Chronic Kidney Disease (CKD)

Epidemiology

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Etiology

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    • xxx
  • Toxin
    • Cadmium (see Cadmium, [[Cadmium]]), [[Cadmium]])
  • Other
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Physiology

Potential Mechanisms Contributing to Development of Pulmonary Hypertension in ESRD

  • Pulmonary vasoconstriction (due to hormonal or metabolic derangements), increased CO (due to AV fistula and anemia), diastolic and systolic CHF (increased frequency in CKD patients), and fluid overload

Diagnosis

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Clinical Manifestations

Pulmonary Manifestations

  • Pulmonary Hypertension (see Pulmonary Hypertension, [[Pulmonary Hypertension]]): reported in 40% of ESRD patients on chronic HD

Hematologic Manifestations

  • Anemia (see Anemia, [[Anemia]])

Neurologic Manifestations

Renal Manifestations

Metabolic Acidosis

  • Physiology
    • Early Chronic Kidney Disease: greater dysfunction in acid excretion than acid anion excretion -> typically have non-anion gap metabolic acidosis (NAGMA) (see Non-Anion Gap Metabolic Acidosis, [[Non-Anion Gap Metabolic Acidosis]]) or anion gap metabolic acidosis (AGMA) (see Metabolic Acidosis-Elevated Anion Gap, [[Metabolic Acidosis-Elevated Anion Gap]]) with delta anion gap/delta bicarbonate ratio <1
    • Later Chronic Kidney Disease: typically have anion gap metabolic acidosis (AGMA) (see Metabolic Acidosis-Elevated Anion Gap, [[Metabolic Acidosis-Elevated Anion Gap]]) with delta anion gap/delta bicarbonate ratio >1

Mildly Elevated Osmolal Gap (see Serum Osmolality, [[Serum Osmolality]])

  • Epidemiology: occurs in CKD with GFR <10 mL/min, without regular hemodialysis
  • Physiology: due to presence of osmotically-active solute(s)
    • Urea
    • Unidentified Small Solutes: these are generally cleared with hemodialysis (and are not present in AKI)
  • Diagnosis: typically results in small osmolal gap (<15-20 mOsm/L)

Other Manifestations

  • Uremic Symptoms
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Treatment

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References

  • Yigla M, Nakhoul F, Sabag A, et al. Pulmonary hypertension in patients with end-stage renal disease. Chest 2003;123:1577-82
  • Nakhoul F, Yigla M, Gilman R, Reisner SA, Abassi Z. The pathogenesis of pulmonary hypertension in haemodialysis patients via arterio-venous access. Nephrol Dial Transplant 2005;20:1686-92