Chronic Kidney Disease, Essay Example

Introduction

Chronic kidney disease (CKD) is an epidemic. Recent publications reveal that “the prevalence rate of CKD in the community at large is high and rising rapidly” (Glassock & Winearls, 2008, p. 1117).  According to the data of the U.S. Renal Data System’s report (2013), chronic kidney disease’ prevalence across the National Health and Nutrition Examination Survey (NHAES) population between 2005 and 2010 was 5.7 percent.  Several studies have revealed that there is a strong correlation between obesity, diabetes and CKD.  The below study is attempting to reveal the most successful evidence-based approaches to tackle this health problem,  along with ways to increase health access across the entire population and reduce health inequalities related to chronic kidney disease.

Identification and Significance of the Problem

The National Chronic Kidney Disease Fact Sheet (National Center for Chronic Disease Prevention and Health Promotion, 2014, p. 1) confirms that CKD is a serious condition that damages kidneys and makes them unable to filter blood as well as healthy ones.  As a result, excess amount of Urea (product of the breakdown of proteins), Creatinine (waste product of the muscles), and dissolved salts will remain in the blood system, causing further health problems. The condition, without treatment can lead to kidney failure, which results in a need of regular dialysis to replace the function of the kidneys: flushing the above substances out of the body.

Although CKD is under reported in the United States, the National Center for Chronic Disease Prevention and Health Promotion (2014, p. 2) confirms that an estimated ten percent of the adult population may have the condition.  Those aged 50 and over are at a higher risk of developing CKD, while the most important risk factors are high blood pressure and diabetes. Krol (2011) confirms, “Persons with CKD have significantly higher rates of morbidity, mortality, hospitalizations, and healthcare utilization” (p. 5). This means that the increase of new cases creates a great burden on the healthcare system’s resources.  Hunsicker (2004) states that, the cost of health care for CKD patients is 1.08 to 2.9 times the expenditure of non-CKD patients’ (p. 1363).

Literature Review

The review of the Agency for Healthcare Research and Quality (AHRQ) (Fink et al., 2012) states that the prevalence of CKD in the U.S. population is 11 percent, while nearly half of the cases are stage 1 or 2. Taking into consideration the stage of the condition is important when creating an intervention method; therefore, the diagnostic criteria for all stages will be detailed below.  The condition is measured through glomerular filtration rate (GFR), determinng the level of kidney function from the blood creatinine test. Sage 1 CKD relates to h GFR ?90 mL/min/1.73 m2, Stage 2 is identified by GFR 60–89 mL/min/1.73 m2, Stage 3 is GFR 30–59 mL/min/1.73 m2, Stage 4’s criteria is GFR 15–29 mL/min/1.73 m2, while Stage 5 is the final outcome of the condition, resulting in kidney failure, GFR <15 mL/min/1.73 m2, and at this point CKD can only be treated using either dialysis or transplantation (Fink et al., 20121, p. 18).

From the above review of diagnostic criteria, it is evident that the more advanced the condition is, the harder and more costly the treatment is. This also indicates that screening, and targeting the at risk population for prevention should be the main focus of health programs attempting to successfully tackle the epidemic of CKD.  Chadban et al. (2010) state that screening and intensive management at an early stage are supported by evidence as the most effective intervention methods. Risk factor categories were identified by the United States Renal Data System (2013) as diabetes, hypertension and cardio-vascular disease. The correlation between these conditions is confirmed and significant when creating an intervention and prevention plan to successfully identify and target at-risk populations.

Risk of mortality has been examined by Tonelli et al. (2006).  The authors created a study to reveal the risks of morbidity related to chronic kidney disease in order to support the planning of public policies.  The review of related publications revealed that most of the studies confirmed an “increased risk for all-cause and cardiovascular death” (p. 242).  The authors call for a more intensive intervention policy in order to reduce morbidity among CKD patients. (Angus, Cairns, Purves, Bryce, MacDonald & Gordon. 2013)

Naqui & Collins (2006) examined the potential complications of kidney disease, in particular focus on infections. The authors state that the incidence of “infectious complications is approximately 3 times greater among CKD patients who have not yet initiated dialysis than the general population” (p. 200).  The research also confirmed that morbidity related to sepsis, urinary tract infections (UTI), and pneumonia among patients with CKD was higher than those who had a healthy kidney.

Because dialysis patients are more prone to infection, policy makers should focus on preventing CKD and treating the early stages of CKD to prevent the higher costs of more complex treatments.

Theoretical Framework for Intervention

The above literature review has revealed that CKD is an epidemic across the U.S. population and there are some confirmed correlations between cardiovascular disease, obesity and diabetes and the risk of developing CKD (U.S. Renal Data System, 2013).

