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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