Human kidneys play a vital role in overall health and wellbeing. The organ functions to filter and remove toxins from the blood. Other responsibilities of the kidneys include the regulation of the PH and levels of potassium in the body, activation of vitamin D to assist the body in the absorption of calcium, as well as the production of hormones essential in the regulation of blood pressure (Fraser & Blakeman, 2016). As such, maintaining a healthy kidney is not only a top individual but a worldwide priority. Yet, such a priority is jeopardized by disorders such as chronic kidney disease (CKD) that affects a significant number of people across the globe. The following paper delves into this condition with a view to understanding its signs and symptoms, prevalence, existing methods of surveillance, epidemiology, current screening and related guidelines, and a plan to address it as a nurse practitioner. The plan will include evidence-based interventions whose outcomes are measurable. In doing this, the paper hopes to not only enlighten on CKD but also contribute to reducing its prevalence. Preventing CKD would be significant in mitigating other health issues such as cardiovascular conditions.
Background and Significance
Chen, Knicely and Grams (2019) posit that CKD simply refers to a continuous malfunction of the kidney or even an abnormality in its structure, featuring a glomerular filtration rate less than 60 ml/min/1.73 m2. On the same note, Webster et al. (2017) argue that it could also be described as signs of kidney damage spanning over three months, notwithstanding the cause of such degradation. According to Fraser and Blakeman (2019), CKD is, most of the time, asymptomatic during the early stages when it would be simpler to manage. As it progresses, it becomes highly likely to result in cardiovascular outcomes and other complex conditions. CKD has symptoms that are often mistaken for other kidney conditions. However, the common signs and symptoms include periorbital and pedal edema, shortness of breath, nausea and vomiting, pain of the bones, inexplicable and constant drowsiness, mental fatigue, uremic frost, muscle cramps, impotence, persistent hiccups, blood in stools, and sleep apnea, among others (Arora, 2019). The disease is often more prevalent among older people, and risk factors include a history of diabetes, hypertension and cardiovascular diseases, smoking, and even obesity (Fraser & Blakeman, 2016).
The Centers for Disease Control and Prevention (2019) notes that CKD is highly prevalent, with some 15% of American adults (37 million people) suffering from the condition. These statistics could be underestimating the prevalence rate owing to the fact that about 90% of U.S. adults do not realize they suffer the disorder, even those whose kidneys do not function properly (CDC, 2019). Various states have different prevalence and incidence rates, depending on numerous factors. Below is a prevalence/incidence rate table for the state of Illinois.
| Characteristic | Prevalence 2018 [Source: (Lederer et al., 2018).] | Prevalence 2017 [Source: AHRQ, n.d.] |
| Total | 20, 770 (0.12%) | 1.0% |
| Age (53 and above) | 0.12% |
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| Sex | Male- 6717 (32.8%) |
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| Race | Female-14053 (67.7%) |
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| Race | Non-Hispanic Whites- 42.4% |
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| African Americans-20.9% |
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| Hispanic- 28.1% |
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The results in the table above are consistent with the national statistics provided by the CDC (2019), which notes that Americans above the age of 65 are the most affected, with an estimated total of 38% of the population diagnosed with CKD. The graph below presents the national CKD statistics.
Source: CDC (2019).
Even at the national level, the fact that numerous people do not know they have CKD makes it challenging to get correct estimations. Otherwise, it is projected that the number is higher than currently established.
Surveillance and Reporting
Crews, Bello and Saadi (2019) posit that a surveillance system replete with definite methods and parameters plays a significant role in the prevention of chronic diseases by providing critical information. The current surveillance method is primarily provided by the CDC’s system, which focuses on five indicators of CKD. Notably, such indicators include awareness of the disease, its risk factors, health repercussions, all the associated quality care practices and procedures, and the ability of a system to manage CKD. The surveillance method includes eight primary steps. At the onset, there is a general selection of topics and measures related to CKD followed by the finding of sources of data and crafting of precise indicators. The other steps comprise data collection, integration, analysis, interpretation and application of the results, development of surveillance instruments, and, finally, distribution of these tools. These tools further provide vital data that is used in monitoring the aforementioned indicators and particulars of CKD. The commonly known reporting process is through the CDC website Chronic Kidney Disease (CKD) Surveillance System launched less than a decade ago. It is not clear whether individual reporting processes are upheld because the existing one only deals with organizations, which act as sources of data. The surveillance system receives and compiles reports from bodies such as the Veterans Affairs Health System, Centers for Medicare and Medicaid Services, medical and associated laboratories, and even private healthcare systems. Members of the public who visit healthcare centers have their data recorded if they are diagnosed with CKD. Even so, the CDC website has been made simple and easily accessible to the general public (Johns & Jaar, n.d.). The CDC reports information on the site in a wide variety of formats, which include but are not limited to videos, simple and complicated graphs and charts, as well as summaries and maps. Other kidney and renal health organizations work in tandem with the CDC to survey, collect data, and report information based on the burden, prevalence, and methods of managing CKD.
Epidemiological Analysis
According to Vaidya and Aeddula (2018), it is difficult to analyze the epidemiology of CKD because it is asymptomatic at the onset until its effects become moderate, making most of the affected unaware of their CKD condition.
