Introduction
End stage renal disease (ESRD) occurs when the kidneys fail to perform basic functions to support the body system. Diabetes and high blood pressure are the main causes of end stage renal disease. These two conditions usually affect the normal functioning of the kidneys. Chronic kidney disease precedes ESRD as it can take almost fifteen years for the kidneys to stop working, before resulting to ESRD. A patient with ESRD requires a hemodialysis machine, which performs the functions of the kidneys that include purification of the blood by removing waste products from physiological processes such as creatinine, urea, and free water from the blood. There are several risk factors involved with end stage renal disease (Rosenberg, 1990).
The aim of the research study is to identify the risk factors of end stage renal disease, while considering the target population. The risk factors associated with end stage renal disease include age, gender, race, presence of diabetes mellitus, education, weight, proteinuria, genetics, smoking habit, hyperlipidemia, hypertension, drug use and other diseases (Nuñez & Oreopoulos, 2007).
Research Population
The study population includes patients with end stage renal disease, and the predisposing risk factors associated with the patients. One of the risk factors of ESRD is older age. Renal failure is prevalent among older people. According to a research conducted by United States Renal Data System in 2006, the incidence of ESRD in the US is approximated to be at least 360 per million of the population. The incidence of ESRD in population between the age of 45 to 65 is about 650 per million of the population. Renal function tends to decline with advancing age. An individual is more at risk of developing ESRD if he or she is more than 50 years old (Chambers, 2010).
Another risk factor of ESRD is race, with African Americans being more prevalent to ESRD compared to whites. The incidence of ESRD in African American population is approximately 3.8 times greater than that of white population. In addition, the incidence of the same disease in Native Americans is 1.8 times greater than the incidence in white population. Occurrence in Hispanics is one and a half times that of non-Hispanics. This is according to data from the United States Renal Data System released in 2006 (Foley, 1994).
Another major risk factor of ESRD is diabetes mellitus. The national data on the prevalence of diabetes indicates that prevalence rate of diabetic end stage renal disease for blacks was higher than that of whites. The data indicates that 77 percent of black patients with diabetic ESRD had non-insulin dependent diabetes mellitus, while 58 per cent of white patients with diabetic ESRD had insulin dependent diabetes mellitus. Overall assessment shows that ESRD is more common in patients with insulin dependent diabetes mellitus compared to non-insulin dependent diabetes mellitus (Black, 2001).
Another risk factor of ESRD is hypertension. Narrowing of the renal artery leads to decreased blood flow to the kidney, which leads to constriction of major blood vessels, raising the blood pressure. Renal hypertension causes increased pressure to the kidneys, which may lead to dysfunction or total failure of the kidneys (Black, 2001).
Behavioral Dimension
Smoking is a known risk factor of ESRD in patients with diabetes and hypertension. Cigarette smoking accelerates the progression of nephropathies, resulting to end stage renal disease. Recreational drugs such as cocaine and opiates have been linked to increased risk of ESRD. Over the counter pain medication are also a risk factor for ESRD when they are overused (Albert, 1994). Abuse of some illicit drugs is also a risk factor for ESRD.
Obesity is a risk factor for end stage renal disease. ESRD is more common in people who are overweight. Due to the restriction in movement that haemodialysis places on the patient, there is a tendency of the patient to sleep more during the day. Haemodialysis patients also face problems in waiting on the haemodialysis machine, as there is limited access to dialysis machines (Evans, 2005).
Psychosocial Dimension
Patients with ESRD have reportedly poor quality of life, with negative impact in their psychological and social life. Studies indicate that a large number of patients with ESRD experience depression and anxiety. Patients undergoing haemodialysis will display more symptoms of depression compared to patients who undergo peritoneal dialysis. This might be linked to localization of the patient in one place since the patient has to be attached to the haemodialysis machine for a long period (Kimmel, 2005).
This lowers the living standards of the patient. Moreover, suicide rate among patients with ESRD who are undergoing haemodialysis is high, with some patients violating their dietary requirements leading to death, which still counts as suicide. ESRD patients have psychosocial problems, with a number of patients showing signs of clinical mental problems (Kimmel, 2005).
Environmental Dimension
ESRD patients need a support system to cope with the change of lifestyle associated with hemodialysis. Studies indicate that good family support leads to strict adherence to the dietary regiment and dialysis routines. Patients on haemodialysis might discontinue dialysis with the notion that they are a burden to those caring for them. In addition, patients in haemodialysis cause disruption in the social lives of their families and caregivers. Patients with ESRD might not be able to continue with their careers while on dialysis as a lot of time is spent on dialysis and there is restriction of free movement and independent living of the patient (Chambers, 2010).
Prevention
In order to prevent end stage renal disease, individuals with diabetes have to keep their blood sugar levels under control to prevent occurrence of kidney disease. Individuals who are susceptible to high blood pressure should take measures to maintain normal blood pressure in order to avoid occurrence of kidney disease. Lowering cholesterol levels also helps in preventing renal failure (Aljama, 2002). People should avoid overuse and abuse of drugs, which may cause the functions of the kidney to deteriorate accelerating the occurrence of ESRD. Individuals with proteinuria should pursue aggressive treatment with drugs, which slows down the deterioration of kidney function. There are risk factors that are hereditary, and depend on the family history (Klagg, 1996).
Public Health Policy Implications
Patients with ESRD put pressure on health care facilities, with the families spending a significant amount of money on Haemodialysis. With reduction of the cases that proceed to ESRD in individuals, hospitals will be able to save resources and them to other fields for better efficiency. Data on risk factors associated with end stage renal care will help in better care for patients on dialysis. With reduction of the risk factors of end stage renal disease, the number on deaths caused by ESRD will fall. More information on the risk factors will help in better care for patients with kidney disease to prevent progression to ESRD (Aljama, 2002).
References
Albert, B. (1994). Renal vascular disease causing end-stage renal disease, incidence, clinical correlates, and outcomes: a 20-year clinical experience. American journal of kidney diseases, 24(2), 32-49.
Aljama, P. (2002). New insights in ESRD. Malden, MA: Blackwell Pub.
Black, N. (2001). Blocked Kidney Artery Causes High Blood Pressure and Kidney Failure. Society of Interventional Radiology, 13(3), 13-25.
Chambers, E. J. (2010). Supportive care for the renal patient (2nd ed.). Oxford: Oxford University Press.
Evans, R. (2005). The Quality of Life of Patients with End-Stage Renal Disease. The New England Journal of Medicine, 5(1), 67.
Foley, R. (1994). Clinical and echocardiographic disease in patients starting end-stage renal disease therapy. official journal of the international society of neuphrology, 21(2), 39-52.
Kimmel, P. (2005). Psychosocial factors in adult end-stage renal disease patients treated with heamodialysis:correlates and outcomes. American journal of kidney diseases, 1(2), 20-30. Web.
Klagg, M. (1996). Blood Pressure and End-Stage Renal Disease in Men. The New England Journal of Medicine, 9(4), 15-45.
Nuñez, J. F., & Oreopoulos, D. G. (2007). The aging kidney in health and disease. New York: Springer.
Rosenberg, W. (1990). End stage renal disease. Stony Brook, NY: Research Foundation of State University of New York.
Aljama, P. (2002). New insights in ESRD. Malden, MA: Blackwell Pub..