A Dialysis Patient With Hyperphosphatemia, Hyperkalemia, and Azotemia Without an Excessive Intake

INTRODUCTION I t is well known that the strict control of serum inorganic phosphorus (IP) and potassium (K) concentrations is important for the prevention of various complications and improving the prognosis of patients with chronic kidney disease (CKD). Hyperkalemia is associated with sudden cardiac death in hemodialysis (HD) patients and hyperphosphatemia is associated with an increase in cardiovascular events and mortality in CKD patients. It is a common practice to restrict IP and K intake when HD patients present with these electrolyte abnormalities. However, these abnormalities are not always caused by an excessive intake. We evaluated and treated a CKD case with hyperphosphatemia, hyperkalemia, and azotemia, likely caused by poor carbohydrate intake.