Acid base and fluid electrolyte disturbances in Chronic Kidney Disease

The kidneys maintain homeostasis in the body avoiding significant alterations in the balance of fluid electrolyte or acid–base balance until the Glomerular filtration rates (GFR) declines to below 25 ml/min due to a series of adaptive changes, both Renal and extra renal. With progressive decline in renal function these mechanisms are overwhelmed resulting in disturbances in water metabolism contributing to hyponatremia and hypernatremia. The altered regulation of sodium transport causes disturbed volume status including volume overload and depletion. The incidence of Hyperkelemia and metabolic acidosis is more frequent in Chronic Kidney Disease (CKD) with GFR below 10 ml/min. In this review article we will attempt to review the renal and extra renal adaptation mechanisms maintaining fluid, electrolyte and acid base balance in CKD along with factors which cause failure of these mechanisms. The article will also highlight the common fluid electrolyte and acid base disorders in CKD and their treatment.