Fast Five Quiz: Chronic Kidney Disease Complications

A. Brent Alper, Jr, MD, MPH


June 05, 2020

In most patients with CKD, hyperkalemia does not develop until the glomerular filtration rate declines to < 0-25 mL/min/1.73 m2. At that point, the kidneys' ability to excrete potassium is impaired. A potassium-rich diet or low serum aldosterone levels may hasten the development of hyperkalemia in patients with CKD.

Hypokalemia is not commonly seen in patients with CKD, but it may develop in patients with extremely poor intake of potassium, gastrointestinal or urinary loss of potassium, or diarrhea. Use of diuretics may also contribute to the development of hypokalemia.

Metabolic acidosis has been shown to have negative effects on protein balance. The effects of this may include:

  • Negative nitrogen balance

  • Increased protein degradation

  • Increased essential amino acid oxidation

  • Reduced albumin synthesis

  • Poor adaptation to a low-protein diet

Metabolic acidosis is usually characterized by a mixture of normal anion gap and increased anion gap. Increased anion gap is typically seen in patients with stage 5 CKD, with the anion gap usually ≤ 20 mEq/L.

Learn more about the effects of CKD.


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