End- stage kidney disease is the final stage of chronic kidney disease (CKD), which is also known as chronic renal disease (CRD). This final stage, stage 5 CKD, is also known as chronic kidney failure (CKF), chronic renal failure (CRF) or end stage renal disease (ESRD). Chronic kidney disease is a progressive loss of kidney function (renal function ) that continues over a span of months to years, through the five stages. The progressive of the kidney disease is measured by the lowering of the glomerular filtration rate (GFR). This is usually measured by the level of creatinine in the patient's bloodserum. Patients with a GFR of less than 60 mL /min/1.73 m are considered to have chronic kidney disease, regardless of whether kidney damage is present and noticed . At this level, the GFR is already lowered by at least half of the normal adult level of healthy kidney function.
Chronic renal failure(CRF) requiring dialysis or transplantation is known as end- stage renal disease (ESRD). In the United States, diabetic nephropathy is the most common and hypertension the second most common cause. Along with glomerulonephritis, these cause approximately 75% of all adult cases. Certain geographic areas have a high incidence of HIV nephropathy. Genetic kidney disease such as polycystic kidney disease is a common cause in young adults. Patients with end- stage renal disease (ESRD) are commonly encountered in the emergency departments (ED) with problems related to the metabolic complications of their renal disease or dialysis complications. Various problems related to vascular access in patients on hemodialysis and to abdominal catheters in patients using continuous ambulatory peritoneal dialysis(CAPD) are also common. Patients who have undergone renal transplantation may experience a variety of transplant- related conditions.
All major organ systems are affected by renal failure. Prevalence of symptoms is a function of the glomerular filtration rate (GFR) , which averages 120 mL / min in a healthy adult. As the GFR falls to less than approximately 20% of normal, symptoms of uremia may begin to occur. They almost are invariably present when the GFR decrease to less than 10% of normal. Measuring GFR requires a timed urine collection as well as measurement of serum creatinine. However, it can be accurately estimated from a patient's age, weight, gender, and serum creatinine level.
Signs and symptoms of renal faiure are due to overt metabolic derangements resulting from inability of failed kidneys to regular electrolyte, fluid, and acid- base balance, they are also due to accumulation of toxic products of amino acid metabolism in the serum.
INCIDENCE AND PREVALENCE
During 2004, the last year with complete data availability , 104,364 patients (approximately 0.03% of the US population ) began renal replacement therapy, an adjusted incidence rate of 339 per 1,000,000 . As of 2005 , more than 485,000 patients were receiving treatment for ESRD in the United States . As a result, patients with ESRD are encountered on a regular basis in US emergency departments .
International
The morbidity and mortality of dialysis patients is much higher in the United States compared with most other countries. This is probably a consequence of selection bias. Due to liberal criteria for receiving government - funded dialysis in the United States and rationing (both medical and economic ) in most other countries, US patients receiving dialysis are on the average older and sicker than those in other countries .
Mortality / Morbidity
Patients in renal failure are prone to all of the complications of any underlying condition, such as diabetes and hypertension . In addition, renal failure causes a variety of metabolic and physiologic derangements .
The most common cause of sudden death in patients with end- stage renal disease (ESRD) is hyperkalemia , which is often encountered in patients after missed dialysis or dietary indiscretion . Serum potassium also rises when the serum is acidemic, even though total body potassium is unchanged . Hyperkalemia is usually asymptomatic and should be treated empirically when suspected and when arrhythmia or cardiovascular compromise is present .
- Iatrogenic complications related to fluid administration (fluid overload) or medications are frequently encountered in patients in renal failure .
- Cardiovascular mortality is 10-20 times higher in dialysis patients than in the normal population .
- Anemia results in fatigue reduced exercise capacity, decreased cognition, and impaired immunity .
- Renal transplant patients are prone to infection , especially in the immediate post- transplant period .
Race
Etiology of end- stage renal disease (ESRD) differs among racial groups primarily because of the prevalence of predisposing conditions, such as diabetes and hypertension. In populations with problematic access and utilization of primary medical care for treatment of predisposing conditions, ESRD often is encountered in relatively young patients. Diseases such as diabetes and hypertension are much less likely to lead to renal failure when appropriately treated . The cost of primary care for these conditions is far lower than for dialysis or transplantation, yet primary care remains poorly funded, while ESRD treatment is reimbursed completely by the government .
In the United States , racial and ethnic discrepancies in ESRD exist, with 2006 rates in the African American and Native American populations 3.6 and 1.8 times greater, respectively, than the rate among whites, and the rate in the Hispanic population 1.5 times higher than of non- Hispanics
Sex
Presentation and treatment of chronic renal failure (CRF) and end- stage renal disease (ESRD) do not differ significantly between men and women . Differences in causes of renal failure are related to the types of underlying conditions prevalent in men and women.
Age
While the etiology of CRF differs among age groups, the presentations and nature of complications are similar. Young children with ESRD often are treated with transplantation rather than dialysis because of a relatively greater long- term benefit compared to that of adults, and due to difficulties related to vascular access for dialysis .
.
No comments:
Post a Comment