CKD COMPLICATIONS
HYPERKALEMIA
Usually show s/s when
K > 7 mmol/L in CKD pts
 Muscle weakness or paralysis
 ECG abnormalities
 Cardiac conduction abnormalities
 Cardiac arrhythmia
TREATMENT
If pt is symptomatic or if
K > 6.5 mmol/L  ER
 IV calcium to antagonize
membrane action
o Protect cardiac tissue
 IV infusion insulin/glucose to
drive extracellular potassium
into cell
 Remove excess K+
o K+ binders, diuretics (loop,
thiazide), dialysis
o Sodium and calcium
polystyrene 15-30 mg po
3x/wk to daily
 Stop meds increasing K+
o RAAS inhibitors, NSAIDs
Miriam Ahmed
METABOLIC ACIDOSIS
HYPERURICEMIA
Uric acid > 430 mmol/L (males)
> 360 mmol/L (females)
TREATMENT
 Decrease dietary acid load
(less protein, more fruits/veggies)
 Sodium bicarbonate
ACUTE ATTACK PROPYLYAXIS 325-650 mg po BID/TID
xanthine oxidase inhibitors o Used to maintain serum
bicarbonate within normal range
 DO NOT USE NSAIDs, (24-30 mmol/L)
even just PRN  Allopurinol 100-400 mg od  Calcium citrate, acetate,
 Colchicine 0.3-0.6 mg o Adjust dose based on eGFR carbonate also help increase
BID-TID PRN (<30 mL/min) due to
accumulation of oxypurinol
bicarbonate
o Adjust dose based o Not as efficient as sodium bicarb
o Causes mobilization of uric
on eGFR
acid from tissue deposit   Dialysis corrects metabolic
 Prednisone 25-50 mg increase risk of gout attacks acidosis through HD dialysate
po daily x 5-7 days when initiating solution, or PD solution
o No taper needed  Use colchicine/ containing sodium bicarbonate
prednisone for 5-7 d
 Febuxostat 40-80 mg po od
o For pts intolerant to
alopurinol
PROTEINURIA: ACEI/ARBs – used regardless of pt’s BP, if pt can tolerate it (BP, SCr or K+)
 No eGFR cutoff to which patient won’t benefit from ACEI/ARB therapy but be more cautious w/ CKD 4-5
 Check SCr and K+ within 1-2 weeks of starting or uptitrating ACEI/ARB
o May need to stop or decrease ACEI/ARB if SCr increases by > 30% or K+ > 6
 SICK DAY MANAGEMENT: hold ACEI/ARB during period of volume depletion