(Level 4)   11. Strazzullo P, et al. BMJ. 2009;339:b4567. (Level 4)   12. Stolarz-Skrzypek K, et al. JAMA. 2011;305:1777–85. (Level 4)   13. O’Donnell MJ, et al. JAMA. 2011;306:2229–38. (Level 4)   14.

Taylor RS, et al. Cochrane Database Syst Rev. 2011;CD009217. Copanlisib concentration (Level 1)   15. Ekinci EI, et al. Diabetes Care. 2011;34:703–9. (Level 4)   16. Kutlugün AA, et al. Nephron Clin Pract. 2011;118:c361–6. (Level 5)   17. Imai E, et al. Clin Exp Nephrol. 2011;15:861–7. (Level 5)   What should the target range of serum potassium levels be in CKD? Patients with advanced CKD are at risk of hyperkalemia. Other risk factors for EPZ5676 in vivo hyperkalemia include metabolic acidosis, diabetes, congestive heart failure, advanced age, and the use of β blockers and renin-angiotensin-aldosterone system (RAAS) inhibitors. In a retrospective cohort of patients cared for over a single year in the Veterans Health Administration, hyperkalemia (≥5.5 mEq/L) was associated with high mortality. Other prospective cohort studies have demonstrated that patients with hypokalemia (<4.0 mEq/L) also were at high risk of all-cause mortality, cardiovascular mortality, heart failure, and end-stage renal disease. Accordingly, we suggest that serum potassium levels should be maintained between 4.0 and 5.4 mEq/L in patients with CKD. In patients

with CKD and hyperkalemia, metabolic acidosis should be evaluated and corrected appropriately. When selleck chemicals serum potassium levels exceed 5.5 mEq/L without metabolic acidosis, nutritional advice relating to fruit, vegetable, and protein intake should be provided. Other treatment options such as reducing the RAAS inhibitor dosage and administering potassium absorbing resin can also be pursued. For hypokalemia (K < 4.0 mEq/L), the administration of potassium-lowering drugs such as diuretics and the dietary intake of fruits, vegetables, and protein sources should be evaluated and managed. Bibliography 1. Einhorn LM, et al. Thymidine kinase Arch Intern Med. 2009;169:1156–6. (Level 4)   2. Miao Y, et al. Diabetologia. 2011;54:44–50. (Level 4)   3. ONTARGET Investigators.

N Engl J Med. 2008;358:1547–59. (Level 2)   4. Korgaonkar S, et al. Clin J Am Soc Nephrol. 2010;5:762–9. (Level 4)   5. Bowling CB, et al. Circ Heart Fail. 2010;3:253–60. (Level 4)   Should metabolic acidosis be corrected to prevent the progression of CKD and the reduction of mortality? Metabolic acidosis, frequently observed in patients with advanced CKD, increases the degradation of muscle protein, reduces albumin synthesis and leads to abnormal bone metabolism. Observational studies have shown that a low serum bicarbonate level is associated with a rapid renal function decline and a high risk of both ESRD and mortality, and that a high serum bicarbonate level is also associated with high mortality. Several RCTs have revealed that sodium bicarbonate delays the development of ESRD and improves the nutritional status of patients with advanced CKD and metabolic acidosis.