Chronic kidney disease (CKD) is a health condition marked by a progressive deterioration of kidney function. The loss of kidney function causes the accumulation of toxic wastes in the body. CKD is a nationwide public health problem that is responsible for many cases of untimely deaths. The purpose of this paper is to describe the prevalence, risk factors, health disparities, mortality, and morbidity rates of CKD. The social justice rationale of a CKD prevention program is also discussed.
Overview of the Problem
The role of the kidney is to filter waste substances from the blood and get rid of them through the urine. The working of the kidney is quantified by glomerulus filtration rate (GFR). Alterations in the GFR can determine how far CKD has progressed. As a result, CKD is classified into five main stages based on the GFR. In stage 1 CKD, a patient has a normal GFR (90 milliliters/minute) but displays symptoms of CKD. Stage 2 CKD is characterized by GFR rates of 60 to 89 milliliters/minute alongside indications of kidney complications, whereas stage 3 has a GFR rate that ranges between 30 and 59 milliliters/minute. On the other hand, stage 4 of the disease has a GFR that ranges from 15 to 29 milliliters/minute, whereas stage 5 has a GFR rate that is less than 15 milliliters/minute. By the time a patient reaches stage 5, which is also known as end-stage renal disease (ESRD), complete renal damage has occurred.
The most common indications of CKD encompass bloodstained urine, anemia, swollen limbs, exhaustion, dark urine and decreased urination. There may be reduced mental attentiveness, loss of sleep, poor appetite, queasiness, itchy skin, muscle cramps, elevated blood pressure, unexplained fluctuations in body weight, and shortness of breath. Men with CKD may have erectile dysfunction.
Mortality and Morbidity
According to the Centers for Disease Control and Prevention [CDC] (2017a), about 4.9 million adults in the United States have been diagnosed with CKD, which constitutes 2% of the US population. Approximately 9.4% of people with CKD during a survey conducted since 1999 were unaware that they had impaired renal function (Healthy People 2020, 2010). At least 661,000 Americans have kidney failure out of which 468,000 people depend on dialysis while 193,000 have undergone successful kidney transplants (Kidney Disease Statistics for the United States [NIDDK], 2016). The prevalence of ESRD is 3.7 fold greater in African Americans than Caucasians (NIDDK, 2016). This rate is 1.4 and 1.5 times greater in Native Americans and Asian Americans, respectively.
Approximately 49,959 deaths in the US are attributed to nephritis, nephrotic syndrome and nephrosis (CDC, 2017a). This number translates to 15.5 deaths per 100,000 population, which ranks CKD 9th among the leading causes of deaths (CDC, 2017a). The age-adjusted death rate for CKD in the USA is 13.1 (CDC, 2017b). States with the highest rates of CKD mortalities include Arkansas, Georgia, Alabama, Indiana, Kentucky, Louisiana, Mississippi, Missouri, North Carolina, and West Virginia, which have rates ranging from 17.1 to 22.8 (CDC, 2017b). On the whole, the mortality rates among Medicare patients with CKD have reduced (NIDDK, 2016). Nevertheless, the death rate is higher in patients with CKD than those without the disorder. The co-occurrence of diabetes and CVD elevates the risk of death. In the State of Maryland, CKD contributes to a death rate of 11.3 to 14.3% (CDC, 2017b).
Risk Factors
The major cause of CKD is diabetes, which can be effectively managed by healthcare teams and their patients if they work together. About 50% of patients with ESRD in the United States have diabetic nephropathy (American Diabetes Association, 2015). Kidney problems in diabetes arise due to hyperfiltration damage, glycosylation products, and reactive oxygen species. Cytokines, growth factors, and certain hormones bring about pathologic changes linked with diabetic nephropathy. Additionally, approximately 8% of patients with insulin independent diabetes already have proteinuria at the time of diagnosis. About half of patients with this form of diagnosis develop nephropathy, whereas 10% suffer from progressive loss of renal function.
Hypertension accounts for approximately 27% of all ESRD patients in the United States (Saran et al., 2017). Systemic hypertension is conveyed to the capillaries within the glomerulus, which causes glomerulosclerosis and lowers kidney function. Obvious kidney dysfunction occurs following 10 years of poorly managed hypertension.
The likelihood of developing CKD can also be transmitted genetically. Mutations in the APOL1 gene are connected with an elevated risk of ESRD. These mutations, which are inherited in an autosomal recessive manner pose a 10-fold risk because of focal glomerulosclerosis and a 7-fold risk attributed to high blood pressure (Newell et al., 2017). These mutations are common in people of African ancestry and predispose them to CKD. Kazancioğlu (2013) reports that the lifetime risk of ESRD is 7.8%, 7.3%, 1.8%, and 2.5% for 20-year-old black women, black men, white women, and white men respectively. Having family members with CKD increases one’s likelihood of developing the disorder. About a quarter of patients undergoing incident dialysis have close relations with ESRD. Therefore, family members of CKD patients should also undergo regular screening to facilitate timely diagnosis of the complication.
Age plays an important role in CKD. Renal function declines as a person ages. More than 50% of elderly patients have CKD in stages 3 to 5 (Vart, Reijneveld, Bültmann, & Gansevoort, 2015). Low birth weight is also linked with CKD. Intrauterine growth limitations lead to a low number of nephrons, which increase an individual’s susceptibility to CKD. Other risk factors for CKD include obesity, smoking, acute kidney injury, as well as the use of alcohol and recreational drugs.
