Disorders of Electrolytes and Acid-Base Homeostasis as Precursors to Chronic Kidney Disease: A Phenotypic Clustering Study in a Rural Indian Population
DOI:
https://doi.org/10.66328/ijprmh.2025.010202Keywords:
Electrolyte Ratio Index, Chronic Kidney Disease, Estimated Glomerular Filtration Rate, Phenotypic Clustering, Renal Risk AssessmentAbstract
Background: Imbalances in electrolytes and acid-base status are recognized early indicators of renal impairment, a relationship of critical importance in low-resource rural communities. This investigation assesses key serum parameters, a derived Electrolyte Ratio Index (ERI), and patient categorization via clustering methods within a rural Indian demographic.
Methods: A total of 200 adults were enrolled in this cross-sectional analysis. Concentrations of serum electrolytes, uric acid, calcium, and creatinine were quantified, with the estimated glomerular filtration rate (eGFR) derived. Analyses were performed on a Vitros 4600 platform. The Electrolyte Ratio Index was computed as (Na⁺ + K⁺ + Cl⁻)/HCO₃⁻. Statistical evaluation employed Pearson correlation, sensitivity-specificity assessment, and k-means clustering.
Results: Commonly observed disturbances included hyponatremia (14.0%), hyperkalaemia (17.5%), reduced bicarbonate (15.0%), and hyperuricemia (22.0%). Bicarbonate concentration demonstrated a significant inverse correlation with serum creatinine (r = -0.47, p < 0.001). An ERI value of ≥15 was associated with a diminished mean eGFR (54.7 ml/min), exhibiting a sensitivity of 60%, specificity of 90%, and a Youden Index of 0.50. Cluster analysis delineated three unique biochemical phenotypes, one of which represented a high-risk renal profile.
Conclusion: Electrolyte and acid-base derangements show a strong association with declining renal function. The ERI and cluster-based phenotyping present viable, economical strategies for the early stratification of chronic kidney disease risk in settings with limited healthcare resources.
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