How does chronic kidney disease (CKD) affect the handling of salt and water in the kidney and what are the effects?

Updated: Jul 21, 2021
  • Author: Pradeep Arora, MD; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Salt and water handling by the kidney is altered in CKD. Extracellular volume expansion and total-body volume overload results from failure of sodium and free-water excretion. This generally becomes clinically manifested when the GFR falls to less than 10-15 mL/min/1.73 m², when compensatory mechanisms have become exhausted.

As kidney function declines further, sodium retention and extracellular volume expansion lead to peripheral edema and, not uncommonly, pulmonary edema and hypertension. At a higher GFR, excess sodium and water intake could result in a similar picture if the ingested amounts of sodium and water exceed the available potential for compensatory excretion.

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