (mmHg) and serum sodium (mEq/L) variables

Variable Frequency (50)

Percentage (100%)

Blood pressure (mmHg)

Normal Stage one hypertension Stage two hypertension Stagethree hypertension HTN (males) HTN (females)

14 19 10 7 26 10

28.0 38.0 20.0 14.0 52.0 20.0

Serum Sodium level (mEq/L)

Normal sodium (135-145mEq/L) Hypernatremia Hyponatremia

17 01 32

34.0 2.0 64.0

M±SD = (131.14±7.32 mEq/L)

Page 4: Electrolyte Imbalance in CKD Patients

International Journal of Trend in Scientific Research and Development (IJTSRD) ISSN: 2456-6470

@ IJTSRD | Available Online @ www.ijtsrd.com | Volume – 2 | Issue – 5 | Jul-Aug 2018 Page: 235

Figure : Distribution of the study population by blood pressure (mmHg) and serum sodium (mEq/L)

variables CONCLUSIONS AND RECOMMENDATIONS Malnutrition is common among hemodialysis patients at Dr. B.R.A. Memorial Hospital Raipur and closely related to morbidity and mortality. Approximately two thirds of the patients showed a

biochemical malnutrition indicators, these include: A. Hypoalbuminemia (58.0%), B. Low predialysis serum creatinine level (64.0%), C. Low serum cholesterol level (84.0%), D. And 60% of the patients had BMI less than the

recommended BMI (23.8 kg/m²) for hemodialysis patients.

There was a marked increase in the prevalence of

CKD complications among hemodialysis patients at DR. B. R. A. Memorial Hospital:

A. Anemia – male – 62.0% - female – 38.0% B. Hypertension (72.0%), C. High turnover bone disease –hypocalcaemia-

72.0% - hypophosphatemia – 72.0% D. Hyperkalemia (20.0%), E. Diabetes mellitus (36%). And the presence of this co-morbidity has a significant adverse impact on patients survival. There was a significant positive correlation

between patients age (yrs), marital status, and monthly income (NIS) with BMI. The data suggests that demographic socioeconomic factors could contribute to a higher percentage of malnutrition.

There was a significant negative correlation between number of visits to ER and the number of

admission days to hospitals over a year with serum albumin level, and BMI. The data suggests that the patients are at a high risk of morbidity and mortality.

There were a significant positive correlations between dietary protein, phosphorous, potassium intake with serum albumin level, serum phosphorous level, serum potassium level respectively. Our results showed that, hemodialysis patients need to decrease consumption of (phosphorous, potassium rich foods) and to increase dietary protein intake, to improve their nutritional status and to reduce CKD complications.

Gastrointestinal symptoms lead to inadequate food intake and may interfere significantly with the patients nutritional status.

The majority (56.0%) of hemodialysis patients didn’t have any diet regimen and about (44.0%) of patients deviated from their fluid restrictions.

ABBREVIATIONS:- UPS Proteasome-ubiquitin system CKD Chronic kidney disease ESRD End-stage renal disease HBV High biological value IS Indoxyl sulfate pCS p-Cresyl sulphate HCl Hydrogen chloride H2SO4 Sulfuric acid H3PO4 Phosphoric acids NaHCO3 Sodium bicarbonate TWEAK TNF-related weak inducer of apoptosis IL-1 Interleukin-1 IL-6 Interleukin-6