Abstract

Renal failure, commonly known as kidney failure, refers to the progressive loss of kidney function leading to the inability of the kidneys to adequately filter waste products from the bloodstream.

This condition poses a significant global health burden, affecting millions of individuals worldwide. It can be classified into acute kidney injury (AKI) and chronic kidney disease (CKD), each with distinct etiologies, risk factors, and clinical manifestations.

This comprehensive review aims to provide a concise overview of renal failure, focusing on its pathophysiology, diagnostic approaches, treatment modalities, and potential complications. The pathophysiological mechanisms underlying renal failure involve various factors, including ischemia, inflammation, toxins, and underlying diseases such as diabetes and hypertension.

Diagnostic evaluation encompasses a combination of clinical assessment, laboratory tests, imaging studies, and renal biopsy, allowing for accurate classification and staging of the disease. Management strategies for renal failure depend on the underlying cause and the severity of kidney dysfunction.

In AKI, interventions primarily aim to address the precipitating factors, restore renal perfusion, and prevent further injury. Treatment options include optimizing fluid and electrolyte balance, discontinuing nephrotoxic medications, and providing renal replacement therapies such as hemodialysis or continuous renal replacement therapy when indicated.

CKD management focuses on slowing disease progression, managing complications, and eventually considering renal replacement therapy options like dialysis or kidney transplantation. While renal failure treatment has advanced significantly in recent years, the condition remains associated with substantial morbidity and mortality rates.

Complications of renal failure include cardiovascular disease, electrolyte imbalances, anemia, bone disorders, and increased susceptibility to infections. Therefore, a multidisciplinary approach involving nephrologists, primary care physicians, dieticians, and other healthcare professionals is crucial to optimize patient outcomes.

CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

On November 15, 1950, Ada DeBold, and her husband Harry, called the first meeting of the Committee for Nephrosis Research in a desperate attempt to save their child. Several months earlier, the couple’s infant son was stricken with nephrosis, a little-known condition that had no real treatment.

DeBold was determined to take positive action as she confronted the challenge of parenting a child with an incurable disease and due to her fortitude, the National Nephrosis Foundation (NNF) was born. The NNF was the inaugural lay group that ultimately became the National Kidney Foundation in 1964 (National Kidney Foundation, 2006). The DeBolds’ son died at age four while nephrosis was still a death sentence but his mother’s efforts to connect patients and doctors paid off just a few years later when a treatment was discovered that has since saved the lives of thousands.

Throughout the 1950s, the Foundation’s main focus was supporting kidney patients and their families (Bello, A.K. et al., 2011). Ada DeBold continued her crusade to help those with all types of kidney disease by raising funds for research and patient services. The organization sought to raise awareness about the dangers of kidney disease by developing and distributing information to the public.

Throughout the 1970s and 1980s, a stronger emphasis on encouraging organ donation and raising public awareness became important roles played by the organization. NKF developed a large library of published material for a wide variety of audiences, and positioned itself as the source for information and support on numerous issues related to kidney disease, especially dialysis and transplantation, for both patients and professionals (Abbate, M. et al., 2006). The American Journal of Kidney Diseases (AJKD) was launched by NKF in 1981 and has become the go-to resource for cutting-edge clinical science, together with NKF’s three other peer-reviewed publications.

The Foundation’s ability to develop and disseminate major programs and to influence government policy continued. NKF was a leader in crafting and passing the National Transplant Act in 1984 which prohibited the sale of organs. Around this time, the Foundation began teaming up with corporate partners to obtain the funding needed to develop education programs that continue to improve the lives and health of kidney patients and their families (Bertram, J.F et al., 2011)

Chronic kidney disease (CKD) is a syndrome defined as persistent alterations in kidney structure, function or both with implications for the health of the individual (Zoccali, C. et al., 2017). Examples of structural abnormalities include cysts, tumors, malformations and atrophy, which are evident on imaging.

By contrast, kidney dysfunction can manifest as hypertension, edema, growth delay in children and changes in output or quality of urine; these changes are most often recognized by increased serum levels of creatinine, cystatin C or blood urea nitrogen (Arora, P. et al., 2013). The most common pathological manifestation of CKD, regardless of the initiating insult or disease, is some form of renal fibrosis (Hill, N.R. et al., 2016).

