Electrolyte Dysregulation in Diabetic with Advanced Chronic Kidney Diseases (CKD): Comparative Analysis of CKD Stages 4 and 5

Asbar Tanjung, Riceina Javonda Lembagus Wirawan

Abstract


Background: Electrolyte imbalance is common in both diabetes mellitus (DM) and chronic kidney disease (CKD). While they may occur independently, their coexistence can exacerbate metabolic disturbances, thereby accelerating disease progression and impairing quality of life.

Objective: to investigates the differences in electrolyte profiles between patients with CKD stages 4 and 5 with DM.

Methods: A cross-sectional comparative design study was employed. A hundred participants (50 with CKD stage 4 and 50 with CKD stage 5 with DM) were recruited from a clinical laboratory during May to June 2024. Serum natrium, kalium, and chloride levels were measured alongside urea, creatinine, GFR, and glucose. The Mann-Whitney U test was applied to compare the electrolyte levels between these CKD stages.

Results: Of 100 participants, more men participating in this study (66% vs. 34%). Pre-elderly (45-59 y.o.) was the most predominant (61%), followed by elderly (>60 years,  20%), and adult (26-45 y.o., 19%). Both groups showed elevated urea, creatinine, and glucose levels with reduced GFR, confirming advanced CKD and DM. There was no significant difference in glucose level between stage 4 and stage 5. A significant difference (p=0.001) was observed in natrium levels, with stage 5 CKD patients exhibiting lower levels compared to those in stage 4. In contrast, kalium and chloride levels showed no significant difference (p=0.71 and p=0.81, respectively) in both groups.

Conclusion: This study highlights the specific vulnerability of natrium homeostasis in advanced CKD with diabetes. Natrium dysregulation observed in stage 5 CKD underscores the need for close monitoring and management of sodium levels in this population.


Keywords


Chronic kidney disease; diabetes mellitus; electrolytes; hypernatremia; renal function

