Sample Healthcare Paper on Chronic Kidney Disease

Chronic Kidney Disease (CKD) results from damaged kidneys that lose their ability to clean blood like healthy kidneys. Without proper functioning kidneys, excess wastes and water build up in the body. The damage can lead to other major health problems, such as hypertension and cardiovascular disease. It is estimated that approximately 37 million people in the United States are currently affected by Chronic Kidney Disease. However, about 90% of the adults with CKD are not aware that they have it. CKD is ranked as the 9th leading cause of death in the USA and a global health concern. This paper focuses on the background and significance of Chronic Kidney Disease, surveillance and reporting mechanisms, the epidemiological analysis of CKD, screening and guidelines, and interventions to address CKD.

Background and Significance

Chronic kidney disease involves the gradual loss of kidney function over time. It means that kidneys are damaged and are unable to filter blood as required (Centers for Disease Control and Prevention [CDC], 2019). The damage can lead to an elevated level of wastes, fluids, and electrolytes in the body (Mayo Clinic Staff, 2019). High blood pressure and diabetes are the two major causes of Chronic Kidney Disease. From 2014 to 2016, these two conditions accounted for nearly 75% of cases of kidney failure (National Kidney Foundation, 2019). In the USA, 1 in 3 adults is at risk of CKD. Genetics, past damage to the kidneys, old age, obesity, and cardiovascular illnesses also put people at a high risk of CKD (CDC, 2019).

The signs and symptoms of CKD may not appear until kidneys are significantly damaged. According to Mayo Clinic Staff (2019), the signs and symptoms of chronic kidney disease include nausea, loss of appetite, vomiting, sleep problems, fatigue, swelling of feet and ankles, decreased concentration, decreased or increased urination, persistent itching, shortness of breath because of fluid buildup in the lungs, chest pain if fluids buildup near the heart and high blood pressure, which is hard to control. Kidney failure results in irreversible damage, and patients have to rely on dialysis or kidney transplant to live.

CKD is more prevalent in adults who are 65 years and older at 38%, 13% in people aged 45-64 years, and 7% in people aged 18-33 years. Chronic kidney diseases are more common in women, 15% than men at 12% in the USA. About 16% Non- Hispanic blacks, 13% Non- Hispanic Whites, and 12% Non- Hispanic Asians have CKD (CDC, 2019). By 2016, the prevalence and incidences of end-stage CKD varied across different states, as shown in Table 1.1 below:

Table 1.1 Comparison of incidence and prevalence rates of CKD in Florida to that of the United States of America

Location Incidence Rate Crude Incidence Rate

 (per million/per year

 

 

 

 

 

Prevalence

Rates

 

Crude Prevalence  Rate

 (per million/per year

Florida 8,342 403  

 

 

43,988

 

 

 

2,102

United States 124, 675 388 726,331 2,274
     

 

The United States Renal Data System (2019) established that the incidence rate of the end-stage Renal Disease in Florida is 403 per million per year as compared to the 388 per million per year in the entire nation in 2016. The prevalence rate in Florida was lower at 2,102 as compared to 2,274 per million per year in the entire United States.

Surveillance and Reporting of CKD

Following the substantial burden of Chronic Kidney Disease, the CDC has been mandated to establish a national surveillance system for the disease. The surveillance system was designed and developed with the help of epidemiologists from the University of California at San Francisco and the University of Michigan (Johns & Jaar, 2013). Previously, there was no place to find comprehensive and detailed information on Chronic Kidney Disease.

The type of information gathered by the surveillance system focuses on five major indicators or topics in CKD, namely awareness, the risk factors, related health consequences, treatment processes, and quality of care and capacity of the health system. The surveillance system also focuses on statistics of incidence and prevalence rates. These five indicators are consistent with the Healthy People 2020 indicators that are 10-year evidence-based national objectives aiming to improve the Americans’ health developed by the Department of Health and Human Sciences. The surveillance website includes a section dedicated to tracking progress towards meeting these 10-year CKD goals (Johns & Jaar, 2013).

