I.

Introduction

DEFINITION
End‐stage renal disease (ESRD) is a chronic failure of normal kidney function, (7)The
loss of kidney function is gradual, and many patients do not have any symptoms until
the end‐stage of the disease.
STATISTICS
(1)According to the National Center for Chronic Disease Prevention and Health
Promotion, about 30 million people, or 15% of adults, in the U.S. are estimated to have
chronic kidney disease. (6) Kidney diseases, especially End Stage Renal Disease
(ESRD), are already the 7 th leading cause of death among the Filipinos. One Filipino
develops chronic renal failure every hour or about 120 Filipinos per million populations
per year. More than 5,000 Filipino patients are presently undergoing dialysis and
approximately 1.1 million people worldwide are on renal replacement therapy.
RISK FACTORS
(3) Risk factors for ESRD include the following: Age- most common in elderly, Gender-
men are more likely than women to develop ESRD, Race -African-Americans have
higher rates of ESRD than people of other races. Diabetes is the biggest risk factor for
developing ESRD. High blood pressure is the second most common cause of ESRD.
Overweight, Proteinuria, Anemia, and Hyperuricemia has higher risk in developing
ESRD. Genetic factors, Smoking, (9)Recreational drugs such as opioids and cocaine.
Glomerulonephritis, this disease damages the glomeruli, which are the filtering units in
the kidney. It is the third leading cause of ESRD.
SIGNS AND SYMPTOMS
(2) Signs and symptoms of kidney disease are often nonspecific, (1) Patients may
experience a wide variety of symptoms as kidney failure progresses. These include
fatigue, weakness, twitches and cramps, swelling of feet and ankles, decrease in
urination or inability to urinate, dry skin, itchy skin, headache, weight loss, nausea,
vomiting, loss of appetite, bone pain, skin and nail changes, muscle chest pain, if fluid
builds up around the lining of the heart, shortness of breath, if fluid builds up in the lungs
and High blood pressure (hypertension) that's difficult to control and easy bruising. (2) It
may also include sleep problems, decreased mental sharpness, confusion, drowsiness,
seizures, and coma.
PREVENTIVE MEASURES
(10) Prevention of End Stage Renal Disease (ESRD) includes three aspects: healthy
lifestyle, treatment of primary disease, and positive treatment of Kidney Failure.
Personal hygiene, increase water intake and prevent urinary tract infection, proper diet
which is low in salt and fat. No smoking and drinking alcohol, control of blood pressure
levels well (about 120/80mmHg). Hypertensive are suggested to control the blood
pressure. Diabetics are recommended to control blood sugar level. Avoid drugs that are
harmful to the kidneys and prevent various infections. (11) According to the Centers for
Disease Control and Prevention, the hepatitis B and pneumococcal polysaccharide
(PPSV23) vaccines can lead to positive outcomes, especially before and during dialysis
treatments.
MEDICAL, SURGICAL, PHARMACOLOGICAL AND NURSING MANAGEMENT
Medical Managements includes: (1) hemodialysis, a patient’s vein or catheter tubing is
used to pump blood outside of the body and through a machine, called a dialyzer, which
filters out waste. The treatment lasts approximately three to four hours, and needs to be
performed approximately three times per week at a dialysis center or appropriate health
clinic. (8) It helps removing extra fluids and waste products from your blood, restoring
electrolyte levels, and helping control your blood pressure. (1) Peritoneal dialysis, the
membrane lining of the body cavity is used as a substitute filter to do the work of the
kidneys. A tubelike catheter, permanently implanted into the abdominal cavity, is used
to inject up to 3 liters of waste-absorbing fluid into the cavity, where it remains for
anywhere from two to six hours before it needs to be drained. The process must be
performed four to six times per day, or patients can use a mechanical device, called a
“cycler,” overnight. Pharmacological Managements includes (11) drug therapy using
angiotensin converting enzyme inhibitors (ACE inhibitors) or angiotensin receptor
blockers (ARBs) for patients with diabetes or hypertension, to control their conditions to
help prevent ESRD. (11) Taking vitamin supplements, such as calcium, vitamin C,
vitamin D, and iron, can help your kidney function and the absorption of essential
nutrients. Surgical Managements includes Kidney transplant involves removing the
affected kidneys and placing a functioning donated organ. (8) Kidney transplant is a
surgical procedure to place the new kidney in your lower abdomen and attach the blood
vessels and ureter — the tube that links the kidney to the bladder — that will allow the
new kidney to function. Nursing Management includes monitoring of vital signs and
intake and output. Diet modification (11) may also need to increase patient’s caloric
intake and decrease protein consumption. A diet low in sodium, potassium, and other
electrolytes may be needed, along with fluid restriction.
COMPLICATIONS
(11) Possible complications of ESRD include: skin infections from dry skin and itching,
increased risk of infections, abnormal electrolyte levels, joint, bone, and muscle pain,
weak bones, nerve damage, changes in blood glucose level. Less common but more
serious complications include: liver failure, heart and blood vessel problems, fluid, build
up around your lungs, hyperparathyroidism, malnutrition, anemia, stomach and
intestinal bleeding, brain dysfunction and dementia, seizures, joint disorders and
fractures.

REFERENCES
(1) The Johns Hopkins Hospital, and Johns Hopkins Health System. Retrieve from
[Link]
(2) 2014 Health Grades Inc. 13 August, 2015 (2:20). Retrieve from
[Link]
(3) Chronic kidney disease (CKD) in adults. EBSCO DynaMed Plus website. Retrieve from
[Link]
(4) What I need to know about kidney failure and how it's treated. National Institute of Diabetes and Digestive and Kidney Diseases
website. Retrieve from [Link]
(5) Centers for Disease Control and Prevention. Chronic Kidney Disease Surveillance System website. [Link]
Accessed January 7, 2019. Retrieve From [Link]
(6) Kidney Health Plus. Retrieved from [Link]
(7) John Wiley & Sons. October-December 2004. Journal of Renal Care. Vol 29. Issue 4. Page 198-202. From
[Link]
(8) 1998-2019 Mayo Foundation for Medical Education and Research (MFMER). From [Link]
conditions/end-stage-renal-disease/symptoms-causes/syc-20354532
(9) What I need to know about kidney failure and how it's treated. National Institute of Diabetes and Digestive and Kidney Diseases
website. Retrieved from [Link]
treatment-thats-right-for-you/Pages/[Link].
(10) How to Prevent End Stage Renal Disease (ESRD), Retrieved From [Link]
prevention/[Link]
(11) Christine DiMaria, Marijane Leonard, and Tim Jewell. July 2017. What You Need to Know About End-Stage Kidney Disease
(ESRD). Retrieve from [Link]
 32
MAKATI MEDICAL CENTER
Nursing Education Research and Development
Nurse Residency Probationary Program – Batch 51

CASE STUDY: END STAGE RENAL

Josue, Stephanie Canlas