Chronic Kidney Disease Effects

Chronic Kidney Disease

Over the last several years, the issue of chronic kidney disease has been increasingly brought to the forefront. This is because when someone becomes older, the more likely they will develop this condition. According to the Center for Disease Control (CDC) and the National Kidney Foundation, once someone reaches above the age of 50, there is a 50% of them becoming susceptible to it. As they increase in age, these probabilities rise dramatically, with the most likely individuals having the greatest chances of experiencing chronic kidney disease at 70 years old. ("2014 National Kidney Disease Fact Sheet," 2014) ("Kidney Disease Facts," 2014)

However, in spite of these issues, the CDC determined that there are number of variables which increase the odds of someone developing the condition. They found that lifestyle choices are one of the biggest factors, with the disease steadily progressing in the course of time. Commenting about these issues the CDC said, "Adults with diabetes or high blood pressure, or both have a higher risk of developing CKD than those without these diseases. Approximately 1 of 3 adults with diabetes and 1 of 5 adults with high blood pressure has CKD. Other risk factors for CKD include cardiovascular disease, obesity, high cholesterol, lupus, and a family history of CKD. Your risk of developing CKD also increases with age, as these risk factors are more common at older age. Men with CKD are 50% more likely than women to have kidney failure CKD can also lead to other health problems including the following: 1) the body can hold in too much fluid, which could lead to swelling in the arms and legs, high blood pressure, or fluid in on the lung lungs (called pulmonary edema). 2) The individual can also develop pericarditis, which is an inflammation of the sac-like membrane (called the pericardium) around the heart. 3) The potassium levels in the blood can go up suddenly (this is called hyperkalemia), which could keep the heart from working as it should. It can even lead to death. 4) The bones may become weak and brittle and possibly more likely to break. 5) The number of red blood cells can become low, making the person feel tired and weak. (This is called anemia). 6) The immune system can become weakened, which makes someone more likely to get an infection. 7) Patients may become depressed or have a lower quality of life. 8) There is the probability they can become malnourished." ("2014 National Kidney Disease Fact Sheet," 2014) These insights are showing how chronic kidney is something which can negatively impact the health of the individual as they become older. In many cases, the odds increase based upon lifestyle choices and genetics. As far as 40 to 60-year-olds are concerned, these issues can lead to greater chances of someone contracting the early signs of the disease and not knowing it.

To prevent this, requires developing an effective health promotion strategy. This will be accomplished by describing the prevention problem, how it applied to advanced practices, analyzing current literature related to interventions, selecting an appropriate health promotion model, designing an intervention strategy to address these challenges and evaluating its efficacy. Together, these elements will illustrate the most effective strategies for reducing the condition and the lasting effects it will have on patients.

Health Promotion / Disease Prevention Problem and Specific Population

The health promotion and disease prevention strategy is focusing on the 40 to 60-year-old demographic. These individuals are the most likely, to show the early warning signs of developing chronic kidney failure. This is because chronic kidney failure is subdivided into various stages. They are focused on looking at the Glomerular filtration rate (i.e. GFR). This is a test that is used to determine how effectively the blood is flowing through the kidney. The glmerular are tiny filters that remove waste from the blood. When they become less effective, is the point the kidneys will start to malfunction. This is the point; the individual will start developing signs which are leading to chronic kidney failure. During this process there are a series of five different stages that will be utilized to include:

Stage 1: This is when there is a GFR > 90 ml / min / 1.73 M2. In these situations there are structural issues which the kidneys such as: persistent microalbuminuria, proteinuria and haematuria. These issues are detected through ultrasounds and biopsy-based tests.

Stage 2: The GFR is 60-89 ml / min / 1.73M2. This when further kidney damage is occurring.

Stage 3: The GFR is 30-59 ml / min / 1.73M2.

Stage 4: The GFR is 15-29 ml / min / 1.73 M2.

Stage 5: The GFR is

As a result, each step becomes more serve with the final part leading to the kidneys completely shutting down. In the 40 to 60-year-old demographic, there are a number of signs which healthcare professionals should be aware of. According to the National Institute of Health (NIH), these factors increase the odds of contracting the disease by 50 to 70%. Evidence of this can be seen with the saying, "Those who are over the age of 40 will gradually increase their chance of having CKD by 50 to 70%. This rises each year and it become more pronounced when the person is exhibiting a number of signs to include: diabetes; hypertension; cardiovascular disease (i.e. schaemic heart disease, chronic heart failure, peripheral vascular disease and cerebral vascular disease); structural renal tract disease, renal calculi or prostatic hypertrophy; multisystem diseases with potential kidney involvement (e.g. systemic lupus erythematosus (SLE); family history of stage 5 CKD or hereditary kidney disease and opportunistic detection of haematuria or proteinuria." Furthermore, the NIH found that the problem impacts 1 in 5 adults who are in this segment. ("Chronic Kidney Disease," 2013) These insights are showing how the problem is prevalent in this segment of the population.

