TY - JOUR
T1 - Treatment of Disorders of Sodium Balance in Chronic Kidney Disease
AU - Ellison, David H.
N1 - Publisher Copyright:
© 2017 National Kidney Foundation, Inc.
PY - 2017/9/1
Y1 - 2017/9/1
N2 - Extracellular fluid volume expansion is nearly universal in patients with CKD. Such volume expansion has features similar to the syndrome of heart failure with preserved ejection fraction, which not only leads to symptoms but can also lead to further organ damage. Unique treatment challenges are present in this patient population, including low glomerular filtration, which limits sodium chloride filtration, intrinsic tubule predisposition to sodium chloride retention, and proteinuria. In addition, pharmacokinetic considerations alter the disposition of diuretics in patients with CKD and nephrotic syndrome. Maintaining extracellular fluid volume near to normal is often necessary for hypertension treatment in this population, but it may also help prevent progressive cardiovascular and kidney damage. Although powerful diuretics can often accomplish this goal, this often comes at a cost of competing adverse effects. An approach to reduce extracellular fluid volume while avoiding adverse effects, therefore, requires a nuanced yet aggressive therapeutic approach.
AB - Extracellular fluid volume expansion is nearly universal in patients with CKD. Such volume expansion has features similar to the syndrome of heart failure with preserved ejection fraction, which not only leads to symptoms but can also lead to further organ damage. Unique treatment challenges are present in this patient population, including low glomerular filtration, which limits sodium chloride filtration, intrinsic tubule predisposition to sodium chloride retention, and proteinuria. In addition, pharmacokinetic considerations alter the disposition of diuretics in patients with CKD and nephrotic syndrome. Maintaining extracellular fluid volume near to normal is often necessary for hypertension treatment in this population, but it may also help prevent progressive cardiovascular and kidney damage. Although powerful diuretics can often accomplish this goal, this often comes at a cost of competing adverse effects. An approach to reduce extracellular fluid volume while avoiding adverse effects, therefore, requires a nuanced yet aggressive therapeutic approach.
KW - Diuretics
KW - Extracellular fluid volume expansion
KW - Nephrotic syndrome
KW - Salt-sensitive hypertension
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U2 - 10.1053/j.ackd.2017.07.003
DO - 10.1053/j.ackd.2017.07.003
M3 - Review article
C2 - 29031361
AN - SCOPUS:85037057305
SN - 1548-5595
VL - 24
SP - 332
EP - 341
JO - Advances in Chronic Kidney Disease
JF - Advances in Chronic Kidney Disease
IS - 5
ER -