Abstract
Today, chronic kidney disease (CKD) is recognized as one of the most pressing problems all over the world. While CKD is difficult to diagnose and other disorders, such as diabetes and cardiovascular diseases, often complicate it, the treatment is still imperfect. To elucidate the problem, four articles pertaining to CKD management in the USA and abroad have been reviewed. According to the results, prevention may be considered the preferred measure, and one should also address the risk groups: age, occupation, and geographical areas can make a substantial impact. The problem demands further research, but the necessity to pay attention to preventive care is urgent.
About CKD
Today, the prevalence of chronic kidney disease (CKD) has become one of the most threatening public health issues all over the globe. Nurses frequently have to deal with patients with CKD and seek optimal solutions. This topic has been chosen because the task of utmost significance is to understand the progression of the disease and its impact and obtain evidence in order to make corresponding decisions.
Although the kidney disease can be treated, and chances of receiving effective treatment are high at the earlier stages, there are no symptoms of the disease that can stimulate a person to go for a check-up and help identify CKD (National Kidney Foundation, 2015). Consequently, late intervention becomes less effective. Approximately 10% of the whole population is affected by CKD, and millions die each year since they do not have a loan of reasonably priced treatment: only 2 million people (12% of the CKD patients) have the opportunity to receive proper treatment, and the overwhelming majority are treated in five countries – the USA, Japan, Germany, Brazil, and Italy (National Kidney Foundation, 2015).
In America, CKD is recognized as one of the most urgent problems: according to Healthy People-2020 program, one of the objectives is to “reduce new cases of chronic kidney disease (CKD) and its complications, disability, death, and economic costs” (Healthy People, n.d., para. 1). In developing countries, such as China, CKD is also a matter of paramount importance, but the researchers consider the lack of information and specific measures that address the disease to be the key obstacles (Zhang et al., 2012). Therefore, CKD is the pressing global health problem that is directly connected with nursing since nurses should manage such patients and provide high-quality care.
Appraisal Synopses
Study #1: Nursing Research Study in the USA
Citation: Aguilar, E. A., Ashraf, H., Frontini, M., Ruiz, M., Reske, T. M., & Cefalu, C. (2013). An analysis of chronic kidney disease risk factors in a Louisiana nursing home population: A cross-sectional study. Journal of the Louisiana State Medical Society, 165(3), 260-267.
Synopsis
What was the purpose of the study?
The article was published in 2013. As for the references, the authors used relevant and recent sources. The purpose of the present paper is to evaluate the development of chronic kidney disease in the elderly on the example of the Louisiana nursing home, and the clinical question is what specific risk factors make a substantial impact on chronic kidney disease in senior adults. Gender, age, and some conditions, namely anemia and cardiovascular diseases, become the central issues of the study associated with CKD and high morbidity rates.
Who participated or contributed data?
The research addresses the aged residents of the Louisiana nursing home. The total number was 103, and, in the course of study, CKD was diagnosed in 23% of the subjects; their age depended on their estimated glomerular filtration rate (eGFR): while the mean age for eGFR <60 was 70,8±13, the same index for eGFR >60 equaled 61,7±14 (Aguilar et al., 2013).
The research team included several physicians and nurses from the United States who directly interacted with senior citizens within the nursing home setting and had to face CKD and related disorders on a regular basis. Masters of Science in Nursing (MSN), Masters of Public Health Nurses, Doctors of Philosophy in Nursing, and Doctors of Medicine took part in this research.
What methods were used to collect data?
Some SRs were used, but the authors also looked for other materials and concentrated on the research literature on geriatrics care issues and the connection between CKD and other diseases. The researchers conducted a cross-sectional study. The data was thoroughly evaluated and processed using consistent methods and approaches. Moreover, the researchers operated means and magnitudes by dint of a custom-made t-test.
The latter was used in order to compare the ultimate statistics regarding the data obtained throughout the research. The researchers utilized correlation factors so as to designate the present relations. They also determined multi-layered associations in order to fit the logistic representations to the obtained evidence. The formula of adjustment of nourishment in renal illness was used to evaluate the glomerular filtration rate. Chronic kidney disease was demarcated bestowing to conventional standards. The researchers chose 60 as an endpoint for additional analysis.
What were the main findings?
The guideline identified the manifold risk factors pertaining to CKD in the nursing home environment. A set of demographic characteristics and concomitant diseases related to higher CKD risks were also determined.
Conclusion
In this article, there are only general recommendations, and the attention is drawn to the facts rather than the strategies of treatment. According to the authors, health care providers should concentrate on several risk groups in order to combat CKD and start early intervention when the symptoms are not present. It is confirmed that the older age (age>65 years), gender (male), and the history of some diseases (congestive heart failure, coronary artery disease, anemia, polypharmacy including NSAIDS, and obesity) are associated with higher rates of morbidity. At the same time, the researchers do not conceal the limitations of the study and underline that more studies are needed since the number of subjects was small, and the relationships between several potentially connected variables were not investigated.