What
As already noted, CKD is defined as a continuous degradation and malfunction of the kidney for at least three months. Together with the signs and symptoms stated in the previous section, it could also show symptoms of the causative disease. This aspect could lead to a confusing situation where a patient unless thoroughly diagnosed, could mistake it for a different condition. Important to note is the fact that these signs and symptoms mostly appear when the disease has relatively affected the patient, making it harder to manage. Nonetheless, the Centers for Disease Control and Prevention (2019) estimate that over 125,000 people were hospitalized for CKD in the United States in 2016, with over 726,000 being on dialysis or requiring a kidney transplant. An approximated total of 240 people succumbs daily to the condition. The CDC adds that over 37 million Americans are currently suffering from the disease, a figure that can only increase as more people continue to report. Worldwide, several studies estimate the rate of prevalence from between 8-13% (Delanaye, Glassock, & De Broe, 2017). Important to note is that the financial costs associated with CKD are massive. In 2013, the U.S. Renal Data System estimated the total cost at over $81 billion for all stages of the disease (Golestaneh et al., 2017). These costs were determined to rise with the age of patients. Currently, there is no specific data on financial costs, but the estimates have arguably shot up because of the evident increase in the prevalence of the condition.
Who
CKD affects the entire population, but the highest prevalence is seen among older people from the age of 50 years and above (Vaidya & Aeddula, 2018). Determinants of health for CKD include age, gender, and race, among others. In America, the CDC (2019) notes that 15% of women suffer from CKD compared to 12% of men and that non-Hispanic blacks are more affected relative to their non-Hispanic whites or non-Hispanic Asians counterparts whose statistics stand at 16%, 13%, and 12%, respectively. Nationally, an estimated 14% of Hispanics suffer from CKD. Among American adults aged 18 years and above, hypertension and diabetes have proven to be the chief cause of CKD. Among the population below the age of 18 years, glomerulonephritis is the primary cause of CKD. Smokers are also put at a higher risk of the illness irrespective of their age, gender, or race. Based on this analysis, health determinants of the disease include underlying conditions, individual habits, as well as socioeconomic and nutritional statuses together with sex, race, and age.
Where
CKD can begin anywhere as long as a person exhibits the risk factors above.
When
CKD has been around for a relatively long time, and its prevalence has been on the increase. The current advances in technology have improved detection, surveillance, and reporting; thus, more people are diagnosed with the disease. It becomes hard to treat at advanced stages.
Why/How
The common causes associated with CKD include glomerulonephritis, diabetes mellitus, and hypertension, but at times, the reason may be unknown. Risk factors of CKD include obesity, high cholesterol, autoimmune diseases, atherosclerosis, kidney and bladder cancer, kidney stones and infection, vasculitis, and scleroderma, among other conditions that interfere with nephrons.
Screening and Guidelines
The widely used screening guidelines are provided by the Kidney Disease Improving Global Outcomes in conjunction with the National Institute for Health and Care Excellence (NICE). They both concur that a patient can only be diagnosed with CKD after their kidney condition has been deteriorating for not less than three months (Fraser & Blakeman, 2016). In particular, at least one element of the following criteria must be continuously present within the stated period: An eGFR below 60Ml/1.73m2; agents of kidney damage such as albuminuria, or abnormalities as seen from imaging, histological disorders, abnormalities resulting from tubular disorders, and a history of kidney transplantation or related procedures. The two bodies also recommend that people with the risk factors earlier identified should be screened for CKD. Currently, there exists a wide range of diagnostic methods, but the common ones include nuclear medicine MAG3 scan, which enables the confirmation of blood flow and any differences in the function in either of the kidneys. Kidney ultrasonography, another popular diagnostic method, works by detecting any pathologic change, and even predicting the reason for such abnormalities. However, the GFR estimation method is perhaps the simplest, easiest, and most effective way to diagnose and screen CKD. According to Gaitonde, Cook and Rivera (2017), GFR (glomerular filtration rate) best determines the renal function and is simply done by measuring serum creatinine. This screening test is highly sensitive, and there is an extremely less likelihood of errors that could lead to misdiagnosis. It also results in specific and definite figures that can be measured against the normal functioning kidney parameters over some time. As a result, it holds an extremely high predictive value, making it one of the most preferred screening and diagnostic methods. The financial cost of GFR and other screening methods vary from one facility to the other, but due to the simplicity of the technique, these costs are always affordable.
Plan: Integrating Evidence
The following plan is divided into primary, secondary, as well as tertiary interventions. Its primary goal is the prevention of the development, continuity, and any complications that may arise from CKD among the general population. The critical primary intervention plan involves lifestyle modification, specifically minimizing the consumption of dietary salt to discourage blood pressure and hypertension, as well as controlling blood glucose to prevent diabetes (Evangelidis et al., 2019). The outcomes will be measured through tests indicating an absence or low risk of contracting these conditions.
The secondary prevention plan will include the identification of the disease during the early stages. In particular, conducting GFR screening on patients as a means of detecting the presence of CKD. The mode of intervention will serve to keep an eGFR above 60ml/1.73m2, with anything less indicating a failure of this intervention.
The tertiary intervention will involve improving care among patients suffering CKD. In particular, Renal Replacement Therapy (RRT) is recommended (Vaidya & Aeddula, 2018). The options available will include hemodialysis, peritoneal dialysis, and kidney transplantation. These are long-term methods, and their usefulness will be measured by conducting screening as indicated above to ensure that the patient is free from the condition.
Summary
CKD is a constant degradation of the kidney and its functions for a period not less than three months with a characteristic glomerular filtration rate less than 60 ml/min/1.73 m2. Its wide range of symptoms often matches those of the accompanying conditions such as diabetes and hypertension. The disease, common among adults from 50 years of age, affects approximately 37 million people in America, and 90% of them fail to realize they are suffering until advanced stages. The CDC developed an effective surveillance system and an electronic reporting method in the form of a website dedicated solely to the condition. The existing screening and diagnostic guidelines primarily depend on measuring the glomerular filtration rate, while others employ imaging techniques. An integrated care plan proposed includes lifestyle modification, suppression of progression through early detection, and Renal Replacement Therapy for advanced cases.