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Intravenous sodium bicarbonate is contraindicated in patients who are losing chloride, such as by vomiting. [9]Because of its sodium content, intravenous sodium bicarbonate should be used with great care, if at all, in patients with congestive heart failure and severe chronic kidney disease, where low sodium intake is strongly indicated to prevent sodium retention. [9]
In the standard 3x/week hemodialysis schedule a URR of 65% is considered the minimum acceptable dose, corresponding to a minimum Kt/V of 1.2 [3] When dialysis is given more frequently than three times a week, the minimum acceptable URR is lower; because more dialysis treatments are given over the week, the dose of dialysis for each treatment ...
All people with a GFR <60 mL/min/1.73 m 2 for 3 months are defined as having chronic kidney disease. [59] Protein in the urine is an independent marker for the worsening of kidney function and cardiovascular disease. Hence, British guidelines append the letter "P" to the stage of chronic kidney disease if protein loss is significant. [60]
The mainstay of treatment is large quantities of intravenous fluids. [3] Other treatments may include dialysis or hemofiltration in more severe cases. [4] [10] Once urine output is established, sodium bicarbonate and mannitol are commonly used but they are poorly supported by the evidence. [3] [4] Outcomes are generally good if treated early. [3]
The CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) formula was first published in May 2009. It was developed in an effort to create a formula more accurate than the MDRD formula, especially when actual GFR is greater than 60 mL/min per 1.73 m 2. This is the formula currently recommended by NICE in the UK. [27]
CKD–MBD broadens the "old" concept of "renal osteodystrophy", which now should be restricted to describing the bone pathology associated with CKD. [1] [2] Thus, renal osteodystrophy is currently considered one measure of the skeletal component of the systemic disorder of CKD–MBD that is quantifiable by histomorphometry of bone biopsy.
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