Study #2: Nursing Research Study in the USA
Citation: Rubinstein, S., Wang, C., & Qu, W. (2013). Occupational risk and chronic kidney disease: A population-based study in the United States adult population. International Journal of Nephrology and Renovascular Disease, 6(1), 53-59.
Synopsis
What was the purpose of the study?
The article was published in 2013. As for the cited sources, the reference list includes 30 items. The majority of the sources are recent, although some articles were published in the 1990s. It may be explained by the purpose of the study – the authors’ intention was to extend the knowledge of the CKD, and they referred to the older sources in order to investigate what was discovered earlier. This study addresses the occupational risks of chronic kidney disease. As the authors state, the previous research did not cover a wide range of occupations and concentrated primarily on nephrotoxins, and they aimed at closing this gap and finding more data. Thus, the relative risks for the CKD progression become the central issue.
Who participated or contributed data?
Three American researchers who work at Nassau University Medical Center and Mayo Clinic as doctors conducted this study. Having earned their Ph.D., they specialize in neurology, anesthesiology and perioperative medicine, pain medicine, physical medicine, and rehabilitation, and this experience gives them the opportunity to shed light on the problem and carry out their research accurately and objectively.
The US adult population is addressed, and the main criterion is the occupation of a person. In this respect, 23 spheres of work, such as legal occupations, food preparation, and serving-related occupations, arts, design, entertainment, sports and media occupations, and so on, are singled out. People aged 18-70 were studied. Their race, education, yearly income, and medical history, particularly cardiovascular disease history, diabetes, and CKD, were taken into account.
What methods were used to collect data?
The authors briefly consider the previously conducted studies and simultaneously use the results of some existing SRs relevant to the topic. The product variable, chronic kidney disease occurrence rate, was well-defined as having fading/ weakening kidneys in the previous year, as established by a medical specialist. The occupation was set to be the predictor variable. It was attained utilizing the census of professional codes, rearranged on the basis of the North American Industrial Classification System.
What were the main findings?
The guideline was successful in eliciting the occupations associated with the highest risks of CKD and examine how the disease manifested itself in different cases. It was found that the impact was not limited to nephrotoxins, and other disorders and factors, especially psychosocial risks, could also trigger kidney problems. By means of a univariate study, the researchers found that adult workers and employees with hypertension had a manifestly increased risk for chronic kidney disease. Amid all the reviewed and evaluated variables, construction, food preparation, and healthcare support occupations were linked to the biggest risks for chronic kidney disease.
Conclusion
The authors draw a conclusion that the higher risks of the development of CKD are associated with healthcare support, legal occupations, production occupations, food preparation, and other spheres. Therefore, they recommend paying more attention to such groups. Besides, they suggest that the alleviation of occupation stress should become one of the main strategies aimed at reducing the risks among all specialists, especially those who belong to the elicited risk groups.
Study #3: Nursing Research Study Non-USA
Citation: Yale, J. F., Bakris, G., Cariou, B., Yue, D., David‐Neto, E., Xi, L.,… & Meininger, G. (2013). Efficacy and safety of canagliflozin in subjects with type 2 diabetes and chronic kidney disease. Diabetes, Obesity, and Metabolism, 15(5), 463-473.
Synopsis
What was the purpose of the study?
The article was published three years ago, in 2013. The majority of the evidence sources were published in 2012 and later, with a few studies dated 2002-2007. The purpose of this study is to assess canagliflozin as the means to improve glycemic control and the efficacy and safety of this method in relation to chronic kidney disease Moreover, the latter often accompanies diabetes and results in end-stage renal failure This issue is extensively discussed in the paper. Particularly, the researchers draw attention to the differences in fasting plasma glucose and the levels of glycated hemoglobin which are considered to be the indicators of efficacy and safety correspondingly.
Who participated or contributed data?
The international team of researchers carried out the study at 89 centers in 19 countries including France, Brazil, Canada, Australia, China, and so on. The team was composed of professors, physicians, and nurses. Adult male and female patients aged 25 and older who had type 2 diabetes and chronic kidney disease (stage 3) are the populations of patients. Different study groups included subjects who either received AHA therapy (both monotherapy and combination therapy that included metformin, sulphonylurea, dipeptidyl peptidase-4 (DPP-4) inhibitor, α-glucosidase inhibitor, GLP-1 analog, pioglitazone or insulin) or not (Yale et al., 2013).
What methods were used to collect data?
The researchers did not use the existing SRs in the context of the study, but they did draw attention to the recent research articles pertaining to the topic. Technically, they performed the meta-analysis, although it is not emphasized in the paper.
What clinical outcomes was the guideline designed to achieve?
What were the main findings?
