Chronic Kidney Disease Assignment Help
Chronic Kidney Disease
Introduction
Chronic kidney disease is conditions that damage the kidney and decreases the kidneys’ ability to function normally. When the disease worsens, toxic waste builds up in the blood causing health complications such as high blood pressure, anaemia, nerve damage, and weak bones (Thomas, Kanso, & Sedor, 2008). Additionally, CKD increases the risk of cardiovascular diseases. Devraj R et al. (2018) describes CKD as a slow and progressive decline in kidney function that leads to end-stage renal disease (ESRD). The criteria for the definition of chronic kidney disease are based on the level of kidney function as estimated by glomerular filtration rate (GFR). Matovinović (2009) uses the following criteria for the definition of CKD. “Kidney damage for ≥ 3 months, as defined by structural or functional abnormalities of the kidney, with or without decreased GFR, that can lead to decreased GFR, manifest by either pathologic abnormalities; or markers of kidney damage, including abnormalities in the composition of the blood or urine, or abnormalities in imaging tests, and GFR < 60 mL/min/1.73 m2 for ≥ 3 months, with or without kidney damage” (P. 3).
Chronic kidney disease (CKD) is among the ten deadliest chronic diseases in the world. Statistics show that 10-15% of the adult population in western countries suffers from CKD and requires expensive treatment and renal replacement therapy. In the United States of America, 26 million people have CKD and another 20 million are at an increased risk (Matovinović, 2009). The comorbidity of CKD with other chronic diseases such as hypertension, diabetes and obesity increases the burden of diseases and death (Mullins et al., 2016). The comorbidity of diseases predisposes individuals to CKD making prevention and early detection of the diseases a healthcare priority. Since patients with CKD are medically complex with a high likelihood of critical comorbidity and increased risk of progression to ESRD and death (Sperati et al., 20190 understanding the cause of the disease, the disease pathophysiology, and impacts on individuals and caregivers are important in its management.
Main Causes of Chronic Kidney Disease
The main causes of CKD are diabetes and high blood pressure contributing two-thirds of worldwide cases. Diabetes causes the blood sugar levels to rise to abnormal levels that damage many body organs including the heart and the kidneys. On the other hand, hypertension or high blood pressures increase the pressure of the blood vessels. When the condition is poorly controlled or uncontrolled altogether, it causes other serious conditions such as stroke, heart attack, and chronic kidney disease. However, it is important to note that CKD is a risk factor for hypertension (Razmaria, 2016). There are other risk factors for chronic kidney disease which include age (>60 years), sex (female), ethnicity (African American), obesity, and high cholesterol levels. The behavioural based risk factors include lack of physical exercise, smoking, and excessive salt intake. Other contributing factors include infections or inflammatory diseases (Glomerulonephritis), inappropriate use of medications (ibuprofen and aspirin), and herbal supplements that damage the kidneys (Razmaria, 2016). Sometimes, the disease runs in families; inherited diseases, such as polycystic kidney disease.
The prevention of chronic disease requires both medical intervention and behavioural changes. According to Razmaria (2016), medical interventions related to the control of diabetes and high blood pressure. This includes controlling diabetes and monitoring HbA1c levels and controlling high blood pressure with kidney-protective blood pressure medications. The behavioural changes interventions include reducing salt intake, stop smoking, eating heart-healthy diets rich in fruits and vegetables, and regular exercise and maintenance of healthy body weight (Razmaria, 2016). These practices are essential in preventing chronic kidney disease since they have an impact on diabetes and hypertension.
Pathophysiology
The pathophysiology of CKD considers renal structural and physiological characteristics and the principles of renal tissue injury and repair. The rate of renal blood flow is 400 ml/100g of tissue per minute exposing the renal tissue to a significant quantity of harmful substance or agent. The dependence of glomerular filtration on the high intra- and transglomerular pressure increases the vulnerability of glomerular capillaries to hemodynamic injury. This explains the contribution of glomerular hypertension and hyperfiltration to the progression of chronic renal disease. The mechanisms of glomerular, tubular and vascular injury are the best approach in explaining the pathophysiology of CKD.
The mechanism of glomerular impairment takes different courses. However, hereditary defects account for a minimum of these diseases. Acquired glomerular diseases are caused by immune-mediated injury as well as metabolic and mechanical stress. Glomerular diseases can be nonproliferative, heterogeneous, or proliferative (Matovinović, 2009). The other mechanisms of glomerular impairment include nonimmunologic glomerular injury, systematic hypertension, and glomerular hypertension. Chronic kidney disease is characterised by renal fibrosis which includes glomerulosclerosis and tubulointerstitial fibrosis. The severity of the tubulointerstitial injury is highly associated with long-term impairment of the renal functions. Renal fibrogenesis, inflammatory infiltrate, profibrotic cytokines, and dames to proteinuria and tubulointerstitial causes tubulointerstitial impairment which is an important pathophysiology of CKD (Matovinović, 2009).
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Impact of the Disease on the Individual and Family/Carers
Impact on the Individual
The impact of CKD on patients is mainly exhibited through the quality of life. Quality of life is a multidimensional concept that examines patient abilities, function, health, psychological state, and well-being. The relationship between disease and quality of life is directly illustrated on “physical performance, emotional, and physical problems, fatigue, mental health, social performance, physical pain, and general health” (Ghiasi et al., 2018). The quality of life for an individual with CKD decreases over time with women experiencing the worst outcome compared to men. The elements of quality of life that decrease include physical function, mental problem, social function, and general health. However, integration of self-management interventions in CKD care model has a positive impact on the patient outcomes.
Self-management programs empower the individual to take responsibility for recovery and treatment (Clarke, Yates, Smith, & Chilcot, 2016). This makes them responsible for the outcome which helps in improving their quality of life by reducing stress, worry, and fear. Self-management has an impact on the illness perception which shows positive psychological and clinical benefits for the patient. Positive illness perception is associated with declining psychological distress and improving well-being. Therefore, although CKD affects the quality of life of an individual, self-management has a positive impact on a patient’s life. Tannor et al. (2019) affirm that CKD has a significant impact on the socio-economic and health status of the individual as it affects personal productive functions leading to low-income status and increases the risk of other diseases such as hypertension presenting cases of advanced disease and poor quality of life.
Impact on Carer/Family
The impact of CKD on the family or carer is diverse depending on which member of the family suffering the disease. Nonetheless, chronic kidney disease has significant psychosocial, emotional, and economic stress regardless of the patient. The family of the patient provides support which includes financial and emotional assistance which drains them. In effect, this has a direct impact on the quality of life of the family/carer. According to Bignall & Goldstein (2015), caring for children with CKD causes caregiver strain expressed through emotional, marital, social, and financial dysfunction that leaves the family depowered. When a child is diagnosed with chronic disease, the family experiences emotional stressors that put it in a ‘chronic condition’ and drains its finances. Low, Smith, Burns, & Jones (2008) show that CKD negative and positive impacts on a family. On the negative side, the family experiences a poor quality of life, as well as increased stress and fatigue. Caring for CKD patient causes a pressure that makes the carer neglect their health, experience social isolation, life restrictions, increased workload, negative economic outcomes, and a changed relationship with the patient, and negative impact on their sexual life. However, caring for a CKD patient increases the family’s sense of responsibility. Moreover, caring for CKD patients is associated with an increased risk of falling into poverty (Morton et al., 2017) as the cost of care is extremely high which causes stress and depression among the caregiver. This can cause health complications among the family members resulting in a poor quality of life.
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