Continuing Medical Education

Important complications of chronic kidney disease

I van der Walt, C R Swanepoel, B Mahala, A M Meyers


The complications of chronic kidney disease (CKD) are dyslipidaemia, hyperkalaemia, metabolic acidosis, anaemia, and bone and mineral
disorders. Dyslipidaemia may be treated with low-density lipoprotein-lowering agents. Statins are ineffective in stages 4 and 5 CKD, but are
indicated for preventing the progression of disease in the earlier stages. Chronic acidosis has recently been shown to be a risk factor in the
progression of CKD renal dysfunction. Therefore, treatment is mandatory. Practically, this should consist of 1 - 2 heaped teaspoons of sodium
bicarbonate 2 - 3 times per day, which is an inexpensive and safe therapy that does not raise the blood pressure in spite of the increased sodium
level. Target levels of haemoglobin, according to international guidelines, are between 10 g/dL and 12 g/dL. The serum phosphate level is raised
in stage 4 CKD, and especially in stage 5 CKD, which is associated with coronary carotid and other vascular calcifications and may result in
ischaemic heart disease, myocardial infarction and stroke. A raised parathyroid hormone level (secondary hyperparathyroidism) is also a major
risk factor for cardiovascular disease and is associated with increased hypertension and resistance to the treatment of CKD-associated anaemia.

Authors' affiliations

I van der Walt, Netcare Jakaranda Hospital, Pretoria, South Africa

C R Swanepoel, Division of Nephrology and Hypertension, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

B Mahala, Netcare Waterfall City Private Hospital, Johannesburg, South Africa

A M Meyers, Donald Gordon Medical Centre, Klerksdorp Hospital, and National Kidney Foundation of South Africa, Johannesburg, South Africa

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Chronic kidney disease

Cite this article

South African Medical Journal 2015;105(4):321. DOI:10.7196/SAMJ.9536

Article History

Date submitted: 2015-02-24
Date published: 2015-03-07

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