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Electrolyte Imbalance in Kidney Failure

author image Robin Gilbert
Robin Gilbert has been writing professionally since 1998 and specializes in health-care topics. Her writing has appeared in the "Emergency Nursing Connection," "Nursing Management Secrets" and "Comprehensive Care of the Pediatric Patients." Gilbert has her Master of Science in nursing from St. Joseph's College in Maine. She has more than 20 years experience in emergency nursing and is a CEN and CPEN.
Electrolyte Imbalance in Kidney Failure
Nurse taking man's blood pressure Photo Credit: George Doyle/Stockbyte/Getty Images

The kidneys play an important role in the regulation of fluids and electrolytes, and when they malfunction it often leads to an electrolyte imbalance. Electrolytes are charged particles involved in the transmission of impulses in nerve and muscles. When imbalances occur, this can lead to serious complications and even death.

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Kidney failure, also known as renal failure, can be either acute or chronic. Acute renal failure has a sudden onset, usually hours to days, and can be caused by trauma, infection or an obstruction. With acute renal failure, if the underlying cause is corrected, kidney function returns. According to "Fluids and Electrolytes Demystified," chronic renal failure involves progressive and irreversible loss of kidney function.


The kidney is the primary organ responsible for potassium excretion. When potassium builds up in the bloodstream, it is called hyperkalemia. Hyperkalemia can cause abdominal cramping, tiredness, muscle weakness or paralysis. According to "RN", severe hyperkalemia will slow down the cardiac impulses and can lead to cardiac arrest.


Sodium plays a major role in fluid balance, neuromuscular function and acid-base balance. The kidneys either conserve or excrete sodium depending on the body's needs. If the kidneys are not able to excrete sodium, hypernatremia will occur. Hypernatremia can lead to disorientation, muscle twitching, increased blood pressure and weakness.


As noted in "Fluids and Electrolytes Demystified," the most frequent cause of hypermagnesemia is renal failure. An excess of magnesium affects the central nervous system, muscles and cardiac system: blood pressure drops, heart rate slows down, and in severe cases coma and cardiac arrest can occur.

Phosphorus and Calcium

Phosphorus and calcium levels are affected by renal failure. Because of the reciprocal relationship between phosphorus and calcium, the retention of phosphorus in renal failure causes a decrease in the level of calcium. Low levels of calcium cause muscle spasms, seizures and abnormal heart rhythms. The presence of high serum levels of phosphorus for extended periods of time may lead to additional complications. As calcium levels remain low, skeletal demineralization starts to occur and calcium deposits occur in vascular cells causing hardened arterial walls. This, in turn, can lead to enlargement of the left ventricle of the heart, high blood pressure and ultimately cardiac failure.

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