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Course Sample:
Introduction
Chronic kidney disease (CKD) is a worldwide public health problem. The end-stage renal disease (ESRD) population in the United States continues to increase. While the incidence of ESRD was almost 65,000 in 1989, the number of dialysis patients approaches 350,000 in 2006 and will reach upwards of 715,000 in 2012. Much of this increase can be attributed to higher rates of hypertensive and diabetic kidney disease, in the general population. In the United States (U.S.), there is a rising incidence and prevalence of kidney failure. The rising prevalence of treated ESRD can be attributed primarily to the increase in the number of patients who start renal replacement therapy (RRT) each year, and to a smaller extent, increased survival of patients with ESRD. Patients with ESRD consume a disproportionate share of health care resources. The total cost of the ESRD program in the U.S. was approximately $35 billion in 2007, a 23 percent increase from 2002.
Despite the magnitude of the resources committed to the treatment of ESRD and the substantial improvements in the quality of dialysis therapy, these patients continue to experience significant mortality and morbidity, and a reduced quality of life. In 2003 alone, more than 82,000 ESRD patients died. Moreover, 50 percent of dialysis patients have three or more comorbid conditions, the mean number of hospital days per year is approximately 14 per patient, and self-reported quality of life is far lower in dialysis patients than in the general population.
Although the exact reasons for the growth of the ESRD program are unknown, it is postulated that changes in the demographics of the population, differences in disease burden among racial groups and under-recognition of earlier stages of CKD and of risk factors for CKD, may partially explain this growth. Unfortunately, CKD, which is highly prevalent in the United States, is commonly "under-diagnosed" and/or "under-treated", resulting in lost opportunities for prevention.
Defining Chronic Renal failure
Confusion surrounds terminology used to describe the various stages of chronic kidney disease. This presentation defines chronic kidney disease (CKD) as the entire continuum of kidney disease from its onset through and including end-stage renal disease (ESRD). However, chronic renal failure (CRF) is defined as kidney disease from its onset through a progressive decline in kidney function to the point of, but not including, ESRD. End-stage renal disease is characterized by significant, irreversible loss of kidney function in which renal replacement therapy is required to sustain life. As shown in Table 1 (below), there are varying stages of chronic renal failure. Stage I is wherein the individual may have an abnormal urinanalysis (i.e. protein loss) but near normal filtration ? GFR. With each subsequent stage there is a reduction in GFR and progressive disease.
Table 1
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Stage |
Description |
GFR,
mL/min/1.73 m2 |
U.S.
Prevalence |
U.S.
Prevalence, % |
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1 |
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