It has also been revealed that the majority of cases remain unreported, while late discovery of the condition can increase the expenditure of the health care system related to treatments. The theoretical framework of the current study  will use in this case will be the Explanatory theory that targets problem behaviors and situations (National Cancer Institute, 2005). It focuses on the social context of the behavior. It is one of the most successful approaches towards creating preventive programs, communication while targeting populations identified as “at risk”.  By making assumptions based on individual and group level behaviors, it is able to address diverse groups and creating a comprehensive plan that focuses on the problematic behavior of the at-risk population.

Green (2000) states that the application of explanatory theory helps policymakers identify the problem within the health care system related to inadequate prevention and screening in order to create policies that improve health outcomes for CKD patients. Further, it can be used to evaluate programs’ outcome. The reasons why so many patients do not seek healthcare, at an early stage of the illness and why they are not identified as a member of the “at-risk population”. The Explanatory theory will allow the authors to successfully address the shortcomings of the U.S. health care system and create positive outcomes.  The intervention plan would focus on prevention, correct identification of at-risk populations, targeted screening programs and interventions to reduce complications and morbidity rates.

The other theory the authors would like to use to create an intervention framework is the Theory of Planned Behavior (TPB). It would help policymakers and health care staff understand the relationship between diverse health beliefs, attitudes and intentions, as well as health related behavior. By examining at-risk populations’ perceived behavioral control, patients could be motivated to seek help at an early stage, reducing the number of acute (Stage 3-4) cases. At-risk groups’ health beliefs will need to be examined in order to understand their perceptions of risk and risky behavior, in order to develop an intervention plan.

Proposed Intervention Methods

Kerr, Bray, Medcalf, Donoghue & Matthews (2012) reviewed the costs associated with treating CKD. The estimation based on research of studies and publication revealed that dialysis was the most expensive intervention, followed by transplant. Non- renal replacement therapy, including primary care; anti-hypertensive prescriptions, consultation and tests were the most cost-effective treatment methods.

Based on the explanatory theory’s principles, the authors would like to reveal why cases of CKD are diagnosed late.  It has been previously confirmed that the further the condition progresses, the more of health care resources need to be utilized.  Morbidity and complication rates also increase as chronic kidney disease progresses from one stage to the next. This provides the authors with clear goals for the intervention: identifying at-risk populations, targeting them and understanding why patients seek health care late.

The intervention plan will be based on results of the above literature review identifying the most at-risk populations. Further, the authors would like to create a community survey among patients already diagnosed with Stage 3 and 4 chronic kidney diseases in order to understand why their illness progressed to that stage, reveal when most of the symptoms start occurring and the motivations of individuals for seeking help. Patients who have diabetes or cardiovascular disease will also be asked whether or not they are aware of their increased risk of chronic kidney disease.

In order to implement a successful intervention plan, it is important to study the current preventive and treatment options available through the U.S. health care system. In order to identify the problems and tackle them, patient surveys and current treatment policies need to be reviewed. The first step of the implementation will be to identify the problem situation or behavior. The theory of planned behavior will help the health care staff determine the aspects that delay at-risk population’s health-seeking approaches and the delay in contacting health care professionals.  The most important problem to tackle is late intervention inadequate health-seeking behavior. Creating a health awareness program in communities, health care institutions and nursing homes with high prevalence of coherent conditions will be important to change patients’ health beliefs and health related behavior, based on the TPB theory.

Next, the authors would like to review the screening schedule across the U.S. population to identify the shortcomings. Several authors (U.S. Renal Data System, USRDS 2013, p. 47) have confirmed that low screening rates contribute towards late intervention. Therefore, policies will be created to support health care staff in identifying at-risk patients and developing a screening plan across the population.  The AHRQ review (2012) emphasizes the importance of early stage screening, setting clear therapeutic goals.

Next, policies need to be evaluated related to diagnosing and treating Stage 1 and Stage 2 chronic kidney disease. It is important to note that by early diagnosis, the number or more advanced cases can be reduced, alongside with morbidity rate and the number of complications that can occur at later stages of the illness.

The interventions plan will, finally focus on an effective early stage treatment plans, creating awareness among at-risk and affected population, in order to change their health behavior. Preventive care education will be provided for individuals who have at least one of the below conditions that increases their risk of chronic kidney failure: cardiovascular disease, hypertension, obesity and diabetes and they will be asked to voluntarily enroll to screening programs.  The Divisions Of Nephrology & Hypertension And General Internal Medicine (2010) confirms that today “Only 5% and 10% of the general Medicare population undergoes a screening urinalysis or a SCr, respectively”. The authors have noted the effectiveness of the screening in early detection.

Finally, the intervention plan will focus on identifying the knowledge gaps among caregivers and health care staff related to available screening and treatment programs in order to allow them to learn about initiatives and successfully communicate the program’s goals, positive health behavior principles towards patients.