It was established that canagliflozin was suitable in patients with diabetes 2 and chronic kidney disease and announce the positive results of this intervention related to efficacy and safety. The overall aftereffect was analogous for canagliflozin and placebo (100 and 300 mg; 79, 74, and 74.5%). When compared with other cohorts, canagliflozin 300 mg proved to cause slightly higher occurrence rates of UTI (urinary tract infection) and aftereffects associated with osmotic diuresis. Moreover, condensed intravascular capacity was detected in canagliflozin 300 mg patients. Canagliflozin was found to cause temporary transformations in renal function limitations that tended to decline towards the starting point throughout a four-week period.
Conclusion
In conclusion, the authors of the article provide two recommendations. They suggest that canagliflozin should be used to treat patients with diabetes type 2 and CKD, but on condition that renal functions are normal or only mildly impaired, the effect will be more noticeable. They also point out that doctors often have to manage limited options in terms of restricted agents, for example, metformin and thiazolidinediones, and canagliflozin may become an optimal solution, but further research evaluating the consequences of the combination therapy and canagliflozin is needed.
Study #4: Nursing Research Study Non-USA
Citation: Zhang, L., Wang, F., Wang, L., Wang, W., Liu, B., Liu, J.,… & Chen, N. (2012). Prevalence of chronic kidney disease in China: A cross-sectional survey. The Lancet, 379(9818), 815-822.
Synopsis
What was the purpose of the study?
The article was published in 2012. The list of references contains 31 sources. It is notable for the up-to-date articles; only three sources dated back to the 1990s, and they were necessary to understand the current situation in the Chinese health care through the lens of the past experience.
The purpose of the present guideline is to address the CKD rates in China which remained unknown in the context of the developing country for a long time while the developed countries were characterized by the widespread occurrence of this disease. The authors underline two issues – eGFR and albuminuria – that become the main criteria to identify the prevalence of chronic kidney disease in China.
Who participated or contributed data?
The research team included Chinese specialists from different cities, universities, and hospitals, predominantly the Doctors of Medicine. As the authors emphasize, the guideline was to address a representative sample of persons aged 18 and older from different regions of the country. Both urban and rural areas were included. As the study was intended to incorporate different categories of population, simple randomization was used (for example, SAS software was utilized in this study).
What methods were used to collect data?
Since there was little information related to the situation in China, the authors used some existing SRs and referred to the large body of international academic literature. They searched PubMed for the articles shedding light on the same or similar topic and found very few papers. They reviewed what had been explored by their colleagues and mentioned some of their own works published earlier.
What were the main findings?
It was expected to assess the level of the CKD prevalence in the country, demonstrate that it was one of the urgent problems similar to the other regions of the world, and determine in which provinces the morbidity rates were the highest. Apart from that, the authors of the research identified the factors connected with the higher risks of CKD development and the level of people’s awareness in relation to their CKD status.
Conclusion
The authors provide a large discussion section and convey the idea that it is vital to take into account geographical areas and focus on those which prove to be at risk, namely the rural areas, the north, and southwest regions were exposed to danger. Besides, it is confirmed that hypertension, diabetes, and cardiovascular disease are the most significant factors associated with CKD. In this context, the authors recommend addressing the major non-communicable diseases and take preventive measures aimed at the economic development of endangered rural areas.
Conclusion
The review was conducted by one person. The review addressed chronic kidney disease as one of the most significant issues since nurses regularly have to deal with it. Various aspects, such as the risk factors, the prevalence of the disease, and the peculiarities of the situation in other countries, were examined. The databases, namely Medline and CINAHL, were utilized. Boolean operators turned out to be effective since they gave the opportunity to exclude unwanted information and advance the search.
The keywords (chronic kidney disease, diabetes, cardiovascular, prevalence, the USA, and other countries) were identified and used. It was considered whether CKD was the main topic or at least one of the central issues. Only the articles containing the results of the original research were selected. Finally, the authors’ location, the place of employment, their degrees, and the journals in which the articles were published were also examined.
The review included four articles. Two of them were written by the groups of researchers (nurses were among the specialists who conducted the study and provided its results). Two articles describe the situation in the USA. Two articles refer to the international experience and the ways CKD is viewed in other countries. Different research designs were used: population-based cohort studies, cross-sectional studies, and longitudinal studies.
To sum it up, chronic kidney disease proves to be the subject of concern as it expands promptly. The elderly and persons of certain occupations (for instance, healthcare support, legal occupations, production occupations) are the risk groups. It is necessary to identify reliable methods of treatment, especially for patients with several diseases. The example of canagliflozin that is used to treat patients with type 2 diabetes and chronic kidney disease illustrates that early intervention is more advantageous. In other words, preventive measures should be the focus of health care professionals’ attention.
References
Healthy People. (n.d.). Chronic kidney disease. Web.
National Kidney Foundation. (2015). Global facts: About kidney disease. Web.