CKD or Chronic Renal failure

30 million people or 15% of US adults are estimated to

have CKD. (CDC data 2011-2014) i.e. 1 in 7 people

Most common risks = DM and HTN

Thiazide diuretics နံပါတ် ၃ အဆင့်ထိ

Loop diuretics ၄ အဆင့်နဲ့ အထက်

Hypocalcemia and hyperphosphatemia

decreased production of calcitriol (1,25 dihydroxyvitamin D) --> decreased intestinal absorption of calcium

reduced GFR --> inadequate excretion of phosphate

increased serum phosphate binds circulating calcium, forming insoluble calcium phosphate and further lowering serum calcium

Hypocalcemia and hyperphosphatemia stimulate release of PTH to maintain normal Ca2+ and PO4- levels , over time this results in parathyroid hyperplasia and secondary hyperparathyroidism

The resulting effects on bone, known as renal osteodystrophy, include pain and increased risk of fracture.

In some cases, chronic parathyroid stimulation leads to the development of autonomously functioning adenomas (tertiary hyperparathyroidism) with very high PTH levels and hypercalcemia

Mx

low-phosphate diet and/or phosphate binders (e.g calcium carbonate, calcium acetate, sevelamer) and supplementation of calcium and vitamin D

The most common complication associated with continuous ambulatory peritoneal dialysis (CAPD) is peritonitis.

Staphylococcus aureus is the most common cause. Others - Staph. epidermidis