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Epidemiology of Chronic Kidney Disease

Zabrina Thein

HLTH-301 Sec 002 - Intro To Public Health Administration

Professor Kristen Linton

November 27, 2020

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Epidemiology of Chronic Kidney Disease

Chosen Disease

Chronic Kidney Disease (CKD) is defined by the Centers for Disease Control and

Prevention (CDC) as “a condition in which the kidneys are damaged and cannot filter blood as

well as they should,” (CDC, 2020). Due to the improper filtration, other health problems; such as

heart disease, stroke, and depression; may result from the excess fluid and waste from blood that

remains in the body.

Those diagnosed with CKD often do not experience any symptoms or illness. Rather, to

determine if a patient has CKD they must receive a series of specific blood and urine tests.

Similar to most diseases, CKD can worsen over time and possibly progress to kidney failure,

such as end-stage renal disease. For instance, recent findings indicate that “fifteen percent of US

adults are estimated to have CKD,” (CDC, 2020). Moreover, kidney diseases are said to be “the

ninth leading cause of death in the United States,” (CDC 2020). The CDC provides a few

friendly tips in order to prevent and slow the progression of CKD:

1.
Keep your blood pressure below 140/90 mm Hg (or target blood pressure your doctor
2.
establishes for you), Get active﹣physical activity helps control blood pressure and
3.
blood sugar levels, Meet with a dietician to create a kidney-healthy eating plan, 4. Take
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medications as instructed, If you smoke, quit because it can worsen kidney disease and
6.
interfere with medication that lowers blood pressure, Include a kidney doctor

(nephrologist) on your health care team. (CDC 2020)

Additionally, Hemodialysis is a common treatment for patients with CKD. It is a procedure in

which a dialysis machiene and a special filter are used to clean and filter your blood. In order to
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perform a hemodialysis, the patient must have a minor surgery to implant a catheter which is

usually placed in the arm.

Current Research

In the first article, Epidemiology of chronic kidney disease in children, they note that

CKD can progress to further irreversible kidney damage, known as end-stage renal disease

(ESRD). The study defines that the causes of CKD are very different in children than those in

adults. For example, in children, CKD can “impair growth and psychosocial adjustment, which

severely impact upon the quality of life,” (Harambat et al., 2011). The most recent report by the

North American Pediatric Renal Trials and Collaborative Studies show congenital causes, such

as congenital anomalies of the kidney and urinary tract (CAKUT) at 46% and hereditary

nephorapathies at 10%, being the most common. Additionally, in the United States, the recorded

annual incidence of ESRD in children slowly rose during the 1980s and then marginally

increased from 14 to 15 pmarp between 1990 and 2008. The adjusted prevalence rose from 60 to

85 in the same period. Furthermore, at the start of renal replacement therapy (RRT) programs in

the 1960s, the fatality rate was 11% for every 100 patient years. It has improved since then,

showing a stable case-fatality rate of 1.3-18 per 100 patient years in the past 15 years. Among

adults who started this kind of therapy during childhood, the average life expectancy was 63

years for those with a functioning graft compared to 38 years for those remaining on dialysis.

The external validity in this study can be found in the North American Pediatric Renal

Trials and Collaborative Studies (NAPRTCS) data collection. For example, they receive their

data from “pediatric nephrology centers on a voluntary basis and include more than 7,000

children aged under 21 years,” (Harambat et al., 2011). Due to this large sample size and the

wide range of ages, their findings have generalizability and can therefore be applied to a
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population. In addition, NAPRTCS include race in their data collection which is another

important factor when considering external validity. As for the internal validity of this study, this

can be found within the sections treatment modalities and modifiable progressions factors. These

sections detail different types of treatment and what type of treatment that countries offer as well

as ways that effectively slow the progression of CKD.

In the second article, Long-term outcome of chronic dialysis in children, states the

increase in mortality rate is specified as an outcome for pediatric patients on chronic dialysis.

