Treatment of Disorders of Sodium Balance in Chronic Kidney Disease

Research output: Contribution to journalReview articlepeer-review

23 Scopus citations


Extracellular fluid volume expansion is nearly universal in patients with CKD. Such volume expansion has features similar to the syndrome of heart failure with preserved ejection fraction, which not only leads to symptoms but can also lead to further organ damage. Unique treatment challenges are present in this patient population, including low glomerular filtration, which limits sodium chloride filtration, intrinsic tubule predisposition to sodium chloride retention, and proteinuria. In addition, pharmacokinetic considerations alter the disposition of diuretics in patients with CKD and nephrotic syndrome. Maintaining extracellular fluid volume near to normal is often necessary for hypertension treatment in this population, but it may also help prevent progressive cardiovascular and kidney damage. Although powerful diuretics can often accomplish this goal, this often comes at a cost of competing adverse effects. An approach to reduce extracellular fluid volume while avoiding adverse effects, therefore, requires a nuanced yet aggressive therapeutic approach.

Original languageEnglish (US)
Pages (from-to)332-341
Number of pages10
JournalAdvances in Chronic Kidney Disease
Issue number5
StatePublished - Sep 1 2017


  • Diuretics
  • Extracellular fluid volume expansion
  • Nephrotic syndrome
  • Salt-sensitive hypertension

ASJC Scopus subject areas

  • Nephrology


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