Which electrolyte abnormalities are commonly seen in end-stage kidney disease?

• A. Hypokalemia, hypophosphatemia, hypercalcemia, metabolic alkalosis.
• B. Hyperkalemia, hyperphosphatemia, hypocalcemia, metabolic acidosis.
• C. Normal electrolytes.
• D. Hyperkalemia only.

Answer: (B)

In end-stage kidney disease, the kidneys lose the ability to maintain electrolyte and acid-base balance, so potassium and phosphate build up while calcium drops and acids accumulate. Potassium isn’t excreted effectively, leading to high potassium levels that can affect heart rhythm. Phosphate clearance is also impaired, causing high phosphate (hyperphosphatemia); this binds calcium and, along with reduced activation of vitamin D, lowers serum calcium (hypocalcemia). The combination of low calcium and phosphate shifts can trigger secondary hyperparathyroidism, but the immediate electrolyte picture is hypocalcemia. At the same time, the kidney’s diminished ability to excrete hydrogen ions causes metabolic acidosis. So the pattern you’d expect is hyperkalemia, hyperphosphatemia, hypocalcemia, and metabolic acidosis.