Assessment of acid base and electrolyte status in patients with chronic kidney disease

Background: Chronic kidney disease (CKD) encompasses a spectrum of pathophysiologic processes associated with abnormal kidney function. The risk of worsening CKD is related with the GFR and the amount of albuminuria. Acid-base and electrolyte homeostasis is vital for proper functioning of numerous metabolic processes and organ functions and kidneys play a critical role in the maintenance and regulation of this homeostasis. Kidney diseases and dysfunction (chronic kidney disease, CKD) results in alterations of electrolyte and acid-base balances. Therefore, we aimed to assessment of Acid Base and Electrolyte Status in Patients with Chronic Kidney Disease for an early detection of CKD and to identify the factors associated with it. Methods: A Prospective observational study was conducted from Aug 2022 to July 2023 among all CKD patient of different stages and different etiology admitted in medicine and nephrology department of MBGH and associated hospital of R.N.T. Medical college Udaipur, Rajasthan. For albuminuria urine ACR was used. For acid base status (H+,PH, HCO) arterial blood gas analysis (ABG) was done as per standard protocol. Venous samples were taken for analysis of H, PH, HCO3 Na, K, CI. Ca, Mg, and Phosphorus. Urine sample sent for urinary cast and complete urine analysis. All data statistically analysed by SPSS version 17. P value <0.05 were considered as statistically significant. Results: This study found acidosis in 76.7% patients, in which Maximum 48.2% belongs to stage G5 followed by stage 4,stage G3b, 12.5% in each, 3.5% belongs to stage G3a. In acidosis Hypertension and diabetes was most responsible factor in 28 patient either independent or with combined effect. 5.3% were due to obstructive uropathy, 3.5% each were due to autoimmune and PCKD. Infectious cause were also associated with 3.5%. Hyperkalemia was found in 37.5% while 5.3% were hypokalemic. In hyperkalemia group maximum 25% patient was in stage G5 followed by G4(5.3%), G3B (5.3) in equal then in stage G3a(1.7%). In hypokalemia 3.5% belongs to stage G3b and 1.7% in stage G3a. in study hyponatremia was found in 19.4% patient and hypernatremia in 5.3%. Hypermagnesemia found in 25% patients and hypomagnesaemia in 5.3%. Conclusions: It is imperative to monitor hypertension, metabolic disorders (DM,etc.) and serum electrolytes concentration in renal dysfunction patients to slow the progression of CKD to end-stage renal disease (ESRD) and other serious complications because maximum patient in our study were in stage G5 and mostly caused by either hypertension or diabetes or both. Metabolic acidosis, hyperkalemia, hyponatremia, hypomagnesemia, hyperchloremia, hypocalcemia and hyperphosphatemia were the most common electrolytes imbalance in CKD.