A client with chronic renal failure is at increased risk for which fluid and electrolyte change?

• A. Water and sodium retention due to decreased glomerular filtration rate
• B. Hyperkalemia with dehydration
• C. Increased urine output with sodium loss
• D. Hypocalcemia due to excessive filtration

Answer: (A)

In chronic renal failure the glomerular filtration rate declines, so the kidney’s ability to excrete water and sodium is reduced. That leads to fluid and salt retention, causing volume overload and edema. This makes the option describing water and sodium retention due to decreased GFR the best match for the typical fluid and electrolyte changes seen in chronic renal failure.

Hyperkalemia is common as well, but dehydration isn’t the typical accompanying state in this scenario. Increased urine output with sodium loss would point to a different stage or condition, not the chronic picture. Hypocalcemia occurs in CKD due to phosphate retention and impaired vitamin D metabolism, not because of excessive filtration.