Chronic kidney disease (CKD) is a prevalent issue in the United States with a high incidence rate. Millions of people in the United States suffer from CKD with most of the patients unaware of their condition. Nurse practitioners contribute significantly to help patients manage CKD to hinder illnesses, enhance optimal health, and relieve suffering. In turn, this enables patients to live fully and happily while dealing with CKD.
The present paper examines the role of nurse practitioners in hindering the progression of CKD. The paper will explore the existing literature regarding the role of nurse practitioners in CKD management and the implication of the information from the current research for practice.
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Summary and Analysis
CKD is a significant public health issue today affecting millions of people. Its features include gradual impairment of renal function and nearly permanent progression to end-stage renal disease (Peeters et al., 2014). The disease and its associated treatments strongly affect the social, mental, and physical wellbeing of patients. Worsening psychological and physical conditions among patients as the disease progresses leads to a poor diagnosis. Patients have limited daily activities and must deal with regular readmissions, which adversely affect both families and patients. In turn, this leads to poor quality of life. The objectives of managing patients with CKD should, thus, be focused on delaying progression, managing symptoms, reducing complication rate and improving quality of life.
Peeters et al. (2014) document the benefits of nurse practitioners in the management of CKD to handle the psychosocial or physical issues among CKD patients. The study demonstrate that nurse practitioners could offer long term support to CKD patients to attenuate kidney function decline and improve renal outcome, which can be achieved through following up on patients after discharge from hospitals until the patient condition improves. The study also shows that extended follow-ups are essential as they positively affect renal endpoints interventions that aim to prevent CKD progression. The research shows the benefits of GFR decline, which is vital in decreasing blood pressure, cholesterol anemia, hyperphosphatemia, low-density lipoprotein, and proteinuria and improves compliance to dietary limits of fluid and salt intake among CKD patients. Through coordinated care, nurse practitioners enhance the rate of GFR reduction and manage many risk factors that could lead to CKD progression. Adjunctive support from nurse practitioners is crucial as it reduces the rate of CKD progression and improves renal outcomes. The Peeters et al. (2014) study, however, focused on the effectiveness of dealing with psychosocial or physical issues without addressing the impact of those issues on the quality of life of patients, which is an important outcome measure for CKD patients in terms of their well-being.
Another study by Gemma et al. (2018) also supports the importance of the additional support by NP in improving risk factors and renal outcome. Based on the study, CKD is a risk factor for the development of the cardiovascular disease, which stresses the importance of hindering CKD progression. The role of NP in inhibiting CKD progression includes intensified support to patients that provides for extended follow-ups. In turn, this improves prognoses and contributes to the prevention of CKD progression.
Li et al. (2014) study demonstrates the significance of quality of life improvements for patients with nurse-led CKD management programs compared to the control group. Based on the research, nurse practitioners can prevent the progression of CKD by helping patients manage their pain, symptoms, sleep, fatigue, mental problems and physical problems interactively (Li et al., 2014). They can do this by following up on patients after hospital discharge to encourage both patients and families to adjust their lives, for instance through adequate exercises to enhance physical function and to lessen symptoms such as pain, depression, anxiety, sleep issues, and fatigue. While the vital quality of life items that demonstrate positive outcomes are inconsistent in the Li et al. (2014) study, the small sample size in the study might account for this inconsistency. In turn, this is inadequate to offer valid proof regarding the role of nurse practitioners in the management of CKD. It is, thus, unclear whether nurse practitioners play a vital role in the management of CKD to prevent its progression.
Another study by Walker, Marshall, and Polaschek (2014) demonstrates the importance of nurse-led interventions in improving the management of risk factors involved in the progression of CKD for patients at a high risk of CKD progression. The study proposes an integrated care framework led by a nurse practitioner to improve the control of accepted risk factors for CKD progression. Based on the research, nurse-led programs entailing sufficient support and training regarding CKD management help patients adhere to lifestyle and medication advice. The role of NPs may involve an NP collaborating with primary care practitioners such as practice nurses to educate patients about best practice and evidence-based CKD management. The study was, however, limited by the risk of confounding and bias due to the absence of clinical data from the time before the intervention. The study was also small scale research that only demonstrates the feasibility of nurse-led interventions without showing evidence of clinical effectiveness of the intervention.
The study by Slesnick et al. (2015) sought to investigate and assess the feasibility and effectiveness of the Chronic Disease Self-Management Program among CKD patients with ESRD. Based on the study, nurse practitioners can play a significant role in caring for CKD patients before the disease progresses to ESRD.NPs can, for instance, use self-efficacy strategies to reduce CKD progression by implementing them in approaches to be used with CKD patients in all phases, particularly for peritoneal dialysis and hemodialysis patients. The study used the Self-Efficacy for Managing Chronic Disease 6-Item Scale. The study also used an educational intervention to influence self-efficacy in a CKD group by implementing programs such as education, group sessions, and class sessions. Self-efficacy was high in the intervention group, even though the study did not describe approaches for improving self-efficacy. While the intervention had a significantly different self-efficacy compared to the control group, the study did not find any substantial blood pressure improvements. The study also did not include any specific theory to guide the development of self-efficacy intervention.
Implications for Practice
A vital objective of caring for CKD patients is to decrease CKD progression and ensure the kidney functions for extended periods from the initial stages. Nurse practitioners play a crucial role in preventing CKD progression because of their frequent interactions with patients and the ability to deal with patients face-to-face regularly. Healthcare organizations should, thus, ensure that nurses have the required resources to assist them in assisting CKD patients. They can also ensure that NPs understand the functions and ideas of different intervention programs such as self-efficacy to design targeted and tailored interventions and support CKD patients to manage their disease. The studies show that an NP-led intervention is practical and can improve risk factors for CKD progression. NPs can also work collaboratively with other primary care practitioners to develop targeted and tailored interventions.
References
Gemma, T., Nishida, H., Oishi, M., Hirai, T., & Fujii, T. (2018, May). The Intervention by Nurse Practitioners Prevents Kidney Disease Progression in Patients with Chronic Kidney Disease. In nephrology dialysis transplantation (Vol. 33). Great Clarendon St, Oxford OX2 6DP, England: Oxford University Press.
Li, J., Wang, H., Xie, H., Mei, G., Cai, W., Ye, J., ... & Zhai, H. (2014). Effects of Post- Discharge Nurse-led Telephone Supportive Care for Patients with Chronic Kidney Disease Undergoing Peritoneal Dialysis in China: a Randomized Controlled Trial. Peritoneal Dialysis International , 34 (3), 278-288.
Peeters, M. J., van Zuilen, A. D., van den Brand, J. A., Bots, M. L., van Buren, M., ten Dam, M. A., ... & van de Ven, P. J. (2014). Nurse Practitioner Care Improves Renal Outcome in Patients with CKD. Journal of the American Society of Nephrology , 25 (2), 390-398.
Slesnick, N., Pienkos, S., Sun, S., Doss-McQuitty, S., & Schiller, B. (2015). The Chronic Disease Self-management Program—A Pilot Study in Patients Undergoing Hemodialysis. Nephrol News Issues , 29 (4), 22-3.
Walker, R. C., Marshall, M. R., & Polaschek, N. R. (2014). A Prospective Clinical Trial of Specialist Renal Nursing in the Primary Care Setting to Prevent Progression of Chronic Kidney: a Quality Improvement Report. BMC family practice , 15 (1), 155.