Chronic kidney disease (CKD) is a condition in which the kidneys’ ability to function decreases, leading to compromises in urine production (Thomas et al., 2009; Webster et al., 2017; Wen et al., 2014). A typical healthy person’s kidney is responsible for removing waste, excess fluid, and toxins from the blood (Centers for Disease Control and Prevention [CDC], 2020).

For instance, blood moves throughout the body and provides nutrition to other internal organs. In that process, it picks up extra fluid, toxins, and waste (Mayo Clinic, 2019). Then, this blood flows through the renal artery and into smaller blood vessels until it reaches the nephrons (National Institute of Diabetes and Digestive and Kidney Disease [NIDDK], 2018). In the nephron, blood gets filtered by tiny blood vessels of glomeruli (NIDDK, 2018).

After that, clean blood exits through the renal vein, most water and other substances return to the body by tubules, and 1 to 2 quarts become urine (NIDDK, 2018). To keep the body working properly and healthy, kidneys need to filter the toxins, extra fluid, and waste out of the blood and carry the body into the urine (Mayo Clinic, 2019).

However, when the kidneys cannot filter wastes, toxins, and excess fluids from the body, it becomes problematic and leads to adverse health outcomes.  Individuals with reduced kidney function are at higher risk of heart disease (CDC, 2020). Because the extra fluids and toxins remain in the bloodstream, this puts pressure on other internal organs, such as the heart, to perform their function, causing hypertension and slowly leading to other heart diseases, such as congestive heart failure (Pugh et al., 2019; & House et al., 2019).

Therefore, if an individual with early CKD stages is left untreated, they can develop end-stage renal disease (ESRD) or kidney failure and early cardiovascular disease (CDC, 2020). Other adverse health outcomes are anemia, increased infections (such as bloodstream infection, Pneumonia, Lower Respiratory Tract (LRTI), sepsis, Urinary Tract Infection (UTI), Methicillin-resistant Staphylococcus aureus (MRSA), and Vancomycin-resistant Staphylococcus aureus (VRSA), low appetite, and depression (CDC, 2020; Ishigami & Matsushita, 2019).

Globally, CKD is listed as the fourteenth leading cause of death (Webster et al., 2017). There are 1.2 million deaths associated with kidney failure and increase 32% since 2005 (Neale et al., 2020).

Typically, high income countries spend 2-3% of their annual health budget on the treatment of ESRD, but less than 0.03% of the population receives treatment (Neale et al., 2020). Nationally, CKD is ranked as the ninth leading cause of death in the United States (CDC, 2020). Nine out of ten adults with CKD are unaware that they have the disease (CDC, 2019). On top of that, one in every two people with low kidney function is not on dialysis because they are unaware that they have CKD (CDC, 2019). CKD is a public health issue because it results in comorbidity and increased risk of ESRD progression, complications, and death (Sperati et al., 2019). In 2012, the World Health Organization (WHO) estimated 864,226 deaths attributed to CKD worldwide (Webster et al., 2017).

CKD accounted for 12.2 deaths per 100,000 people and was estimated to reach 14 per 100,000 people by 2030 (Webster et al., 2017). Furthermore, CKD also accounted for 2,968,600 disability-adjusted life years (DALYs) worldwide and 2,546,700 life years lost in 2012 (Webster et al., 2017). In 2017, CKD accounted for 35.8 million DALYs, and 1.2 million people died from CKD (Bikbov et al., 2020). As for kidney failure, WHO estimated that about 1.2 million people died in 2015 (Luychx et al., 2018). WHO also estimated 7.1 million people with ESRD died without dialysis access (Luychx et al., 2018). Overall, five to ten million people die annually from kidney disease (Luychx et al., 2018).

In the past 20 years, worldwide deaths from kidney disease have increased 82% (Sperati et al., 2019). The prevalence of CKD in the United States is estimated at 15% (over 2000 patients) of the non-institutionalized adult population, per the United States nephrology providers (Sperati et al., 2019).  In more up-to-date data, the CDC (2020) found that about 37 million American adults have CKD. For every seven American adults, there is one person with CKD (CDC, 2020).

