The National Kidney Foundation (2017) posited that on average, 10% of the world’s population is affected by chronic kidney disease (CKD), and the mortality global mortality rate ranges into millions as majority of those affected have limited access to healthcare. Chronic kidney disease is gaining momentum as a global disease burden, climbing from the 27 th position in 1990 to 18 th position in 2010 in the list of the leading causes of mortality, only second to HIV and AIDs. It is estimated that over 2 million people are currently under treatment for CKD, which may represent only 10% of cases in need of treatment. In the US, CKD is the 9 th leading cause of death, and an average of 31 million people, representing 15% of the population live with the disease (American Kidney Fund, 2017, CDC, 2017). However, the CDC observed that awareness of CKD remains low among many population segments including physicians, a trend that needs reversal towards reduction of the burden. Exploration presentation, diagnosis, predisposing factors, and treatment options is necessary to highlight the need for screening of the disease.
Clinical Presentation of Chronic Kidney Disease
Chronic kidney disease results to a number of complications if not diagnosed early including risk of cardiovascular mortality, acute kidney injury, kidney disease progression, anemia, decline in cognition, and mineral and bone problems (Jha, Garcia-Garcia, Iseki et al. 2013). Complications are an outcome of the nature of the disease, which the National Institute of Diabetes and Digestive and Kidney Disease defines as any condition that decreases the normal functioning of the kidney over a period of time. Development of CKD over many years leading to end-stage kidney disease is a common occurrence, hence the need for early detection.
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According to American Kidney Fund, diabetes and hypertension are the leading and second causes of kidney failure, creating further complications in CKD diagnosis. Presentation of CKD is largely dependent on accumulation of fluids and waste from failure of the kidney to filter blood, and varies according to the stages in the development of the disease. Stages 1-3 where the glomerular filtration rate is greater than 30 mL/min/1.73 m², patients with CKD are mostly asymptomatic when defined from the perspective of negative symptoms caused by the reduction in glomerular filtration rate. At these stages, patients have no clinical manifestations in terms of disturbances in water and electrolyte balance.
Manifestations of the disturbances in water or electrolyte balance occurs in stage 4-5 of CKD when the GFR < 30 mL/min/1.73 m². At this stage positive symptoms such as edema, hematuria, and polyuria, get pronounced, in patients with nephrotic syndrome, cystic diseases, and tubulointerstitial disease, thus representing early symptoms of the disease. Further complications such as uremic manifestations, metabolic acidosis presented as protein-energy malnutrition, muscle weakness, and loss of lean body mass. Change in how the kidney regulates water and solutes in CKD, causes peripheral edema and occasionally pulmonary edema and high blood pressure. Anemia also develops manifested as fatigue, in ability to exercise normally, and impairment of cognitive and immune functions. Different stages of cardiovascular disease also present. Uremia in end-stage CKD is manifested through pericarditis, encephalopathy, peripheral neuropathy, restless leg syndrome, platelet dysfunction, erectile dysfunction, gastrointestinal problems, fatigue, and skin problems.
Diagnosis of CKD and the Role of Predisposing Factors
Clinical pathology and cause are critical to diagnosis of CKD as markers of kidney damage may show pathology (Levey & Coresh, 2012). As a result, predisposing factors play an important role in diagnosis, with the recognition of CKD as a global health problem that should be managed in the early stages. The first and most important stage in diagnosis involves discussion of the patient’s personal and family history. Genetics is critical to diagnosis as people from a family with history of CKD are at a higher risk of developing the disease. In addition, genetics is a risk factor for diabetes and hypertension, which are the leading causes of CKD globally. Lifestyle and individual behavior may also predispose a person to risk of developing conditions associated with CKD or the disease itself. According to CDC (2017), gender is critical in diagnosis as women are at higher risk of developing CKD than men (16% against 13%). Race is also of significance with CKD established to be more prevalent among non-Hispanic blacks than non-Hispanic whites. These factors bear immense significance when examining patients for CKD.
Diagnosis of CKD depends on the stage of the disease. For instance, physical examination may not reveal positive diagnosis results even in the presence of risk factors as stages 1-3 are commonly asymptomatic. However, each of the five stages of CKD development is characterized by changes in GFR, which can be detected through different laboratory tests, an important process that informs treatment. Failure of the kidney leads to accumulation of waste that can be detected. Blood tests seek to establish the level of waste such as creatinine and urea, whose elevation in blood indicates kidney problem. Urine analysis establishes abnormalities that point to CKD including its cause. Imaging tests are also vital in the assessment of the kidney structure, as well as kidney biopsy where a sample of kidney tissue is obtained for analysis.