The prevalence of children on renal replacement therapy (RRT) has increased world wide and

therefore consists of at least 2% of any national dialysis or transplant programme. This article

has collected their data from a number of organizations in different countries. For example, the

United States Renal Data System’s (USRDS) data from the 2006 reports an altered “mortality

rate for dialysis patients (age 0–19 years) who started treatment between 1995 and 1999 of

56.5/1,000 patient years at risk,” (Shroff & Ledermann, 2009). In their most recent report the

North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) declared that the

patient survival rates were “95%, 90.1% and 85.7% at 1 year, 2 years, and 3 years, respectively,”

(Shroff & Ledermann, 2009). Therefore, meticulous care to reduce modifiable risk factors is

important for this group who still have a lifetime chance of renal replacement.

The external validity in this article can be found in the data they have compiled from

NAPRTCS, United States Renal Data System (USRDS), United Network for Organ Sharing

(UNOS), European Renal Assosciation-European Dialysis and Transplant Association

(ERA-EDTA) as well as the Australia and New Zealand Dialysis and Transplant Assosciation

(ANZDATA). To be more specific, this study has collected data from a variety of organizations

which allows for a diverse amount of demographical factors. Therefore, this would make the
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studies findings generalizable and applicable to a population. On the other hand, threats to the

internal validity of this study relate to the different types of instrumentation, participation, and

testing amongst the variety of organizations they collected data from. More specifically, this

could skew how reliable the studies' conclusion is.

In the third article, Social support of adults and elderly with chroinc kidney disease on

dialysis, the studies main objective is to “evaluate the instrumental and emotional support of

patients with chronic kidney disease on hemodialysis” (Silvia et al., 2016). To collect a suffiecnt

amount of reliable data, a descriptive cross-sectional study was conducted using a Questionnaire

of the Sociodemographic and Clinical Characterization and the Social Support Scale for people

living with the Human Immunodeficiency Virus (HIV) - adapted for renal patients. There was a

convenience sample of 103 participants with an average age of 54.81 years who met the

following criteria: “18 years or older, be diagnosed with terminal CKD and be on hemodialysis,”

(Silvia et al., 2016). As defined in the results, the main causes of CKD include: the prevalence of

systemic arterial hypertension (53.4%) and type 2 diabetes mellitus (16.5%). After analyzing the

collected data, the article states there was a significant relationship between the level of

perceived social support and aspects of quality of life.

In accordance with a cross-sectional study, they used a “Questionarre of the

Sociodemographic and Clinical Characterization and the Social Support Scale for People Living

with the Human Immunodeficiency Virus (HIV) - adapter for renal patients,” (Silvia et al.,

2016). The internal validity in this article can be found in the data collected from the Social

Support Scale. The average score of social support of patients with CKD on hemodialysis

resulted in 3.92 emotional support and 3.81 for the instrumental support, indicating a good

availability of perceived support. 45% of the participants were satisfied with the availability of
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support in the management and resolution of operational issues of treatment, practical activities

of daily living, and material and financial assistance.

Health Belief Model

As stated earlier, the risk of developing CKD is higher if you have diabetes, high blood

pressure, heart disease, family history of CKD, obesity. Perceived susceptibility of CKD will

vary among those who are either high or low risk. For instance, a patient who is at higher risk of

developing CKD has a higher perceived susceptibility and, therefore, is more likely to engage in

preventative behaviors, such as lowering sodium intake and staying active. However, individuals

who are at low-risk, they will have a lower perceived susceptibility and continue any unhealthy

behaviors as they may deny the possibility of developing CKD. For example, females who had

low health literacy had lower perceived susceptibility to CKD compared to males and those with

higher health literacy, (Boulware et al., 2009). This study also concluded that race and poorer

blood pressure management adherence scores were related to a greater perceived susceptibility.

