List common acute complications.
Bacteremia secondary to UTI or pneumonia
IV catheter-related infection
Hemodialysis catheter-related infection
Peritoneal dialysis-associated peritonitis
Drug toxicity 
Describe the anemia of chronic disease.
Pathophysiology: ↓ synthesis of erythropoietin → ↓ stimulation of RBC production → normocytic, normochromic anemia
↓ Hemoglobin (Hb)
MCV is usually normal.
Manage correctable causes of anemia.
Obtain diagnostic studies for iron deficiency.
Check for and potentially treat vitamin B12 deficiency and folate deficiency.
Consider erythropoietin-stimulating agents (ESAs): for patients with Hb < 10.0 g/dL 
Treatment target: usually Hb concentration between 11 and 12 g/dL
Measure TSAT and ferritin at least every 3 months to determine if adjunctive iron replacement therapy is needed.
Adverse effects include increased risk of thrombosis, an increase in blood pressure, and headache.
Avoid blood transfusions: particularly in patients eligible for renal transplantation (risk of alloimmunization)
Describe the CKD mineral and bone disorder (CKD-MBD)
CKD-MBD refers to abnormalities in mineral and/or bone metabolism in CKD.
Renal osteodystrophy refers specifically to issues with bone metabolism due to CKD.
CKD results in hypocalcemia via different mechanisms.
↓ Renal excretion of phosphate → hyperphosphatemia → calcium phosphate precipitation in tissues → ↓ Ca2+
↓ Renal hydroxylation of vitamin D → ↓ 1,25-dihydroxyvitamin D → ↓ intestinal Ca2+ absorption → ↓ Ca2+
Chronically decreased calcium levels can cause secondary hyperparathyroidism, which can progress to tertiary hyperparathyroidism.
Secondary hyperparathyroidism: high turnover bone disease or osteitis fibrosa cystica (metabolic bone disease)
Osteomalacia: defective bone mineralization
Mixed uremic bone disease: secondary hyperparathyroidism with osteomalacia
Adynamic bone disease: decreased bone formation without osteomalacia
Clinical features (may be asymptomatic initially)
Bone and periarticular pain
Muscular weakness and pain
Focal vascular calcification (atherosclerotic plaques)
Diffuse vascular calcification (medial calcific sclerosis and calcific uremic arteriolopathy)
Laboratory studies: frequent monitoring with a mineral and bone disorder panel
Imaging (not routinely indicated)
X-ray may show sclerotic changes (rugger jersey spine), brown tumors, and/or subperiosteal bone thinning.
Consider bone mineral density testing for patients with CKD category G3–G5.
Treatment (under specialist guidance): The goal is to normalize phosphate, calcium, and PTH levels. 
Treatment of hyperphosphatemia, e.g.:
Dietary phosphate restriction
Phosphate binders (e.g., sevelamer)
Treatment of hyperparathyroidism, e.g.:
Cholecalciferol or ergocalciferol supplementation for vitamin D deficiency or insufficiency
Calcitriol (not routinely recommended)
Calcimimetics (e.g., cinacalcet)
Parathyroidectomy (last-line therapy)