Expected Results

The intervention plan is expected to increase the number of early stage chronic kidney failure diagnoses, however, early intervention will, in a long term, result in fewer number of advanced cases (Stage -3-5).  The health education program will also promote patients’ lifestyle changes to reduce risks of the condition. Focusing on at-risk populations, it is likely that more early stage cases will be diagnosed.  As the treatment outcomes of early stage CKD are more positive than later stages’, it is likely that in 3-5 years’ time the number of cases can be reduced within the population that was originally targeted by the program.  The health care costs associated with treating CKD are likely to decrease, as even though more cases would be diagnosed, a smaller proportion of them will be advanced, requiring dialysis or kidney transplant; the most expensive intervention methods. Costs associated with treating complications and infections, due to the reduced number of advanced cases will also be declining.

Conclusion

Based on the above literature, research and theoretical review of chronic kidney disease, the author of the current study has concluded that early detection, screening and stage 1-2 intervention, alongside with targeted education of at-risk populations to change health-related behaviors and high risk lifestyles is the most effective approach to develop an intervention framework. Based on the statistical review concluded, it is evident that early detection can not only result in lower mortality rate but better overall health outcomes and lower cost of treatment at the same time. Determining health behavior motivators across at-risk populations should be the first step in order to determine the barriers of prevention and early detection of CKD, however, the knowledge of health care staff treating related illnesses should also be reviewed. Staff, community and health care based education plans can create long-term positive results, reducing the number of serious, advanced cases, the utilization of health care resources, while improving the overall health outcome of the affected population.  While the low detection and high morbidity rate has been already identified by researchers as the main problem in CKD care, the utilization of the explanatory theory is needed to understand why patients seek help late and why health care professionals fail to identify the condition at an early stage. The author of the current study believes that by understanding patient behaviors and health beliefs, CKD care, prevention and treatment options can be improved and the number of new cases can be reduced.

References

Angus K, Cairns G, Purves R, Bryce S, MacDonald L. &Gordon R. (2013) Systematic literature review to examine the evidence for the effectiveness of interventions that use theories and models of behavior change: towards the prevention and control of communicable diseases. Stockholm: ECDC;

Chadban S, Howell M, Twigg S, Thomas M, Jerums G, Cass A, Campbell D, Nicholls K, Tong A, Mangos G, Stack A, MacIsaac RJ, Girgis S, Colagiuri R, Colagiuri S &Craig, J. (2010) Cost-effectiveness and socioeconomic implications of prevention and management of chronic kidney disease in type 2 diabetes. Nephrology, 2010; 15, S195–S203

Fink HA, Ishani A, Taylor BC, Greer NL, MacDonald, R, Rossini D, Sadiq S, Lankireddy S, Kane RL, Wilt TJ. (2012) Chronic Kidney Disease Stages 1–3: Screening, Monitoring, and Treatment. Comparative Effectiveness Review No. 37. (Prepared by the Minnesota Evidence-based Practice Center under Contract No. HHSA 290-2007-10064-I.) AHRQ Publication No. 11(12)-EHC075-EF. Rockville, MD: Agency for Healthcare Research   and  Quality. Retrieved from www.effectivehealthcare.ahrq.gov/reports/final.cfm

Glassock, R. & Winearls, C. (2008) An epidemic of chronic kidney disease: fact or fiction? Nephrology Dialysis Transplantation. (2008) 23: 1117–1121

Green, J. (2000) The role of theory in evidence-based health promotion. Oxford University Press.

Hunsicker, L. (2004) The consequences and costs of chronic kidney disease before ESRD. Journal of the American Society of Nephrology. 15: 1363–1364, 2004

Kerr, M., Bray, B., Medcalf, J., Donoghue, D. & Matthews, B. (2012) Estimating the ?nancial cost of chronic kidney disease to the NHS in England. Nephrology Dialysis Transplantation. (2012) 0: 1–8

Krol, G. (2011) Chronic kidney disease staging and progression. Henry Ford Health System, Divisions of Nephrology & Hypertension and General Internal Medicine. Sixth Edition.

National Center for Chronic Disease Prevention and Health Promotion Division of Diabetes Translation. (2014) National Chronic Kidney Disease Fact Sheet, 2014 Retrieved from: http://www.cdc.gov/diabetes/pubs/pdf/kidney_factsheet.pdf

Naqvi, S. & Collins, A. (2006) Infectious Complications in Chronic Kidney Disease. Advances in Chronic Kidney Disease, Vol 13, No 3 (July), 2006: pp 199-204

Tonelli, Wiebe, Culleton, House, Rabbat, Fok, McAllister & Garg (2006) Chronic Kidney Disease and Mortality Risk: A Systematic Review. Journal of the American Society of Nephrology.  17: 2034 –2047, 2006

U.S. Renal Data System, USRDS 2013 (2013) Annual data report: Atlas of chronic kidney disease and end-stage renal disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2013

National Cancer Institute (2005) Theory at a glance. A guide for health promotion practice. (Second Edition) U.S. Department Of Health And Human Services. National Institutes of Health.