The CDC regularly reports on the data gathered. Information gathered by the surveillance system website is available for the general public. It is presented in different forms, including figures, charts, maps, videos, and summaries. The CDC also generates a Fact Sheet containing a detailed overview of the CKD burden in the United States (CDC, 2019). The information from the surveillance system is important for CKD patients, the general public, and health care providers, and policymakers. The information helps in quantifying the burden of the disease, promoting disease awareness, and coming up with policies for prevention and improved treatment for CKD patients (Johns & Jaar, 2013).

Epidemiological Analysis

Chronic Kidney Disease is recognized as a public health crisis in the United States. The disease is described by lasting damage to the kidneys, which occurs slowly over months or years. CKD occurs when a condition or a disease impairs the proper functioning of the kidney, resulting in kidney damage. The disease occurs as a result of major diseases or conditions, which are high blood pressure and diabetes mellitus. In the United States, about 1 in 5 adults with high blood pressure and 1 in 3 adults with diabetes may develop CKD (National Kidney Foundation, 2019).

People from some demographic groups in the United States are more at risk of CKD than others. The burden of Kidney Disease is correlated with social-economic factors in most societies across the world. In the United States, people of low social-economic status and minority and racial/ethnic groups are more affected by the diseases (Crews, Belllo, & Saadi, 2019).  African Americans are three times more likely to develop Chronic Kidney Disease than the White people. The Hispanics are roughly 1.3 times likely to be diagnosed with CKD than the Non- Hispanics (National Kidney Foundation, 2019). Children and adolescents with untreated health conditions, such as high blood pressure or obesity, are likely to develop CKD.

The socially disadvantaged groups are at higher risk of CKD due to inequalities that result in difficulties in preventing the clinical causes of CKD such as diabetes and hypertension. Socioeconomic status influences people’s lifestyle behavior. People with low- income may face barriers to healthy eating and access to medical care, which increases their risk for kidney disease (Crews, Belllo & Saadi, 2019). The cost of addressing CKD is high in the United States. In 2016, the Medicare cost was $114billion for people with all stages of CKD.  The patients undergoing dialysis spent approximately $89,000 and kidney transplant patients used up $35,000. Emotional and mental health issues are social costs associated with CKD patients (National Kidney Foundation, 2019).

Screening and Diagnosis Guidelines

The goal of screening for CKD is to recognize the diseases at its early stages and come up with early interventions. The clinical guidelines for screening Chronic Kidney Disease recommend screening to be done for all asymptomatic adults without a diagnosed CKD. Screening for CKD is done using various screening tests. Some of the common tests include a test for albuminuria to detect any presence of protein in the urine and the serum creatinine test in  the blood to measure the glomerular filtration rate (GFR). It is recommended to screen for diabetes, hypertension, obesity, and the use of aspirin to prevent cardiovascular disease, which is associated with CKD (Agency for Healthcare Research and Quality, 2014).

The specificity and sensitivity of a screening test determine its validity. Sensitivity describes the capability of a screening test to accurately identify those who have CKD. The ability of a test to correctly detect people who do not have the illness determines its specificity. When a CKD screening test can yield the same results repeatedly under similar conditions, then it is said to be reliable. The ability of a positive test to predict a positive result of a given disease is positive predictive value, and the ability of a negative test to rule out a disease based on a negative result is known as negative predictive value (Jaar, Khatib, Plantinga, Boulware, & Powe, 2007).

The urine albumin-creatinine ratio test is a quantitative measurement test used for the detection of Chronic Kidney Disease by detecting albuminuria in clinical settings. The test has the highest validity. A study done to identify the accuracy of the test found out that the sensitivity and the specificity of this test are 83.2% and 80.0%, respectively. The predictive value of the test was identified as a positive 50% and negative predictive value at 95% (Mctaggart et al., 2012).

Plan: Integrating Evidence

Prevention interventions for CKD are important in the management of risk factors of the disease and early treatment of the disease. Conducting screening for CKD is an important preventive intervention. Between 1996 and 2003, incidences of diabetes-related CKD in Native American reduced CKD by 54 % due to prevention interventions (National Kidney Foundation, 2019). The interventions will be measured by identifying the number of people who have been screened early, people undergoing early treatment in the early stages, and reduced complications of the disease. Prevention also includes providing health education to people on a proper lifestyle to reduce the risk factors of CKD.

