Metabolic acidosis and hyperkalemia (higher than normal potassium level in the blood) are very common among end stage renal disease patients due to kidney functions of balancing water, electrolytes and acid-base are greatly disturbed.
Metabolic acidosis and end stage renal disease
Metabolic acidosis is due to excessive building up of acidic substances such as phosphoric acid, sulfuric acid, etc in the patients’ body due to dysfunction of renal filtration system. If there is just mild metabolic acidosis, patients can have no or few symptoms. However with the continuous progression of illness and gradual accumulation of metabolic wastes in the body, patients can have obvious symptoms and discomforts such as loss of appetite, nausea, vomiting, fatigue, long and deep breath, etc. These symptoms will develop when HCO3< 15mmol/L.
Renal disease patients with metabolic acidosis should have more alkaline foods such as most fruits and vegetables. Some foods such as hawthorn and tomatoes are typical alkaline foods though they taste acid.
Hyperkalemia and ESRD
When GFR falls below 20-25ml/min or even lower, renal functions of discharging potassium gradually declines and it is very easy for patients to develop hyperkalemia. Especially if patients have metabolic acidosis, infections, traumas, gastrointestinal bleeding, too much intake of potassium, etc.
Severe hyperkalemia (serum potassium is higher than 6.5mmol/L) has certain dangers and immediately treatment should be offered or the patient’s life might be threatened. High blood potassium that can not be controlled by medicines, along with creatinine level higher than 8 requires the start of dialysis.
Of cause in some conditions ESRD patients can also develop hypokalemia (low blood potassium) such as inadequate potassium intake, too much loss of potassium due to gastrointestinal reactions like nausea, vomiting, diarrhea as well as some diuretics that have the function of discharging potassium at the same time of relieving water and sodium retention.
However hyperkalemia is much more common in clinic, therefore renal failure patients should have regular check of blood potassium level and avoid or at least limit foods that are rich in potassium.
Common foods that are high-potassium: banana, spinach, yam, orange, etc.
Common foods that are low-potassium: onion, celery, tomatoes, cabbage, carrot, cucumber, apple, pear, etc.
Of cause, only proper diets is not enough for end stage renal disease patients because their kidney functions have been severely damaged. Effective and timely treatments should be received to help promote kidney functions so that metabolic acidosis and hyperkalemia can be cured from the root.
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