References


  1. Jadoul M, Aoun M, Masimango Imani M. The major global burden of chronic kidney disease. Lancet Glob Health. 2024;12(3):e342-3. doi:10.1016/S2214-109X(24)00050-0
  2. Kovesdy CP. Epidemiology of chronic kidney disease: an update 2022. Kidney Int Suppl. 2022;12(1):7-11. doi:10.1016/j.kisu.2021.11.003
  3. Francis A, Harhay MN, Ong ACM, Tummalapalli SL, Ortiz A, Fogo AB, et al. Chronic kidney disease and the global public health agenda: an international consensus. Nat Rev Nephrol. 2024;20(7):473-85. doi:10.1038/s41581-024-00820-6
  4. Shahbazi F, Doosti-Irani A, Soltanian A, Poorolajal J. Global forecasting of chronic kidney disease mortality rates and numbers with the generalized additive model. BMC Nephrol. 2024;25(1):32. doi:10.1186/s12882-024-03449-y
  5. Stevens PE, Ahmed SB, Carrero JJ, Foster B, Francis A, Hall RK, et al. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int. 2024;105(4 Suppl):S117-314. doi:10.1016/j.kint.2024.01.015
  6. Chen TK, Hoenig MP, Nitsch D, Grams ME. Advances in the management of chronic kidney disease. BMJ. 2023;383:e074216. doi:10.1136/bmj-2023-074216
  7. Mallamaci F, Tripepi G. Risk factors of chronic kidney disease progression: between old and new concepts. J Clin Med. 2024;13(3):678. doi:10.3390/jcm13030678
  8. Burnier M, Damianaki A. Hypertension as cardiovascular risk factor in chronic kidney disease. Circ Res. 2023;132(8):1050-63. doi:10.1161/CIRCRESAHA.122.321786
  9. Webster AC, Nagler EV, Morton RL, Masson P. Chronic kidney disease. Lancet. 2017;389(10075):1238-52. doi:10.1016/S0140-6736(16)32064-5
  10. Tao P, Chien CW, Liu C, Zheng J, Sun D, Zeng J, et al. Diabetes mellitus is a risk factor for incident chronic kidney disease: a nationwide cohort study. Heliyon. 2024;10(7):e28780. doi:10.1016/j.heliyon.2024.e28780
  11. de Boer IH, Khunti K, Sadusky T, Tuttle KR, Neumiller JJ, Rhee CM, et al. Diabetes management in chronic kidney disease: a consensus report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO). Diabetes Care. 2022;45(12):3075-90. doi:10.2337/dci22-0027
  12. Nicholas SB, Wright EE, Billings LK, Ambriz E, Gee P, Peeler T. Living with chronic kidney disease and type 2 diabetes mellitus: the patient and clinician perspective. Adv Ther. 2023;40(1):1-18. doi:10.1007/s12325-022-02325-9
  13. Kumar M, Dev S, Khalid MU, Siddenthi SM, Noman M, John C, et al. The bidirectional link between diabetes and kidney disease: mechanisms and management. Cureus. 2023;15(9):e45712. doi:10.7759/cureus.45712
  14. Eshetu B, Worede A, Fentie A, Chane E, Fetene G, Wondifraw H, et al. Assessment of electrolyte imbalance and associated factors among adult diabetic patients attending the University of Gondar Comprehensive Specialized Hospital, Ethiopia: a comparative cross-sectional study. Diabetes Metab Syndr Obes. 2023;16:1207-20. doi:10.2147/DMSO.S409678
  15. Dhondup T, Qian Q. Acid-base and electrolyte disorders in patients with and without chronic kidney disease: an update. Kidney Dis. 2017;3(4):136-48. doi:10.1159/000479802
  16. Karinda TUS, Sugeng CEC, Moeis ES. Gambaran komplikasi penyakit ginjal kronik non dialisis di Poliklinik Ginjal-Hipertensi RSUP Prof. Dr. R. D. Kandou periode Januari 2017 – Desember 2018. e-CliniC. 2019;7(2):1-6. doi:10.35790/ecl.v7i2.24306
  17. Behera BP. Comparative study of serum electrolytes Na+, K+, Ca++ in patients of chronic kidney disease in relation to its severity. Int J Pharm Pharm Sci. 2020;8(5):142-8. doi: https://doi.org/10.18203/2320-6012.ijrms20201924
  18. Lee HJ, Son YJ. Prevalence and associated factors of frailty and mortality in patients with end-stage renal disease undergoing hemodialysis: a systematic review and meta-analysis. Int J Environ Res Public Health. 2021;18(7):3471. doi:10.3390/ijerph18073471
  19. Timerga A, Kelta E, Kenenisa C, Zawdie B, Habte A, Haile K. Serum electrolytes disorder and its associated factors among adults admitted with metabolic syndrome in Jimma Medical Center, South West Ethiopia: facility based cross-sectional study. PLoS One. 2020;15(11):e0241486. doi:10.1371/journal.pone.0241486
  20. Khan RN, Saba F, Kausar SF, Siddiqui MH. Pattern of electrolyte imbalance in type 2 diabetes patients: experience from a tertiary care hospital. Pak J Med Sci. 2019;35(3):797-801. doi:10.12669/pjms.35.3.54
  21. Goia-Nishide K, Coregliano-Ring L, Rangel ÉB. Hyperkalemia in diabetes mellitus setting. Diseases. 2022;10(2):20. doi:10.3390/diseases10020020
  22. Murat S, Kaya H, Çavusoglu Y, Yilmaz MB. Hyperkalemia in chronic heart failure with renal dysfunction or diabetes mellitus: results from the TREAT-HF study. Turk Kardiyol Dern Ars. 2021;49(3):198-205. doi:10.5543/tkda.2021.75479
  23. Arzhan S, Lew SQ, Ing TS, Tzamaloukas AH, Unruh ML. Dysnatremias in chronic kidney disease: pathophysiology, manifestations, and treatment. Front Med. 2021;8:769387. doi:10.3389/fmed.2021.769387
  24. Levey AS, Eckardt KU, Tsukamoto Y, Levin A, Coresh J, Rossert J, et al. Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int. 2005;67(6):2089-100. doi:10.1111/j.1523-1755.2005.00365.x
  25. Hallan SI, Orth SR. The KDOQI 2002 classification of chronic kidney disease: for whom the bell tolls. Nephrol Dial Transplant. 2010;25(9):2832-6. doi:10.1093/ndt/gfq370
  26. Ellison DH. Treatment of disorders of sodium balance in chronic kidney disease. Clin J Am Soc Nephrol. 2018;13(2):310-20. doi:10.2215/CJN.09780917




DOI: https://doi.org/10.15850/ijihs.v13n2.4197

Article Metrics

Abstract view : 0 times



 

This Journal indexed by

                   

 


Creative Commons License
IJIHS is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License



View My Stats