After studying this chapter, you should be able to:
• describe the underlying pathophysiology and risk factors of chronic kidney disease (CKD)
• describe the different treatment options for people with CKD
• understand the health prevention and health promotion requirements for people with CKD
• identify issues affecting quality of life related to treatment of CKD
• understand the nurse's role in working with patients with CKD.
Chronic kidney disease (CKD) continues to be an under-recognised condition globally and occurs in both adults and children. Kidney Health Australia (2015b) suggests that around 1.7 million Australians over the age of 18 have clinical evidence of CKD, and less than 10 per cent of people with the condition are aware that they have it, as CKD typically has no symptoms. Unfortunately, up to 90 per cent of kidney function can be lost before symptoms become evident. These results are similar in New Zealand with an estimated 7–10 per cent (approximately 210 000 people in 2015) of the total population living with some degree of CKD. The New Zealand Ministry of Health (NZMOH, 2015) states that there was an increase of 84 per cent in 12 years of reported cases of end stage CKD within the New Zealand population.
CKD is diagnosed when a person has evidence of kidney damage and/or a reduced kidney function which lasts longer than three months (Sandilands, Dhaun, Dear & Webb, 2013). CKD can be categorised into five stages (1–5), in accordance with the glomerular filtration rate (GFR) and the presence of albuminuria. End stage kidney disease (ESKD) is the most severe form of CKD, with those affected often requiring kidney replacement therapy, either in the form of dialysis or kidney transplantation, without which they would not survive (Hite & DeBellis, 2009).
The health care and economic burden of CKD on individuals, communities and globally is high, and is predicted to further increase as the population ages and the prevalence of diabetes increases. The cost of CKD to the Australian and New Zealand health care budgets accounted for around 1.7 per cent of total expenditure in 2004–05 ($898.7 million), with the cost of treatment for a patient with ESKD on kidney replacement therapy (KRT) such as haemodialysis ranging from $101 189 per person per year in a hospital to $54 017 per person per year in the community/home self-care (AIHW, 2014; NZMOH, 2015).