Implications of Potential Treatment Options for CKD
It is important to reiterate that screening and intervention are necessary in the prevention of the disease and implementation of management strategies reduces the incidence of end-stage kidney disease (Levey & Coresh, 2012). Treatment options are targeted at delaying or halting the progression of the disease; diagnosis and treatment of pathologic manifestations; and timely planning for long-term kidney replacement. Therapy for CKD depends on the stage of the disease based on severity of renal failure. Therapy includes lifestyle changes, medication for controlling associated complications, dialysis to replicate some of the kidney functions in advanced stages, and kidney transplant after progression to stage 5 of complete renal failure.
Medication is a sensitive option because the kidney is responsible for elimination of metabolites of drugs from the blood. In case of renal failure, harmful metabolites may accumulate from such medications exacerbating the condition. Drugs compounding the effects of disease should be contraindicated and must be closely monitored. Hemodialysis and peritoneal dialysis are used to filter waste from the blood, and though this treatment option is effective, the frequency with which it is done presents a challenge to patients and practitioners. In addition, the cost of dialysis makes this treatment option inaccessible to middle and low income earners. Kidney transplant may also present challenges in relation to time taken for a perfect match to be available, and the possibility of rejection of the transplant by the host.
Impact of Patient Factors on Diagnosis and Treatment of Patients with CKD
There is a consensus about the negative contribution of patient factors in the diagnosis of CKD (Jha, Garcia-Garcia, Iseki et al. , 2012). Patient factors impact on early identification of patients, modification of risk factors, and implementation of interventions. According to Kazancioğlu (2013) a person’s genetic and phenotypic make up influences the risk of CKD. While patients with a family history of the disease can be treated as suspected cases, those with no history pose challenges. The co-occurrence of CKD with risk factors such as hypertension in patients with family history of high blood pressure can result to misleading diagnosis because of “negative symptoms.” Patients with high blood pressure, diabetes, cystic or hereditary congenital disease, and glomerulonephritis compound the diagnosis process and treatment, which must account for both conditions increasing the risk of negative impacts from contraindicated drugs. Genetics may also impact reception of a kidney transplant by the host. Demographic factors such as old age, gender, ethnicity, low birth weight, and old age have also been established to increase the risk of CKD, and may impact the effective of treatment. Lifestyle and behavior that predisposes one to CKD complicates diagnosis and reduced the efficiency of treatment by delaying or accelerating progression of the disease from stage to another.
Conclusion
Chronic kidney disease is a significant global disease burden with millions of people suffering from it and other under treatment for the disease. The disease presents in a number of ways as manifestations of accumulation of fluids due to kidney failure, which are symptomatic in the late stages of the disease progression. Diagnosis is based on detection of elements indicative of renal pathology in the blood or urine, and may also entail imaging of the kidney structure or a biopsy. Treatment of CKD aims to reduce or halt progression to the end-stage and includes changes in lifestyle, medication, dialysis, or a kidney transplant. These treatment options can have negative impacts based on the underlying condition of the patient, which may be detrimental to their effectiveness.
References
American Kidney Fund. (2017), Kidney disease statistics- 2015. Retrieved 17/07/2017 from: http://www.kidneyfund.org/assets/pdf/kidney-disease-statistics.pdf.
Center for Disease Control and Prevention. (2017). National chronic kidney disease Fact sheet, 2017. Retrieved 17/07/2017 from: https://www.cdc.gov/diabetes/pubs/pdf/kidney_factsheet.pdf.
Jha, V., Garcia-Garcia, G., Iseki, K., Li, Z., Naicker, S., Plattner, B., ... & Yang, C. W. (2013). Chronic kidney disease: global dimension and perspectives. The Lancet , 382 (9888), 260-272.
Kazancioğlu, R. (2013). Risk factors for chronic kidney disease: an update. Kidney international supplements , 3 (4), 368-371.
Levey, A. S., & Coresh, J. (2012). Chronic kidney disease. The lancet , 379 (9811), 165-180.
National Kidney Foundation. (2017). Global facts: About kidney disease. Retrieved 17/07/2017 from: https://www.kidney.org/kidneydisease/global-facts-about-kidney-disease.
