Chronic kidney disease (CKD) is a public health problem, and its prevalence has gradually increased over the years. This disease has a high prevalence among the blacks. The burden of chronic kidney disease and end-stage renal disease is directly and progressively related to hypertension; 30% of the end-stage renal disease cases are attributed to hypertension. The article “Intensive Blood-Pressure Control in Hypertensive Chronic Kidney Disease” aims at evaluating the effects of intensive blood-pressure target on the progression of chronic kidney disease in black patients with hypertensive CKD, in comparison to traditional blood-pressure (Appel et al., 2010). This study utilizes data from two phases: trial and cohort phases, to establish the long-term effects of lowered blood pressure on the progression of CKD (p. 919). This paper is a critique of the aforementioned article with the aim of getting a better comprehension of the application of research protocols to ensure validity and reliability are achieved.
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This study lacks in details because it does not give details on research tools used. The study was conducted commensurate with the recommendations of the institutional review board at each study center and the study-wide scientific advisory committee. These recommendations ensured that the correct ethical principles were applied to protect the participants. Participants took part in the study willingly as indicated by the issuance of written informed consent (Coughlan, Cronin & Ryan, 2007). Data collection, seemingly, was done in two phases with a transition period of around six months. The study does not indicate the number of patients who were enrolled into the cohort phase because there is mention of patients with end-stage renal disease (ESRD) not being recruited in this second phase (Appel et al., 2010, p. 920).
Baseline characteristics were not entirely similar between the two groups, and there is no explanation to justify why smoking patterns, protein to creatinine ratios and proteinuria levels were not the same in the two study groups. These parameters were not reason for inclusion or exclusion of participants. In addition, baseline characteristics for the trial phase were applied to the cohort phase, yet there is a probability that changes might have developed that could have affected the study results. Therefore, significant differences in baseline characteristics at cohort phase between the two study groups could have introduced bias into the study results.
The study utilizes different anti-hypertensive drugs, and it does not indicate if the drugs yield similar effects and accompanying side effects. The study is biased based on the therapy used because particular drugs are seemingly administered until the targeted blood pressure levels are attained. There were explicit inclusion and exclusion criteria, but these were not adequate since other confounding factors seem to affect the outcome of results. There is no mention of how diet and physical activity were controlled or regulated to ensure that these do not affect the outcome of results (NHS, 2014).
The problem statement is clearly stated and justified. Chronic kidney disease has been highlighted as a public health concern, whose prevalence is gradually increasing. As a result, a huge financial burden is experienced by some governments, for example, the federal government of the US, as they attempt to redress the issue. There is a need to determine the long-term effects of lowered blood pressure on the progression of CKD given the fact that hypertension is one of the causative factors of CKD. The research article topic is relevant to nursing practice because it indicates the essence of lowering blood pressure in relation to CKD. In comparison with previous studies that did not evaluate the progression of CKD for more than five years, this study aimed at examining the progression of CKD in the long-term, but it did not mention the number of years.
The study is a cohort study with a large sample size. The study is researchable, and it has shown progression of CKD through the serum creatinine levels. Whereas the study indicated no significant difference in the primary outcome (serum creatinine), a significant difference was observed in relation to baseline protein-creatinine ratios. The conclusion is linked to the objective and background of the study. The conclusion reinforces the fact that lowered blood pressure retards progression of CKD in patients with proteinuria. The study indicates that lowered blood pressure is beneficial to patients with a protein-to-creatinine ratio (PCR) of more than 0.22 in comparison to those with a PCR of less than 0.22.
The discussion section has compared the results of the study with previous studies that aimed at evaluating the effects of reduced blood pressure. The study has highlighted its strengths and weaknesses, but does not indicate where this study can be generalized despite the fact that it has been conducted among the blacks. The residential location of the blacks is important because all blacks do not live in the same neighborhood. Unfortunately, this study does not suggest how future research can validate the results obtained. Therefore, the quality of this discussion section is not ascertained. There is a great need to carry out more research on the same topic, but specificity on the therapy used is very imperative and baseline characteristics for all parameters should be the same. Confounding factors such as physical activity and diet should be adequately controlled.
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Research is vital to nursing practice because it helps to address prevailing gaps in practice; thereby, improve practice. The research study under review enables the nurse to understand the circumstances when lowered blood pressure is beneficial in retarding the progression of CKD. Credibility of study results, however, is not guaranteed because the sampling procedure and the location where the study was conducted are unknown. In addition, there was no randomization of participants in the cohort phase.
Appel, L., Wright, J., Jr., Greene, T., Agodoa, L., Astor, B., Bakris, G., …Rostand, S. (2010). Intensive Blood-Pressure Control in Hypertensive Chronic Kidney Disease. The NEW ENGLAND JOURNAL of MEDICINE, 363, 918-929.
Coughlan, M., Cronin, P., & Ryan, F. (2007). Step-by-step guide to critiquing research. Part 1: quantitative research. British Journal of Nursing, 16(11), 658-663.
NHS. (2014). High blood pressure (Hypertension)-Causes. Web.