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Nephrologists are expected to play a role in this determination, but all too often the nephrologist, like other physicians, must be prompted to deal with end-of-life issues. If no one is available to do the prompting, the patient's death may be needlessly prolonged. The amount to which the nephrologist takes on end-of-life care will be reflected in their approach to the patient. At one end of the spectrum, discomfort with dying can lead to passivity, where the nephrologist serves purely passive role, overseeing dialysis and focusing on fluid and electrolyte balance. At the other end, the nephrologist can be seen as taking a leading role in end of life care (Siegler, Del Monte, Rosati, and von Gunten, 2002).
Chronic diseases are now thought to be the leading causes of death around the world. The World Health Organization (WHO) has reported that there were approximately 58 million deaths worldwide in 2005, with 35 million of these being caused by chronic disease. In many developed countries CVD and cancer are thought to be the leading causes of death. The WHO report has called for governments to provide leadership in addressing the projected continued increase in deaths due to chronic diseases (Levey, Atkins, Coresh, Cohen, Collins, Eckardt, Nahas, Jaber, Jadoul, Levin, Powe11, Rossert, Wheeler, Lameire, and Eknoyan, 2007).
It has been discussed that there is a need for CKD public policy programs in developed and developing countries. In some countries, the frequency of kidney failure due to some type of CKD is leveling off and even declining. This is thought to be due to early detection and treatment. Although the incidence of kidney failure varies considerably throughout the world, the number of patients and the cost of providing dialysis and transplantation continue to go up. Very few countries have policies in place for CKD and most are unaware of the high prevalence, its contribution to other diseases, or its economic burden. Prevention, early detection and intervention are thought to be the more cost-effective strategies for fighting CKD (Levey, Atkins, Coresh, Cohen, Collins, Eckardt, Nahas, Jaber, Jadoul, Levin, Powe11, Rossert, Wheeler, Lameire, and Eknoyan, 2007).
It is felt that there is a need for CKD publicity campaigns that are aimed at increasing the community's awareness of CKD and its adverse impact on people's health. There is a tremendous need to emphasize the need for programs that target high risk groups for early detection and best care plans in high risk groups. All CKD programs should be established and pursued in a joint fashion with diabetes and cardiovascular disease because they so often overlap. It is also essential that there is a national monitoring program in order to watch the incidence and prevalence of CKD in order to help focus on its reduction (Report Backs Need for Political Parties to Upgrade Chronic Kidney Disease Policy. (2009).
There also needs to be a plan developed for education directed at health care professionals about the advantages and methods of early screening, diagnosis, and treatment of CKD and its complications. A plan needs to be developed to educate health care professionals and individuals with CKD about the advantages and options for early renal replacement therapy. And recommendations need to be made on the implementation of a cost-effective plan for early screening, diagnosis, and treatment of CKD (Addressing Chronic Kidney Disease in Texas, 2009).
GFR is a central measure of kidney function that can be estimated through a calculation that is based on serum creatinine levels and patient demographics, such as age, gender, body size, and ethnicity. Estimated GFR (eGFR) is known as a simple, cost effective method that can be used to assess the progression of kidney disease. The National Institute of Diabetes and Digestive and Kidney Diseases conducted at survey in which it found that 38% of labs automatically report eGFR, with the highest reporting coming from high volume labs and the lowest from low-volume independent labs, particularly those that are located in physician offices. Implementation of automatic eGFR reporting can dramatically increase early detection and intervention which will help to impede disease progression of this disease. It is also helpful as an annual measure in order to help manage patient care. It has been recommended that there be education of clinical laboratory professionals in order to promote calculation and reporting of eGFR with all serum creatinine determinations for individuals 18 years and older (Addressing Chronic Kidney Disease in Texas, 2009).
The incidence of Chronic Kidney Disease is an ever growing national public health issue. Those who are diagnosed with this disease more often than not end up with ESRD as it progresses along. Once this happens the treatment options are limited to dialysis or transplant. When talking about the elderly populations that have CKD the likely hood of transplant goes down with age. This leaves dialysis as their only option. The procedure of dialysis has been found to affect patients very differently. It has been discovered that there is a high incidence of quality of life issues with elderly patients that undergo dialysis.
If there were a public policy enacted in regards to chronic kidney disease the hope would be that there would be instances of early detection and treatment. The hope would be to reduce the amount of patients that end up with ESRD and thus have to undergo dialysis. Education is the key to prevention and so the policy should focus on specific issues of kidney health aimed at the general public. It should also focus on education about prevention screenings and early detection aimed at health care personnel.
The population in this country is quickly growing older and chronic diseases are becoming more prevalent in this group. It is very important that everyone works together to try and bring about a reduction in the amount of people who end up with chronic kidney disease so that all the issues that surround ESRD and dialysis can also be reduced. The older that a person gets the less likely it is that a transplant is even an option for them. This leaves these people with dialysis as their only alternative. Not only is dialysis costly and very time consuming for the patient to undergo it has also been shown to be very debilitating for some patients, especially the older ones.
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Tamura, Manjula Kurella, Covinsky,…[continue]
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It is also important to distinguish between the subjective or personal view of quality of life and the professional's objective evaluation of the health status of individuals (Tyrrell et al., 2005, p. 375). With regard to the patient's quality of life and treatment the above study notes that; "We have observed that some older dialysis patients experience considerable difficulties with this treatment regime. Apart from physical discomfort, some patients have
" (AAFP, nd) The Health Maintenance Organization further should "…negotiate with both public and private payers for adequate reimbursement or direct payment to cover the expenses of interpreter services so that they can establish services without burdening physicians…" and the private industry should be "…engaged by medical organizations, including the AAFP, and patient advocacy groups to consider innovative ways to provide interpreter services to both employees and the medically underserved." (AAFP,
Cultural Issues in End of Life Care In this age of increased social diversity the cultural aspects of end-of-life care have become increasingly important in the nursing profession. This importance is however complicated by technology and the cultural problematics of extended life care through artificial means. In the book Cultural Issues in End-of-Life Decision Making (Braun, K, Pietsch, J.H. Blanchette, P. 1999) the crucial point is made that "providing cultural and
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