PATTERNS AND PREVALENCE OF DYSELECTROLYTEMIA IN NON-DIALYSIS CHRONIC KIDNEY DISEASE OUTPATIENTS: A RETROSPECTIVE ANALYSIS FROM A TERTIARY CARE CENTER IN NORTH INDIA

Introduction:

Dyselectrolytemia is a frequent complication in chronic kidney disease (CKD) and can significantly impact clinical outcomes, particularly as the disease progresses. This study aims to evaluate the prevalence and patterns of dyselectrolytemia among non-dialysis CKD outpatients at a tertiary care center in North India.

Methods:

This retrospective study enrolled all non-dialysis CKD patients who attended Nephrology outpatient department between May 2024 and July 2024. The patients' serum levels of creatinine (eGFR calculation using CKD-EPI equation), electrolytes, and intact PTH levels were collected and analysed. Patients' comorbidities, basic disease, and medications been prescribed were also recorded.

Results:

In total 508 patients were enrolled, out of which, 198 patients (38.97%) were diabetic, 97 (19.2%) had CAD, and 41 (8%) were hypothyroid. The most common underlying kidney disease was chronic interstitial nephritis (37%), followed by diabetic kidney disease (34%), chronic glomerulonephritis (14%), and ADPKD (8%). In 10% patients, basic disease was unknown. Intact PTH levels were measured in 180 patients, with elevated levels observed in 139 (77%) cases.

Dyselectrolytemia was prevalent across all CKD stages (Table 1), with the most common abnormality being hyperkalemia (55%), followed by hypocalcemia (45%), hyperphosphatemia (36%), and hyponatremia (23%). Fifty-nine cases (11.6%) were found to have all electrolytes within normal limits (34 in CKD stage 2 and 21 in stage 4). Hyperkalemia was present in 67 (57%) patients in stage 3, 108 (60%) in stage 4, and 98 (81%) in stage 5ND CKD, showing a significant correlation with advancing CKD (p < 0.001). Hypocalcemia was detected in 49 (42%) patients in stage 3, 95 (53%) in stage 4, and 72 (59%) in stage 5ND CKD, also demonstrating significant correlation with CKD progression (p < 0.001). Hyperphosphatemia was noted in 22 (19%) patients in stage 3, 78 (44%) in stage 4, and 81 (67%) in stage 5ND CKD, with a highly significant association with advanced CKD (p < 0.001). Hyponatremia was observed in 35 (30%) patients in stage 3, 54 (30%) in stage 4, and 26 (21%) in stage 5ND CKD (p < 0.001).

RAAS inhibitors were prescribed in 239 (47%) patients, predominantly in CKD stages 3 and 4. Diuretics were prescribed to 229 (45%) patients, primarily in CKD stages 4 and 5ND. The use of these medications correlated with higher incidences of hyperkalemia and hyponatremia.

Conclusions:

Dyselectrolytemia is highly prevalent (88.4%) among non-dialysis CKD patients and becomes more pronounced with advancing stages. Hyperkalemia and hypocalcemia are particularly common and are significantly associated with the severity of CKD. The use of RAAS inhibitors and diuretics, contributes to the observed electrolyte imbalances. With this study, we want to reiterate the importance of regular electrolyte monitoring and personalised management strategies to mitigate the risks associated with dyselectrolytemia in CKD patients.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.