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The aim is to:

 

Fluid balance Prevent hypervolaemia (Na restriction, diuretics)
Avoid hypovolaemia (no oedema, postural hypotension)
Watch out for sodium-losing patients who will benefit from Na supplementation.
Hypertension See blood pressure in renal disease
Diet See diet
Hyperlipidaemia See hyperlipidaemia
Acidosis Prescribe NaHCO3 to keep plasma bicarbonate ≥20 if Na load permits

Osteodystrophy

Prescribe alfacalcidol (calcitriol equally effective) when there is hypocalcaemia or when PTH >2x normal in the presence of normal serum calcium.
PO4 should be kept at ≤1.8 mmol/l by dietary restriction and the use of phosphate binders.

See osteodystrophy.

 

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