Nephro Flash Vol-10, No-1, 2024

Urolithiasis is an age-old disease and has a growing global incidence and prevalence. In a 2017 study from northern India, the lifetime prevalence of urinary stones was noted to be 7.9%. In the year 2019, more than a fifth of all incident cases of urolithiasis worldwide occurred in India.

Stones develop in the kidney and usually do not cause any symptoms. As they travel down the ureter, they can cause pain termed renal or ureteric colic. Stones can occur as a result of various causes (Figure 1). Patients can present with unilateral colicky pain in the flank or abdomen, nausea, vomiting, fever, and hematuria.

Treatment of stones is tailored to each patient and depends on multiple factors. The size, location, and composition of stones are key factors guiding treatment decisions.

Chronic kidney disease (CKD) is a global public health issue and has a strong link with conditions like cardiovascular disease and diabetes. A systematic review and analysis published in 2022 estimated the prevalence of CKD in Asia and noted the absolute number of individuals with CKD in India to be up to 140.2 million. Kidneys are involved in regulating fluid and electrolytes in the body. Conditions like CKD and end-stage renal disease (ESRD) are associated with potassium derangements, metabolic acidosis, etc.

The extracellular fluid has only 2% of the total potassium while the intracellular fluid has most of the body's potassium (98%). Kidneys maintain the body's potassium homeostasis and remove the excess potassium. However, in patients with ESRD undergoing hemodialysis, non-renal potassium excretion and dialytic removal play a crucial role in potassium balance as renal excretion is decreased. Potassium derangements, including hyperkalemia and, to a lesser extent, hypokalemia, can be seen in patients with CKD.

This article focuses on hypokalemia in CKD and dialysis patients and management of hypokalemia, including the role of potassium supplementation.