This is problematic, as it can lead to higher mortality rates at a younger age. A good example of this can seen with the results from a study conducted by Turin (2012) who said, "Life expectancy is commonly used as an indicator of health and reflects disease burden in the population. The life expectancy for patients with lower levels of kidney function has not been reported. The abridged life table method was applied to calculate the life expectancies of men and women from age 30 to 85 years, by levels of kidney function as defined by estimated glomerular filtration rate (eGFR): 60, 45 -- 59, 30 -- 44 and 15 -- 29 mL/min/1.73 m2. Men and women aged 40 years had a life expectancy of 30.5 and 34.6 years at eGFR ?60 mL/min/1.73 m2, 24.5 and 28.7 years at eGFR 45 -- 59 mL/min/1.73 m2, 14.5 and 16.5 years at eGFR 30 -- 44 mL/min/1.73 m2 and 10.4 and 9.1 years at eGFR 15 -- 29 mL/min/1.73 m2, respectively. Life expectancy was longer for women compared with men at all ages and eGFR categories, other than for eGFR 15 -- 29 mL/min/1.73 m2 where there was no difference in life expectancy by gender. A lower level of kidney function is associated with a reduction in life expectancy for both men and women." (Turin, 2012) These insights are showing how life expectancy declines dramatically the more advanced the patient's condition. This means that unless some kind of drastic action is taken at different stages. There is a realistic possibility the underlying situation will become worse.

One of the main reasons why healthcare professionals have trouble preventing the problem is from tests failing to identify when someone is acquiring the condition early. While at the same time, they generalize as to if someone is more susceptible when they may or may not be. According to Bauer (2008), these issues can lead to under or over diagnosing the problem with him saying, "Awareness of chronic kidney disease (CKD) has increased in part because of the definitions and treatment guidelines set out by Kidney Disease Outcomes Quality Initiative (KDOQI); however, the staging system set forth by these guidelines has led to several problems and unforeseen consequences. Stages 1 and 2 CKD are difficult to determine using the standard Modification of Diet in Renal Disease (MDRD) estimation of GFR, and their clinical significance in the absence of other risk factors is unclear. Just because microalbuminuria in people without diabetes is a cardiovascular risk factor does not make it kidney disease. Most patients who receive a diagnosis of stage 3 CKD (GFR between 30 and 59 ml/min) are elderly people, and the vast majority of these patients will die before they reach ESRD. The staging system needs to be modified to reflect the severity and complications of CKD. It is suggested that stages 1 and 2 be eliminated and stages 3, 4, and 5, be simply termed moderate impairment, severe impairment, and kidney failure, respectively. In addition, age should be a modifying factor, especially in moderate kidney impairment. These changes would allow identification and treatment of clinically relevant disease and avoidance of what can seem exaggerated prevalence estimates." (Bauer, 2008) These insights are showing how the inability to accurately screen for the condition is compounding the problem. To deal with these challenges, a new approach must be taken. This will help to improve the accuracy of test results and identify the possible impacts on patients.

Relationship to Individual Advanced Role

This problem relates to advanced practice nursing, as these individuals are quickly becoming the primary care provider for the patient. This means that they will help with screening the person and discussing the condition with them / their families. During this process, the nurse will serve as mentor, coach, educator and healthcare professional. Their job is to identify their condition as early as possible, discuss the long-term ramifications and educate the patient / caregivers about the importance of making changes in their lives. When this happens, they can effectively intervene and prevent their condition from becoming worse. (Roy, 2014)

A good example of this can be seen with insight from Miller (2006) who said, "Chronic kidney disease in adults is associated with complications that require nursing interventions in both the inpatient and outpatient settings. Given the progressive nature of the disease and the complexity of the treatment regimen, it is important that nurses be comfortable implementing acute and preventive care strategies and facilitating the coordination of care. In addition, the need for multiple therapies can be distressing for patients and their families, further supporting the role of the nurse in patient and family education and decision making regarding the plan of care." (Miller, 2006) These insights are showing how healthcare professionals must have greater amounts of flexibility in working with patients. This means that they need to understand what the patient is going through and be prepared to help them in the long-term. It is at this point, when they can be effective in reducing the chances of the patient having complications.

Critical Analysis of Relevant Literature

In general, most intervention strategies focused on having the patient receive specific treatment options such as dialysis and insulin. According to a study conducted by Mehran (2004), these strategies have been shown to be successful to a certain extent with him saying, "Chronic kidney disease (CKD) is a frequent complication of diabetes mellitus. However, the role of CKD in outcomes of patients with diabetes who have undergone percutaneous coronary intervention (PCI) has not been studied specifically. Therefore, we investigated the impact of CKD on prognosis of patients with diabetes who underwent PCI. Of 1,575 diabetic patients who underwent PCI, 1,046 (66%) had preserved renal function, 492 (31%) had CKD (baseline serum creatinine >1.5 mg/dl or estimated glomerular filtration rate

Moreover, Navaneethan (2009) found that the individual must make changes in their lifestyle and activities. In order to prevent their condition from becoming worse with him saying, "Obesity is an independent risk factor for development and progression of chronic kidney disease (CKD). We conducted a systematic review to assess the benefits of intentional weight loss in patients with non-dialysis-dependent CKD and glomerular hyperfiltration. Thirteen studies were included. In patients with CKD, body mass index (BMI) decreased significantly (weighted mean difference [WMD] ?3.67 kg/m2; 95% confidence interval [CI] ?6.56 to ?0.78) at the end of the study period with nonsurgical interventions. This was associated with a significant decrease in proteinuria (WMD ?1.31 g/24 h; 95% CI ?2.11 to ?0.51) and systolic BP with no further decrease in GFR during a mean follow-up of 7.4 mo. 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