Things that need to be monitored if you have a chronic kidney disease.

“Chronic kidney disease” or CKD is defined as lasting damage to kidneys that can get worse over time. If the damage is very bad, your kidneys may stop working. This is called kidney failure, or end-stage renal disease (ESRD). If your kidneys fail, you will need dialysis or a kidney transplant in order to live.

Thus, regular check-up and laboratory tests are required from CKD patients in order to determine their current health status. They have to check their creatinine level regularly and also they have to monitor their potassium, phosphorus, calcium, and sodium intake as any irregular among these would be dangerous.

1) Creatinine 

Creatinine is a chemical waste product in the blood that passes through the kidneys to be filtered and eliminated by urinating. The normal creatinine level for an adult is 0.5-0.8 mg/dL.

When your kidneys are damage, chemical waste products won't be filtered efficiently. Then, there will likely be an increase in creatinine levels in the blood and water build up may occur in the body causing swelling in the legs and shortness of breath. That is when dialysis is needed to maintain health.

There are signs that your kidneys are not functioning well. Some of these include:
  • loss of appetite
  • vomiting
  • itching
  • weakness
  • swelling
  • shortness of breath
  • flu-like symptoms.

2) Potassium

Potassium plays an important role in keeping your heart rate at a normal rhythm.  It also helps maintain a normal blood pressure. The normal blood potassium level is 3.8 to 5 millimoles per liter (mmol/L).

High Potassium (Hyperkalemia) causes bradycardia (slow heart rate).

If you have high potassium level, it will cause hyperkalemia. Hyperkalemia is the medical term that describes a potassium level in your blood that is higher than normal. Hyperkalemia causes dangerous, irregular heart rhythms as shown below.

Usual Signs and Symptoms of Hyperkalemia
  • Weakness
  • Fatigue
  • Frank muscle paralysis
  • Dyspnea
  • Palpitations
  • Chest pain
  • Nausea or vomiting
  • Paresthesias
In worst situations, it could cause respiratory paralysis or cardiac arrest and can quickly be fatal.

If you have a normal potassium level, your heart rhythm should be like the pic below. Remember, a normal resting heart rate for adults ranges from 60 to 100 beats a minute.

3) Calcium
Calcium is the most abundant mineral found in the body. About 99% of the calcium in the body is in your bones and teeth. The remaining 1% is found in blood and soft tissues. The normal calcium level for an adult is 8.7-10.4 mg/dL.

Kidney damage causes imbalances in bone metabolism and increases the risk of getting a bone disease. These imbalances also cause calcium deposits in the blood vessels and may contribute to heart disease.

Having high calcium in blood or Hypercalcemia can weaken the bones and increase the risk of calcification. Active vitamin D cannot be taken if calcium levels are too high because it will increase the risk of phosphorus deposits in soft tissues such as arteries, heart lungs, eyes and skin.

Common Symptoms of Hypercalcemia
  • constipation
  • nausea
  • vomiting
  • abdominal pain
  • loss of appetite
  • emotional disturbances
  • delirium
  • hallucinations
  • muscle weakness
  • abnormal heart rhythms

On the other hand, if levels of calcium are low (Hypocalcemia) for long periods, people may develop dry scaly skin, brittle nails, and coarse hair. Muscle cramps involving the back and legs are also common. Over time, other symptoms of hypocalcemia can affect the brain and cause neurologic or psychologic symptoms such as confusion, memory loss, delirium, depression, and hallucinations. These symptoms disappear if the calcium level is restored.

4) Phosphorus 
Aside from calcium, phosphorus is another most abundant mineral in the body. Calcium and phosphorus work closely together to build strong bones and teeth. Around 85% of the body's phosphorus is in bones and teeth. The normal phosphorus level in an adult is 2.4-5.1 mg/dL

Phosphorous plays a significant role in the health of your kidneys, bones, muscles, and blood vessels, as well as each cell and tissue throughout your body. Having high phosphorus levels can cause body changes that pull calcium out of your bones, making them weak. It could also lead to dangerous calcium deposits in blood vessels, lungs, eyes, and heart.

Some signs and symptoms of having high phosphorus in your blood include:
  • muscle cramps
  • tetany
  • perioral numbness or tingling
  • bone and joint pain
  • pruritus or severe itching
  • rashes
  • Fatigue
  • Shortness of breath
  • Anorexia
  • Nausea
  • Vomiting
  • Sleep disturbances
You can maintain you phosphorus level normal by keeping your diet on track and taking medications for phosphorus control. Doctors usually prescribed phosphate binder medications like Renvela in order to help control the amount of phosphorus your body absorbs from the food you eat. 

5) Hemoglobin (Hgb)
Hemoglobin is the protein in red blood cells that carries oxygen from the lungs to the cells of the body. The test for hemoglobin is usually part of a blood test called a Complete Blood Count or CBC. The normal range of hemoglobin for an adult is 12.0-16.0 g/dL.

When your kidneys are damaged, they do not make enough erythropoietin (EPO). As a result, the bone marrow makes fewer red blood cells, causing anemia. Other common causes of anemia in people with kidney disease include blood loss from hemodialysis and low levels of iron nutrients found in their food.

Symptoms of Anemia:
  • looking pale
  • feeling tired
  • having little energy 
  • poor appetite
  • trouble sleeping
  • trouble thinking clearly
  • feeling dizzy or having headaches
  • rapid heartbeat
  • shortness of breath
  • depression
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