Chronic Kidney Disease (CKD) is among the main public health crises that the Department of Health and Human Services has listed in the Healthy People 2020 program. CKD has resulted in incessant torment and deprived status of life for the victims coupled with causing premature deaths as well as financial crises in the private and public arena.
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The aim of the Healthy People 2020 (HP2020) program in relation to the disease is to minimize the incidents of CKD, its impediments, loss of life, and financial expenses incurred during treatment. This paper assesses the magnitude of CKD, develops a program, and sets objectives on how the program can be used to achieve the aim of the Healthy People 2020 in relation to CKD.
Overview of Chronic Kidney Disease
According to the Healthy People 2020 (2013), CKD is a state whereby the kidney slowly becomes dysfunctional. It normally does not reveal the symptoms until when it gets to late stages. Blood and urine examinations are normally performed to identify it during the early stages.
High blood pressure and diabetes patients and those with a family background of CKD are often advised to go for screening yearly, as they are highly vulnerable to the ailment. The latter diseases induce strain on the kidney hence causing vulnerability to CKD. Furthermore, CKD is linked to old age. Statistics show that the ratio of those with CKD in age between 65 and 74 is 1:5 for men and 1:4 for women (U.S. Renal Data System, 2013).
The detection of CKD has been a recurrent problem, as most datasets do not have the biochemical information that shows the utmost accuracy in detecting the ailment. Most random samples lack incidence rates as well as financial information, thus making it hard to analyze how the vulnerable population accesses treatment and the extreme incidences in CKD, diabetes, and heart disease victims.
However, the recent 2013 USRDS report shows that in 2011, 13.1 percent of acute kidney injury patients received renal assessment follow-ups after being discharged. This percentage was 1.3 percent higher than the precedent year, as well as the 12.4 percent set by the Healthy People 2020 program (Healthy People 2020, 2013).
In a bid to handle the issue of diabetic individuals who are highly vulnerable to CKD, HP2020 program had an objective that 37 percent of diabetic patients go through a yearly urine albumin screening.
The 2013 reports show that the aged population receiving this screening was 40.8 percent in 2011, thus surpassing the percentage set by HP2020, but lower than what would be anticipated by the clinical policies. Another key goal of HP2020 is to lessen the cases of End-Stage Renal Disease (ESRD), which is an ailment that accounts for 6.4 percent (34 billion) of the Medicare budget. Moreover, ESRD studies show that diabetic individuals are highly prone to ESRDs (U.S. Renal Data System, 2013).
However, if patients get timely kidney transplant, they are likely to survive as opposed to those who go through dialysis. Unfortunately, one of the emerging issues in handling ESRD and CKD is the availability of kidney for transplantation. The number of ESRD patients who get an organ transplant after 3 years of being listed has drastically reduced.
The decline has dispassionately affected all patients. Considering how this aspect might raise the mortality rate of CKD patients, contrary to the objectives of HP2020, it is necessary to develop a program that would raise the supply of organs for transplantation (Süsal & Morath, 2011).
Partners for raising the supply of organs for transplantation: paired exchange program
- U.S. Department of Health and Human Services
- The National Institute of Diabetes and Digestive and Kidney Diseases
- Center for Disease Control and Prevention
- U.S. National Library of Medicine
- Living Kidney Donors Network
Paired Kidney Exchange Program
Kidney transplantation increases the quality of life of ESRD patients and it is less expensive as compared to dialysis in the end. The number of patients who require kidney transplant has increased in the near past, thus prompting the state to develop strategies to raise the supply of kidneys and such strategies like organized programs developed to enhance the approval of the purchase of dead donor organ have had a positive impact. Nevertheless, paired kidney exchange program can turn out to be more effective than the latter.
The program, which has been utilized in Australia, has witnessed noticeable success. Woodroffe and Ferrari (2013) note that the Australian Paired Kidney Exchange Program Biannual Report 2013 showed that out of 152 pairs that were included in match runs, 87 matches were given. In the United Kingdom, 55 kidney transplants were successfully done through the paired kidney donation program between 2012 and 2013 (Organ Donation, 2013).
John Hopkins Comprehensive Transplant Center has also applied this program to transplant incompatible kidneys. The program has proved successful since its introduction in 2001. It is to be applied where a living donor exchanges his/her unsuited kidney with that of another donor/recipient pair. It helps participants to receive a well-suited kidney and reduces the time for those waiting for compatible kidneys (Comprehensive Transplant Center, 2013).
All partners will work in unity for this program to be accomplished. The matching procedure will be performed on a periodical basis, with approximate 44 pairs. During the matching procedure, efforts will be made to detect the participating pairs so that the kidneys donated through the Living Kidney Donor Network are transplanted to compatible participants, whilst shunning immunologic challenges of tissue incongruity.
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When compatible match is determined, the parties will approve the transplant and eventually the cross matching. A successful matching is referred to as chain and when there is a mismatch in the chain, a chain break occurs. A chain break causes the difference in the ratio of the matches to that of transplants (Ferrari et al., 2012).
The main challenge of this program is that getting a compatible kidney for blood group O is difficult. Roodnat et al. (2012) observe that when a transplant is conducted between individuals with disparate blood groups, an immune system reaction referred to as ABO incompatibility emerges.
Nonetheless, this challenge can be resolved using a unique treatment known as ABO incompatible transplantation. Ferrari et al. (2011) note that the approximate wait time can be between a month and two years, which is indeed lower than the normal waiting time.
Objectives of the Paired Kidney Exchange Program
- Increase the supply of kidneys for transplantation
- Prolong the lives of CKD patients
- Reduced the cost of treating ESRDs
- Reduce the mortality rate of ESRD patients on dialysis
The intellectuals behind the HP2020 program anticipated to boost the health of the Americans by creating and assessing the national health goals.
As one of its key objectives, HP2020 projected to lessen the prolonged problem of CKD and advance quality of life for the victims as well as regulate economic cost of managing the ailment. The Paired Kidney Exchange program is one of the best means of achieving this objective. It is a cheap, easy, and effective way of treating ESRD. The state should thus take a keen interest in this program, as its impacts are promising.
Comprehensive Transplant Center: Paired Kidney Exchange. (2013). Web.
Ferrari, P., Fidler, S., Woodroffe, C., Tassone, G., & D’Orsogna, L. (2012). Comparison of time on the deceased donor kidney waitlist versus time on the kidney paired donation registry in the Australian program. Transplant International, 25(10), 1026-1031.
Ferrari, P., Fidler, S., Wright, J., Woodroffe, C., Slater, P., Van Althuis-Jones, A. Holdsworth, R., & Christiansen, T. (2011). Virtual cross match approach to maximize matching in paired kidney donation. American Journal of Transplantation, 11(2), 272-278.
Healthy People 2020: Chronic Kidney Disease. (2013). Web.
Organ Donation: Transplant Activity Report. (2013). Web.
Roodnat, J., van de Wetering, J., Claas, F., Ijzermans, J., & Weimar, W. (2012).
Persistently low transplantation rate of ABO blood type O and highly sensitized patients despite alternative transplantation programs. Transplant International, 25(9), 987-993.
Süsal, C., & Morath, C. (2011). Current approaches to the management of highly sensitized kidney transplant patients. Tissue Antigens, 77(3), 177-186.
U.S. Renal Data System: USRDS 2013 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. (2013).
Bethseda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases.
Woodroffe, C., & Ferrari, P. (2013). The Australian paired Kidney Exchange (AKX) program – the first three years. Transplant Journal of Australasia, 22(3),10-14.