8 mg/dL

and albumin is 3.1 g/dL, then corrected Ca = 7.8 + (4 − 3.1) = 7.8 + 0.9 = 8.7 mg/dL In case of hyperphosphatemia is associated with kidney failure, phosphorus intake is restricted. Phosphorus intake has a close positive relation with protein intake. Accordingly, implementation mTOR inhibitor of low-protein diet is beneficial for phosphorus restriction. Milk products, liver, dried young sardine, smelts, or whole dried fish contain high phosphorus. Exercise buy eFT-508 Throughout all stages of CKD, overprescription of rest is unnecessary, although it is important to avoid overwork and to get sufficient sleep and good rest. Exercise plans should be tailored to fit an individual patient, carefully considering blood pressure, urinary protein, kidney function, and others. Smoking cessation Smoking is regarded as a serious risk factor for CKD progression and has a harmful INCB28060 supplier effect on general health. Alcohol intake No report is available on alcohol exerting an adverse influence on CKD. Generally, appropriate alcohol intake as expressed in ethanol is less than 20–30 mL/day in men (180 mL of Japanese sake) and less than 10–20 mL/day in women.”
“Table 23-1

Emergency treatment of hyperkalemia: CKD stage 3 and over Measures Effect Example of the treatment Ca gluconate, iv Cardiac protection Ca gluconate 10 mL, 5 min, iv Loop diuretics, iv Increase the urinary excretion Furosemide 20 mg + saline 20 mL NaHCO3 Shift into cells 7% NaHCO3 20 mL, iv Glucose-insulin Shift into cells 10 g of glucose with 1 unit insulin, div. No glucose if hyperglycemia Cation exchanger resin Removal 30 g, dissolved in 100 mL warm water, then given into rectum, and left for 1 h Hemodialysis Removal 3 h or longer

depending on the plasma K As CKD stage progresses, metabolic acidosis develops and serum potassium (K) increases. In case of severe hyperkalemia, ECG recording should be performed to evaluate the emergency. A hyperkalemic patient with abnormal ECG findings should be treated as emergency and be consulted with nephrologists thereafter. The causes of hyperkalemia in CKD are mainly due to drugs such as ACE inhibitors, ARBs, spironolactone, etc. and to excess of potassium-rich diet (Table 23-1). Hyperkalemia As CKD progresses in stage, acidosis and hyperkalemia are observed. Hyperkalemia is defined Celecoxib as serum potassium level greater than or equal to 5.5 mEq/L. Hyperkalemia greater than 7 mEq/L may potentially cause cardiac arrest and thus should be treated as emergency. If severe hyperkalemia is observed despite the absence of reduced kidney function, pseudohyperkalemia due to hemolysis of blood specimen or else is considered. Hyperkalemia is a risk for arrhythmia. In case of severe hyperkalemia emergency levels should be confirmed by ECG abnormalities such as tenting T wave, prolongation of PQ times followed by disappearance of P wave and widening of QRS complex.