CKD, Mbbs Lecture
CKD, Mbbs Lecture
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• Sodium bicarbonate
– Maintain serum bicarbonate > 22 meq/L
– 0.5-1.0 meq/kg per day
– Watch for sodium loading
• Volume expansion
• HTN
Mineral metabolism
• Calcium and phosphate metabolism
abnormalities associated with:
– Renal osteodystrophy
– Calciphylaxis and vascular calcification
• 14 of 16 ESRD/HD pts (20-30 yrs) had
calcification on CT scan
• 3 of 60 in the control group
• Give phosphate binders- Caco3, AlHO,
Savelemaer, Lanthonum Carbonate
• Vit D analog- Calcitriol
Dyslipidemia
• Abnormalities in the lipid profile
– Triglycerides
– Total cholesterol
• NCEP recommends reducing lipid levels in
high-risk populations
• Targets for lipid-lowering therapy considered
the same as those for the secondary
prevention of CV disease
Nutrition
• Think about uremia
– Catabolic state
– Anorexia
– Decreased protein intake
CV disease
• 70% of HD patients have concomitant CV
disease