Health Disparities
The initial stages of CKD have similar rates across various racial, ethnic, and socioeconomic groups (Crews et al., 2018). However, the incidence of ESRD in the United States is higher in minorities compared to non-Hispanic white populations (Nicholas, Kalantar-Zadeh, & Norris, 2015). Hypertensive kidney disease is a leading cause of ESRD among blacks. The incidence of ESRD is 3.5 to 5 fold higher in black patients as opposed to white patients. On the whole, non-diabetic CKD affects black patients disproportionately. Williams and Pollak (2013) reported that the incident of nephropathy linked to human immunodeficiency virus infection in blacks was 500% higher than in whites. The National Health and Nutrition Examination Survey (NHANES) data indicate that the incidence of CKD in Mexican Americans is approximately 19% compared to may have CKD compared with an approximate rate of 15% in non-Hispanic whites (Norton, 2016). Moreover, Hispanics are 1.5 times more prone to advancing to ESRD than non-Hispanic people. In spite of this, blacks and Hispanics tend to stay alive longer on dialysis than other populations.
Nicholas et al. (2015) report the health disparities in CKD in the State of Maryland. A group of approximately 2,500 community-living black and white adults aged between 30 and 64 years in Baltimore City, Maryland, was categorized based on the socioeconomic standing (Nicholas et al., 2015). It was observed that low socioeconomic status contributed to the development of CK following adjustments for comorbid disease, demographics, and insurance status. However, race did not contribute to the observed CKD disparities. On the other hand, stratifying the population by race indicated that low socioeconomic standing was linked to CKD in African Americans, but not in whites (Nicholas et al., 2015). This finding suggested that the influence of socioeconomic status on CKD differs across racial groups.
Social Justice Rationale for the Program
Patients should be aware of their health condition because impaired renal function can greatly decrease the quality of life in terms of diet, fluid intake, and activities. Additionally, nurses can only expect patients who are conscious of their health status to adhere to discharge planning measures. Having the correct information concerning one’s health empowers an individual to control his or her health status and make sound health decisions. It is also necessary to investigate health disparities of a health problem to access accurate information to direct nursing interventions.
Socioeconomic patterns have an impact on some CKD risk factors and access to quality care for CKD risk factors in addition to mediating many cultural and environmental factors that affect complex medical disorders (Nicholas et al., 2015). The impact of these disparities on health upshots facilitates an understanding of distinctive genomic, biological, socio-cultural, environmental, and healthcare system factors and predispositions that can enhance clinical outcomes for patients with CKD.
A large proportion of the racial disparities in CKD are linked to nonbiologic factors, for example, social determinants of health. These determinants encompass may shape health upshots by decreasing access to basic resources such as healthy food, quality healthcare services, and secure places for physical activity. Social determinants of health also determine individuals’ exposure to occupational and environmental toxins, which aggravate stress and stress-associated health outcomes, thereby producing contending demands that diminish the capacity for management of health. Furthermore, social determinants of health affect prenatal development, which influences kidney function during later stages of life (Luyckx et al., 2013).
Conclusion
CKD is a significant health problem in the United States. Understanding the risk factors and health disparities associated with the disease can help nurses to put in place measures to enhance prompt diagnosis and treatment. Such knowledge also directs the management of some of the modifiable risk factors for ESRD hence alleviating the economic and health burden of CKD.
References
American Diabetes Association. (2015). Standards of medical care in diabetes—2015 abridged for primary care providers. Clinical Diabetes: A Publication of the American Diabetes Association, 33(2), 97-111.
Centers for Disease Control and Prevention. (2017a). Kidney disease. Web.
Centers for Disease Control and Prevention. (2017b). Kidney disease mortality by state. Web.
Crews, D. C., Banerjee, T., Wesson, D. E., Morgenstern, H., Saran, R., Burrows, N. R.,… Powe, N. R. (2018). Race/ethnicity, dietary acid load, and risk of end-stage renal disease among US adults with chronic kidney disease. American Journal of Nephrology, 47(3), 174-181.
Healthy People 2020 (2010). The national health and nutrition examination survey. Web.
KazancioÄźlu, R. (2013). Risk factors for chronic kidney disease: An update. Kidney International Supplements, 3(4), 368-371.
Kidney Disease Statistics for the United States (NIDDK). (2016). Kidney disease statistics for the United States.Web.
Luyckx, V. A., Bertram, J. F., Brenner, B. M., Fall, C., Hoy, W. E., Ozanne, S. E., & Vikse, B. E. (2013). Effect of fetal and child health on kidney development and long-term risk of hypertension and kidney disease. The Lancet, 382(9888), 273-283.
Newell, K. A., Formica, R. N., Gill, J. S., Schold, J. D., Allan, J. S., Covington, S. H.,… Chandraker, A. (2017). Integrating APOL1 gene variants into renal transplantation: Considerations arising from the American Society of Transplantation Expert Conference. American Journal of Transplantation, 17(4), 901-911.
Nicholas, S. B., Kalantar-Zadeh, K., & Norris, K. C. (2015). Socioeconomic disparities in chronic kidney disease. Advances in Chronic Kidney Disease, 22(1), 6-15.
Norton, J. (2016). Health disparities in chronic kidney disease: The role of social factors. Physician Assistant Clinics, 1(1), 187-204.
Saran, R., Robinson, B., Abbott, K. C., Agodoa, L. Y., Albertus, P., Ayanian, J.,… Cope, E. (2017). US Renal Data System 2016 annual data report: Epidemiology of kidney disease in the United States. American Journal of Kidney Diseases, 69(3), A7-A8.
Vart, P., Reijneveld, S. A., BĂĽltmann, U., & Gansevoort, R. T. (2015). Added value of screening for CKD among the elderly or persons with low socioeconomic status. Clinical Journal of the American Society of Nephrology, 10(4), 562-570.
Williams, W. W., & Pollak, M. R. (2013). Health disparities in kidney disease—emerging data from the human genome. The New England Journal of Medicine, 369(23), 2260-2261.