It is important to help patient s understand the realistic probability of developing CKD

and its progression to ESRD so they can make changes to any unhealthy behaviors. In a study

conducted among CKD patients living in a district in Sri Lanka, they administered a locally

validated questionnaire to assess the presence and severity of symptoms of 1174 randomly

selected CKD patients. Common symptoms of CKD include fatigue, pruritus, irritability, anxiety,

and nausea. According to the study, the most prevalent symptoms during the first week were

bone/joint pain (87.6%; 95% CI 85.6–89.5), feeling irritable (78.6%; 95% CI 76.2–81.0), muscle

cramps (77.5%; 95% CI 75.0–79.9), lack of energy (75.7%; 95% CI 73.2–78.2) and difficulty in

sleeping (68.5%; 95% CI 65.8–71.2). The least prevalent symptoms were diarrhea (5.8%; 95%

CI 4.4–7.2), vomiting (13.7%; 95% CI 11.7–15.7), hiccups (16.5%; 95% CI 14.3–18.6) and
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change in skin color (17.5%; 95% CI 15.3–19.8). As for the perceived benefits of preventative

behaviors and treatments for CKD, goals, such as monitoring and maining a low blood pressure,

will effectively decrease the severity of CKD. Also, although dialysis is only necessary in the

later stages of CKD, the procedure is meant to efficiently clean and filter the blood. For instance,

patients with ESRD who undergo dialysis have been known to experience a drastic improvement

in both their physical and psychological well being.

That being said, there are a number of barriers patients must overcome when battling

with CKD, such as difficulty sustaining improved behavior and medical costs. Generally, it is

difficult for most people to break unhealthy habits. To illustrate, a poor diet can negatively

impact someone with diabetes which could further progress to CKD. Therefore, taking control of

dietary meals, such as sodium intake and blood sugar, could assist in preventing the development

of CKD. In terms of costs, the CDC states that “overall Medicare costs for people with CKD

were over $84 billion in 2017, or more than $22,000 per person,” (Centers for Disease Control

and Prevention, 2020). On top of that, the CDC also notes that “total Medicare spending

(excluding prescription drugs) for patients with ESRD or kidney failure reached $36 billion in

2017, or nearly $80,000 per person, accounting for about 7% of the Medicare paid claims costs,”

(2020). Therefore, due to these sizable costs, care for patients with CKD is quite expensive and

is a significant barrier for those who are unable to access affordable healthcare.
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References

Boulware, L. E., Carson, K. A., Troll, M. U., Powe, N. R., & Cooper, L. A. (2009). Perceived

susceptibility to chronic kidney disease among high-risk patients seen in primary care

practices. Journal of General Internal Medicine, 24(10), 1123–1129.

Chronic kidney disease basics. (2020, March 4). Retrieved November 14, 2020, from Cdc.gov

website: https://www.cdc.gov/kidneydisease/basics.html

Harambat, J., van Stralen, K. J., Kim, J. J., & Tizard, E. J. (2012). Epidemiology of chronic

kidney disease in children. Pediatric Nephrology (Berlin, Germany), 27(3), 363–373.

Hemodialysis. (2016, January 11). Retrieved November 14, 2020, from Kidney.org website:

https://www.kidney.org/atoz/content/hemodialysis

Senanayake, S., Gunawardena, N., Palihawadana, P., Bandara, P., Haniffa, R., Karunarathna, R.,

& Kumara, P. (2017). Symptom burden in chronic kidney disease; a population based

cross sectional study. BMC Nephrology, 18(1). doi:10.1186/s12882-017-0638-y

Shroff, R., & Ledermann, S. (2009). Long-term outcome of chronic dialysis in children.

Pediatric Nephrology (Berlin, Germany), 24(3), 463–474.

Silva, S. M. da, Braido, N. F., Ottaviani, A. C., Gesualdo, G. D., Zazzetta, M. S., & Orlandi, F.

de S. (2016). Social support of adults and elderly with chronic kidney disease on dialysis.

Revista Latino-Americana de Enfermagem, 24, e2752.