Every 24 hours, 340 people are on dialysis treatment for their kidney failures (CDC, 2020). In 2016, nearly 125,000 people were treated for ESRD, while 766,000 people were on dialysis or living with kidney transplants in the United States (CDC, 2020). The progressive trends of CKD and ESRD have increased medical expenditures enormously in the United States.   In sub-Saharan Africa (SSA), CKD affects approximately 14% of the adult population but varies substantially by region (Mills KT et al., 2015).

Despite similar estimated prevalence globally and in SSA, there is disproportionate CKD-associated morbidity and mortality in low- and middle-income settings, including SSA (Stanifer JW et al., 2017) Available data on the burden of CKD in South Africa varies from 2 to 23.9% – in part due to differences in study design and definitions used for CKD (Peer N et al.,2020). In these South African studies, associated risk for CKD included older age, high body mass index (BMI), sex, cholesterol, diabetes, and hypertension.

While the true burden of CKD in SA remains speculative, prevalence is thought to be high because of the rise in non-communicable diseases (NCD) such as obesity, hypertension, diabetes, and persistent communicable diseases such as HIV infection (Moosa M et al., 2015). Furthermore, many rural communities are undergoing rapid sociodemographic and epidemiological transitions that exacerbate the risk of infectious and NCD (Kabudula CW et al., 2017). Chronic kidney disease disproportionately affects low income and middle-income countries (LMICs) with a prevalence that is 15% higher than that in high-income countries (Glassock RJ, et al., 2017) In addition to poorly controlled diabetes mellitus and hypertension, infection, and herbal an environmental toxins play an essential role in the epidemiology of CKD in these settings (Jha V, Garcia-Garcia G, et al., 2013). Chronic kidney disease is both a cause and consequence of non-communicable diseases (NCDs) (Neuen BL,. et al., 2017The burden of CKD in LMICs is worsened by limited accessibility to and affordability of renal replacement therapy (RRT). The number of people requiring RRT worldwide is projected to increase from 3.3 million to 5.4 million people by 2030 with most of this increase in developing countries (Bamgboye E, et al., 2017). A large-scale population based study of about 8000 participants aged 40–60years from six communities in sub-Saharan Africa revealed an age-standardized prevalence of CKD of 2.4% (George JA, Brandenburg. et al., 2019).

By 2030, it is estimated that over 70% of people with end stage kidney disease will be living in developing countries like countries in sub-Saharan Africa due to the rising prevalence of diabetes mellitus, hypertension, obesity, and HIV in these sub-Saharan countries (Matsha TE. et al., 2018) The prevalence of CKD in adult Cameroonians varied between 11 and 14.2% (Kaze FF, et al., 2018)

1.2 Problem Statement

Globally, CKD is listed as the fourteenth leading cause of death (Webster et al., 2017). There are 1.2 million deaths associated with kidney failure and increase 32% since 2005 (Neale et al., 2020).

Typically, high income countries spend 2-3% of their annual health budget on the treatment of ESRD, but less than 0.03% of the population receives treatment (Neale et al., 2020). Nationally, CKD is ranked as the ninth leading cause of death in the United States (CDC, 2020). Again, the number of people requiring RRT worldwide is projected to increase from 3.3 million to 5.4 million people by 2030 with most of this increase in developing countries (Bamgboye E, et al., 2017).

A large-scale population based study of about 8000 participants aged 40–60years from six communities in sub-Saharan Africa revealed an age-standardized prevalence of CKD of 2.4% (George JA, Brandenburg. et al., 2019).

By 2030, it is estimated that over 70% of people with end stage kidney disease will be living in developing countries like countries in sub-Saharan Africa due to the rising prevalence of diabetes mellitus, hypertension, obesity, and HIV in these sub-Saharan countries (Matsha TE. et al., 2018) The prevalence of CKD in adult Cameroonians varied between 11 and 14.2% (Kaze FF, et al., 2018). Furthermore, during my internship I weakness many family suffering due to one of the family members having chronic renal failure this make the researcher to carried out a research on the risk factor and prevention.

1.3 Objective

1.3.1 General Objective

To assess parent’s knowledge on the risk factor and prevention of chronic kidney failure in Buea Town community

1.3.2 Specific Objective

1. To assess parent knowledge on chronic kidney failure in Buea Town community
2. To determine the risk factor of chronic kidney failure in Buea Town community
3. To determine the prevention of chronic kidney failure in Buea Town community

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