Chronic Kidney Disease, Research Paper Example

Introduction

Chronic kidney disease (CKD) is a complex disease that is characterized by a continuous decline in kidney function that may have a significant impact on overall health and wellbeing. This condition is challenging on many fronts because it has a negative influence on quality of life and the ability of affected patients to effectively function in daily living. Due to the multi-systemic impacts of the disease, it is important for healthcare providers to provide a comprehensive educational platform upon which patients are able to understand the disease and to be better prepared to manage the side effects and other obstacles that must be addressed on a regular basis. Therefore, it is important to address care plans and to discuss treatments openly with patients in order to consider the options that are available in order to minimize and/or prolong the damage that is associated with the disease.

Stages of Chronic Kidney Disease

Patients with CKD are likely to experience a number of stages related to the disease, which are typically defined as follows: 1) Stage 1, which is characterized by a glomerular filtration rate (GFR) of 90 or above, includes relatively normal kidney function but genetic signs associated with disease formation; 2) Stage 2, which is characterized by a GFR of 60-89 and mild kidney dysfunction; 3) Stage 3a-b, which is characterized by a GFR of 49-59 (3a) and 30-44 (3b) and includes moderate kidney dysfunction; 4) Stage 4, which is characterized by a GFR of 15-29 and severe kidney dysfunction; and 5) Stage 5, which is characterized by a GFR of less than 15 or a dialysis state and is encompassed by endstage renal failure (The Renal Association, 2013). These stages are important for patients in order to better understand the nature and progression of the disease for patients who are affected by the disease and its symptoms as they impact quality of life.

Pathophysiological Mechanisms

CKD is characterized by gradual or rapid destruction of nephrons within the kidneys, and GFR is able to be maintained naturally for a period of time, even in the face of nephron loss and kidney damage (Arora, 2015). However, hyperfiltration and hypertrophy of neurons within the kidneys is a key contributor to kidney dysfunction, particularly as capillaries may be damaged due to expanded amounts of glomerular pressure, thereby contributing to further decline and a condition known as global glomerulosclerosis (Arora, 2015). Furthermore, factors that contribute to the formation of CKD include systemic hypertension, uncontrolled diabetes, smoking, hyperlipidemia, and the development of nephrotoxins, among other causes (Arora, 2015). One of the most critical issues is the relationship between diabetes and CKD, which must be addressed further on a case-by-case basis with the goal to improve control of diabetes and to treat CKD on a concurrent basis (Arora, 2015).

Clinical Manifestations

Some of the most common clinical manifestations of the disease include lower levels of energy, difficulty sleeping, low appetite, dry skin that is also very itchy, swollen ankles and feet, and the desire to urinate more frequently (National Kidney Foundation, 2015). For patients who have already been diagnosed with diabetes and/or have hypertension, there is an increased risk of developing CKD due to the impact of these chronic disease states on patient health and wellbeing and a gradual decline in body organs and systems (National Kidney Foundation, 2015). Therefore, patients must be evaluated in the context of these and other symptoms, and a full diagnostic workup is required in order to ensure that patients receive the best possible forms of treatment that are based upon their specific condition and progression of the disease (National Kidney Foundation, 2015).

Fluid and Electrolyte Imbalances

Patients with CKD are likely to experience instability in fluids and electrolytes when there is a progressive decline in GFR, and this condition is particularly evident when this level falls below 15; these imbalances may include hyperkalemia, metabolic acidosis, and excessive volume levels (Lascano, Schreiber, & Nurko, 2010).

Complications

Patients with CKD may experience any number of complications when the GFR continues to decline at a steady rate; fluid and electrolyte balances are common; hormone imbalances that contribute to secondary hyperparathyroidism; bone disease; and neuropathy, malnutrition, and fatigue, among others (Lascano et.al, 2010). These factors play a significant role in an overall decline of kidney function that may ultimately contribute to system failure as the disease progresses through its different levels.

Progressive Changes

The disease may progress rapidly in some patients more than in others, and this is contingent upon other factors that may impact patient health, such as other chronic diseases that include hypertension and diabetes. When these conditions are not effectively controlled, there is a greater risk of kidney dysfunction that could have a significant impact on overall health and wellbeing for a given patient population. When GFR continues to decline as the disease progresses, kidney function becomes increasingly limited and poses a serious risk to patients in many ways, particularly as the damage increases; therefore, patients must be continuously monitored to identify changes that will have a lasting impact on the progression of the disease through expanded care and the administration of treatments to minimize risk and further damage to the kidneys and to other organs over time.

Interventions

Patients with CKD must be continuously monitored in order to address symptoms of the disease and to prevent further complications. Therefore, treatments must emphasize slowing down the progress of the disease as best as possible, using proven techniques and treatments for the affected patients (Arora, 2015). Consultations with specialists are required in order to determine the nature and stage of the disease, along with other contributors to the plan of care, including nurses, social workers, and renal dietitians, among others as needed (Arora, 2015). In addition, patients may develop obstructive sleep apnea when they rely on dialysis; therefore, this condition must also be monitored if a diagnosis is made (Arora, 2015).

Treatments

For patients with CKD, a number of treatment methods are available that are dependent upon the stage of the disease and the nature of its progression in specific patients. For example, some patients may receive renal replacement therapy, depending on their level of disease progression; diets may be prescribed to patients to minimize disease risk; and continuous monitoring through consultations and evaluations are necessary in order to achieve the desired outcomes (Arora, 2015).

Conclusion

Patients with CKD face a number of challenges as the progression of the disease minimizes kidney function and increases the risk of multi-systemic failure. Therefore, it is important to develop expert knowledge of the disease and to communicate with patients regarding the nature of the disease in order to prevent further complications and to minimize the damage that is incurred. Patients must be monitored on a continuous basis and receive the appropriate care and treatment in order to effectively manage the disease at all times.

References

Arora, P. (2015). Chronic kidney disease. Retrieved from http://emedicine.medscape.com/article/238798-overview

Lascano, M.E., Schreiber, M.J., & Nurko, S. (2010). Chronic kidney disease. Retrieved from http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/nephrology/chronic-kidney-disease/

National Kidney Foundation (2015). About chronic kidney disease. Retrieved from https://www.kidney.org/kidneydisease/aboutckd

The Renal Association (2013). CKD Stages. Retrieved from http://www.renal.org/information-resources/the-uk-eckd-guide/ckd-stages#sthash.n02dVtUv.dpbs

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