Treatment Issues Of End Stage Renal Disease

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“Bones can break, muscles can atrophy, glands can loaf, even the brain can go to sleep without immediate danger to survival. But should kidneys fail. Neither bone, muscle, gland, nor brain could carry on. ” The kidneys are primary organ of urinary system. The kidney is the one of the major vital organ. Proper function of the urinary system is essential. The primary functions of the kidneys are to regulate the volume and composition of extracellular cellular fluid and to excrete the waste product from the body. Disorders of kidney are currently the leading cause of death throughout the country.

Renal failure is characterized by the damage of kidneys from various diseases like Diabetes mellitus, hypertension, Glomerular nephritis, nephritic syndrome and poisoning resulting in temporary or permanent damage with severe loss of kidney function. Renal failure is absolutely incompatible with survival unless patient undergoes continuous treatmentThe symptoms of renal failure depend on its severity, or the degree of reduction in Glomerular filtration rate, constellation uremic symptoms that eventually develops, reflects malfunction of several organ systems, most notably the neuromuscular, cardiovascular, and gastrointestinal systems.

Chronic Renal Failure (CRF) is a progressive destruction of kidney function in which the body metabolism and water and electrolyte balance would be disturbs resulting in uremia. The main treatment of end stage renal disease (ESRD) is kidney transplantation, but regarding the difficulties of kidney transplant, the patients should be treated with hemodialysis, until they find a kidney for transplantation. According to international society of nephrology (2017) ESRD incidence rates at 151 and 232 per million populations, respectively. It would mean that about 220, 000 -275, 000 new patients need Renal replacement therapy every year in this part of the world. It is estimated that there are about 55, 000 patients on dialysis in India, and the dialysis population is growing at the rate of 10 – 20 annually. In 2016, 113, 136 patients in the United States started treatment for ESRD.

According to centre for national disease control & prevention Diabetes and hypertension are the leading causes of ESRD. In 2016, diabetes or hypertension was listed as the primary cause for 7 of 10 new cases of ESRD in the United States. As per the World Health Organization (WHO) 2014 Global Burden of Disease Project, kidney disease along with urinary tract problems account for nearly 850, 000 deaths every year. The status of chronic kidney disease (CKD) all over the world is quite alarming. Risk factors for developing CKD differ between races and countries. It would be interesting to know the incidence of CKD and its causes in India, which is a densely populated country with low income, different food, cultural traditions and lifestyle habits. In contrast to high-income countries, patients with ESRD have to pay for dialysis and transplantation themselves. The currently reported incidence of CRF in India is based on extrapolated data from the United States, According to NHANES the cost of CKD treatment in year 2010 is about 28 billion it is estimated that by the year 2020, the cost will be 54 billion.

Globally over 1. 5 million chronic kidney diseases disorders cases survive with either hemo or peritoneal dialysis, the number of people on dialysis increasing by 5. 6% from 2012 to 2016. It is estimated that a total of 871, 000 people receiving treatment at the end of 2010, 22% were receiving dialysis at hospital, 50% on satellite centers, 27% at home. Over 50% of people die every day related to chronic kidney diseases. According to National kidney and urological information centre it is said that the mortality rate for dialysis from 1980-2012 there is about 500 number of death per 10, 000 population. In India 90% patients cannot afford the Cost. Over 1 million people worldwide are alive on dialysis or with a functioning graft. Incidence of CKD has doubled in the last 15 years. In the USA, 30 million people suffer from CKD and by 2012-2016 >800 000 patients will require renal replacement therapy, costing US$48 billion. By 2020 chronic kidney diseases are arising out of hyper would result in 46 million fatalities. When a person is diagnosed as having CKD, conservative therapy is attempted before maintenance dialysis begins. The goals of conservative therapy are to preserve existing renal function, treat the clinical manifestations, prevent complications and provide for the patient comfort through early recognition, diagnosis and appropriate treatment.

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Despite in improvement in diagnostic methods and different treatment modalities the patient are prone to get a number of problems and complications. Education is a part of treatment in a health care delivery system health professionals are educating their parents, families, society for thousands of years to keep them healthy to avoid illness. The patients must be aware of their health illness so they can be benefited for themselves.

Patients with End Stage Renal Disease (ESRD) are virtually benefited by means of renal replacement therapies including dialysis treatment and renal transplantation. However treated ESRD remains a serious condition associated with high rates of mortality and morbidity and substantial cost to individual patients and society. In recent years efforts have been directed towards preventing ESRD by slowing the progression of renal failure towards end stage and thus reducing the mortality rate by Renal Replacement Therapy (RRT) and by dialysis. Most of the studies have focused on one or the other of these strategies, providing little importance on the effect of pre- dialysis treatment and continuous patient education on survival after initiation of dialysis. Hemodialysis is one of three renal replacement therapies the other two being renal transplant, and peritoneal dialysis. Hemodialysis is the most common method used to treat advanced and permanent kidney failure. Since the 1960s, when hemodialysis first became a practical treatment for kidney failure, hemodialysis treatments more effective and minimize side effects. In recent years, more compact and simpler dialysis machines have made home dialysis increasingly attractive. However, even with better procedures and equipment, hemodialysis is still a complicated and inconvenient therapy that requires a coordinated effort from whole health care team, including nephrologists, dialysis nurse, dialysis technician, dietitian, and social worker. The most important members of health care team are patient and their family.

By learning about their treatment, patient can work with health care team to themselves the best possible results, and they can lead a full, active life. Many have played a role in developing dialysis as a practical treatment for renal failure, starting with Thomas Graham of Glasgow, who first presented the principles of solute transport across a semi permeable membrane in 1854. The artificial kidney was first developed by Abel, Rountree and Turner in 1913, Dr. Willem Kolff was the first to construct a working dialyzer in 1943 creation, Kolff’s invention of the dialyzer was used for acute renal failure was not seen as a viable treatment for patients with stage 5 chronic kidney disease (CKD) then, Dr. Nils Alwall encased a modified version of this kidney practical application of hemodialysis, which was done in 1946.

ESRD treatment modalities of the year( 2016- 2017)is about 458, 861. 172, 553patients were treated with dialysis therapy. . ESRD patients had a working transplanted kidney more than 10 times as many ESRD patients receive hemodialysis (HD) treatments at a clinic as those who do peritoneal dialysis (PD) and home HD. Clients with end stage renal disease require continual care. Daily self-care includes managing a complex treatment regimen of dietary restrictions, fluid limitations, medications, and vascular access care this day-to-day care is the responsibility of the client. Research shows that dialysis patients who are actively involved in and take direct accountability for their care, generally experience and sustain improved clinical outcomes. By taking a more active role in their dialysis treatment, they may find that there are empowered and feel a renewed control over their life. Self-care management, also known in the literature as self-management, for adults with ESRD treated with hemodialysis more recently, self-care has been suggested as an alternative to replace the focus on compliance. Self-care management is a newer strategy for clients with ESRD and self-management has been added to the latest edition of the Nephrology Nursing Standards of Practice and Guidelines for Care Burrows-Hudson & Prowant, NNJ. The best practice information sheet reported that RRT renal replacement therapy globally with the incidences of ESRD growing at approximately 10% annually.

The burden of cost meets the rising incidence of ESRD so large investment required effective management and care interventions such as self-care for dialysis patients. Exploring self-management in ESRD is extremely important for patients as they encounter several challenges including ongoing symptoms, complex treatments and restrictions, uncertainty about life.

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