CHRONIC KIDNEY DISEASE

Chronic Kidney Disease

Chronic Kidney Disease

Introduction

Kidney failure is the result of pathologies (diseases) on the kidneys and is characterized by a reduced number of nephrons. The nephron is a small, functional unit whose main constituent is the glomerulus. The glomerulus is a tiny sphere or blood filtration occurs and where the urine is developed so primitive. Chronic Kidney Disease, or CKD, is one of contributing factors for kidney failure. CKD is a severe public health problem associated with increasing incidence rates, rising healthcare costs, and high rates of mortality from co morbid conditions. In the US, based on 2008 data, the United States Renal Data System (USRDS) reports:

An estimated 33 million Americans, 16 percent of the population, have kidney disease.

Approximately 550,000 patients are undergoing dialysis or have had a kidney transplant to sustain life; In 2008, 88,620 people died of kidney failure; and

Medicare costs reached $59.4 billion and almost $26.8 billion respectively for CKD and End-Stage Renal Disease (ESRD) in 2008.

CKD Treatment

Kidney disease treatment consists of a specific treatment and disease-specific treatment. Specific treatment is prescribed depending on the specific disease. If glomerulonephritis occurs in the kidney disease, steroids like BIARL (disease modifying antirheumatic drugs) are used. With infectious lesions of the kidneys and urinary tract infections, antibiotics are prescribed. In diabetic nephropathy correction of blood glucose is sought. Nefroprotektivnoe treatment is indicated for all chronic kidney disease and is aimed at slowing the progression of renal failure (Coresh, 2007).

The main treatment for nefroprotektivnom blockade of the renin-angiotensin-aldosterone system is treated by use of drugs like blockers of the angiotensin, converting enzyme inhibitors, angiotensin receptor blockers, antagonists of aldosterone, and direct renin inhibitors. The most important part of treatment leads to a reduction of proteinuria level, hypertension by normalization (RAAS blockade), and the protection of the proximal epithelium from the toxic protein endocytosis (hydrophilic statins, and antioxidants). A nonspecific treatment is an important antihypertensive therapy applied in concomitant hypertension. With the progression to chronic renal failure, appropriate therapy is carried out (often requiring acceptance of erythropoietin and vitamin D (Dubose, 2006). Kidney Disease Outcomes Quality Initiative (KDOQI) care model is used to address CKD from pre-disease through kidney failure. Strategies include:

Data, surveillance, and applied research to:

Measure and monitor trends in the CKD burden,

Target interventions to high-risk populations, and

Identify cost-effective interventions and strategies;

Health communications related to public, patient, and healthcare professional education and outreach;

Policy, environmental, and systems changes in the state and community levels; and

Partnering with state chronic disease programs, and national, state, and local agencies

Clinical Care Guidelines

The National Kidney Foundation provides a set of Clinical Care Guidelines for the management and treatment of Chronic Kidney Disease. These guidelines provide comprehensive disease-management strategies for different stages of CKD. This stage-wise prevention and management guidelines can be depicted using the following table:

Source: National Kidney Foundation Clinical Care Guidelines for CKD

Review of and Recommendation Concerning Cost Effective Screening, Diagnosis & Treatment of CKD

Recommendation 1: Setting Consensus

First of all, the practitioners must draw a consensus on the ...