Medical interventions should be provided to patients with chronic kidney disease. Some of the medical interventions include supporting patients undergoing dialysis and kidney transplant to manage kidney problems. Other medical interventions include treatment for complications, including high blood pressure and diabetes. These interventions are evaluated through the number of patients with reduced complications and deaths related to CKD (Mayo Clinic Staff, 2019).

Self-management interventions are fundamental in addressing CKD. These interventions shift from education programs only to encouraging patients to be responsible for their illness. The interventions are beneficial as patients become active determiners of their health. Studies have shown that self-care improves blood pressure levels, urine protein decline, and exercise levels as compared to standard treatment. The measurement of the usefulness of the interventions includes monitoring blood pressure levels and urine protein levels to determine how self-management treatment helps in preventing CKD progression (Peng et al., 2019).

Conclusion

The burden of Chronic Kidney Disease is expected to rise. Currently, the disease is prevalent among approximately 37 million people in the United States. The major causes of CKD are diabetes and high blood pressure. The signs and symptoms of the disease mostly occur in the later stages. The incidence rate of CKD in 2016 in Florida was higher than at the national level, while the prevalence rate in the United States remained high than in Florida. The CDC has been mandated to establish a national surveillance system for CKD. The CDC generates reports such as the Fact Sheets on CDC indicators. In the United States, African Americans are at more risk of CKD. The risk is increased by the low social-economic status of various groups in the United States. The cost of managing the disease is currently very high. The urine albumin-creatinine ratio test is a screening test for CKD with demonstrated high specificity and sensitivity. Screening is very important to allow for early treatment. Some of the three key interventions in management CKD are preventive interventions, medical interventions, and self- management interventions. Addressing CKD requires a multidisciplinary action that involves all stakeholders, including health practitioners, policymakers, research institutions, community organizations, and patients.

 

 

 

References

Agency for Healthcare Research and Quality. (2014). Guide to Clinical Preventive Services. Rockville, MD.

Centers for Disease Control and Prevention. Chronic Kidney Disease in the United States, 2019. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2019.

Crews, D. C., Bello, A. K., & Saadi, G. (2019). Burden, Access, and Disparities in Kidney Disease. Nephron141(4), 219–226. DOI: 10.1159/000495557

Jaar, B. G., Khatib, R., Plantinga, L., Boulware, L. E., & Powe, N. R. (2007). Principles of Screening for Chronic Kidney Disease. Clinical Journal of the American Society of Nephrology3(2), 601–609. DOI: 10.2215/cjn.02540607

Johns, T., & Jaar, B. G. (2013). U.S. Centers for Disease Control and Prevention launches new chronic kidney disease surveillance system website. BMC Nephrology14(1). DOI: 10.1186/1471-2369-14-196

Mayo Clinic Staff. (2019, August 15). Chronic kidney disease. Retrieved from https://www.mayoclinic.org/diseases-conditions/chronic-kidney-disease/diagnosis-treatment/drc-20354527.

Mctaggart, M. P., Price, C. P., Pinnock, R. G., Stevens, P. E., Newall, R. G., & Lamb, E. J. (2012). The Diagnostic Accuracy of a Urine Albumin-Creatinine Ratio Point-of-Care Test for Detection of Albuminuria in Primary Care. American Journal of Kidney Diseases60(5), 787–794. DOI: 10.1053/j.ajkd.2012.05.009

National Kidney Foundation. (2019, September 4). Kidney Disease: The Basics. Retrieved from https://www.kidney.org/news/newsroom/factsheets/KidneyDiseaseBasics

Peng, S., He, J., Huang, J., Lun, L., Zeng, J., Zeng, S., & Wu, Y. (2019). Self-management interventions for chronic kidney disease: A systematic review and meta-analysis. BMC Nephrology20(1). DOI: 10.1186/s12882-019-1309-y

United States renal data system. (2018). Retrieved from https://www.usrds.org/2018/view/v2_01.aspx.