Electrolyte and Acid-Base Imbalance as Early Markers of CKD: A Cluster-Based Analysis in a Rural Indian Setting
Shriyanshi Sing
NIMS Medical College, Jaipur, India.
Heera Lal Kumawat *
LNCT Medical College, Indore, India.
Shilpa Rattan
Shri Mata Vaishno Devi Institute of Medical Excellence, Katra, India.
Abid Manzoor
Shri Mata Vaishno Devi Institute of Medical Excellence, Katra, India.
Sana Rafiq
Shri Mata Vaishno Devi Institute of Medical Excellence, Katra, India.
Abid Hussain
SGT Medical College, Gurugram, Haryana, India.
*Author to whom correspondence should be addressed.
Abstract
Background: Electrolyte and acid-base imbalances are early markers of chronic kidney disease (CKD), especially relevant in underserved rural populations. This study evaluates key biochemical parameters, the Electrolyte Stress Index (ESI), and clustering-based patient stratification in a rural Indian cohort.
Methods: A cross-sectional study was conducted on 200 adults. Serum electrolytes, uric acid, calcium, creatinine, and eGFR were analyzed using the Vitros 4600 analyzer. ESI was calculated as (Na⁺ + K⁺ + Cl⁻)/HCO₃⁻. Pearson’s correlation, sensitivity-specificity analysis, and k-means clustering were applied for statistical evaluation.
Results: Hyponatremia (14.0%), hyperkalaemia (17.5%), low HCO₃⁻ (15.0%), and hyperuricemia (22.0%) were prevalent. HCO₃⁻ showed a strong negative correlation with creatinine (r = -0.47, p < 0.001). ESI ≥15 was linked to lower mean GFR (54.7 ml/min), with a sensitivity of 60%, specificity of 90%, and Youden Index of 0.50. Clustering revealed three distinct biochemical profiles, including high-risk renal phenotypes.
Conclusion: Electrolyte abnormalities correlated strongly with renal dysfunction. ESI and cluster analysis offer promising, low-cost tools for early CKD risk stratification in resource-limited settings.
Keywords: Electrolyte stress index, CKD (Chronic Kidney Disease), Rural India, Bicarbonate, eGFR, K-means clustering, biochemical profile, renal risk