Global Dimension and Perspectives

Question: Discuss about the Global Dimension and Perspectives. Answer: Introduction: The lifestyle choices of Robert as mentioned in case study involves regular smoking, heavy alcoholism and manual functionality alone. The lifestyle choice of smoking contributes to the progression of chronic kidney disease (CKD). Smoking contributes to blood pressure and heart rate increase in the body, it reduces the kidney blood flow further accelerating production of angiotensin II. Smoking also damages arteries branches and renal arteries in kidneys. Further, smoking leads to loss of kidney function (Chambers, Germain Brown, 2010). Zhang et al. (2012) indicated that smoking increases proteinuria risk, the increase of protein release in urine confirms proteinuria. In the case of Robert, large concentrations of protein are detected in his urine. Appel et al. (2010) also supported by stating that people with hypertension and diabetes preferring smoking as lifestyle choice develop CKD risk. Jha et al. (2013) stated that smoking slows down the blood flow rate to vital organs like kid ney leading to worsening of existing diseases in these organs. Another lifestyle choice of Robert is alcoholism that also directly affects kidneys of the body. Zhang et al. (2012) stated that More than four drinks/per day lead to progression of kidney disease. Regular drinking habit possesses the double risk to development of CKD in the body as well as drinking alcohol along with smoking possess five times increased risk to develop CKD compared to people who don't drink alcohol or smoke in excess. Etgen et al. (2012) indicated that kidney works to filter harmful substances of the body where alcohol is one such substance leading to harder functioning of kidney. The drying effect of alcohol damages normal kidney function as well as disrupts the hormonal regulation in the kidney. Cardiovascular disease and diabetes type-2 are considered to be risk factors for chronic kidney diseases. Jha et al. (2013) studied that 30% of type-1 DM and 50% of type-2 DM patients suffers the risk of kidney failure. The high blood sugar level in the body disturbs the filtration performed in the kidney. Excess blood sugar makes kidney filtration harder leading to protein leakage in the urine under serious conditions. The presence of protein in urine indicates kidney failure. Robert is also facing the same situation of high protein concentration in urine. Type -2 diabetes mellitus also causes small blood vessels injuries leading to improper blood cleaning in the kidney. Further, damages to nerves is another effect of type-2 diabetes that leads to difficulty in emptying the bladder supporting kidney failure because the back-up pressure in the bladder can cause major kidney injuries. Zhang et al. (2012) indicated that blood glucose, hypertension, cholesterol and BMI are major risk factors for chronic cardiovascular diseases having much-involved risk to chronic kidney diseases. Levey Coresh (2012) studied that damaged blood vessels due to cardiovascular conditions increase the risk of eye disease, kidney failure, stroke and heart attack. The fat deposition (cholesterol, triglycerides, HDL) in the blood vessels due to cardiovascular diseases hinders the normal filtration process occurring in the kidney. This fat deposition increases the blood pressure leading to improper filtration in kidney glomerulus region. Further, Jha et al. (2013) indicated that in cardiovascular disease generally, the blood vessel confront injuries, blockages and damages that can lead to leakage of substance in kidney provoking kidney failure. The stages of Chronic Kidney Disease (CKD) are determined by the Glomerular Filtration rate (GFR) of the patient. Basically, as per GFR rate there are five stages of chronic kidney disease as described below: - Stage 1 GFR 90ml/min Stage 2 GFR = 60 to 89ml/min Stage 3 GFR = 45 to 59ml/min Stage 4 GFR = 15 to 29ml/min Stage 5 GFR 15ml/min The GFR measurement result of Robert being 11ml/min indicates that he has entered the STAGE -5 of chronic kidney disease. This stage -5 is considered as end-stage of chronic kidney disease named as established renal failure condition. With the GFR value of 15ml/min or less the patient has surely entered the end-stage of renal failure where dialysis or kidney transplant becomes a critical requirement (Fox et al. 2012). According to Hallan et al. (2012) some of the most common symptoms of stage 5 CKD are appetite loss, headaches, weakness, vomiting or nausea, itching, swelling, muscular cramps, skin defects and pigmentation. This indicates that vomiting, nausea and tiredness are regular symptoms of stage 5 CKD, therefore, Robert was facing them as the indication of him entering stage 5 of CKD. As the result of kidneys filtration inability, there is a deposition of toxins, waste products and dirt in the blood that is named as Uremia. This Uremia leads to nausea and vomiting conditions in CKD. Uremia basically occurs only in the stage -5 of CKD. Further, the electrode imbalance in the stage -5 occurs when the kidney is not able to filter phosphate, acids and potassium from the body developing muscular weakness and hence the patient feels tiredness (Fox et al. 2012). This indicates that electrode imbalance and uremic syndrome are a reason for the appearance of nausea, vomiting and tiredness in Roberts health condition. According to Zhang et al. (2012), dialysis is usually recommended when the patient is nearing the stage -5 of CKD where the severe symptoms like uremia, pain, toxin deposition, dyspnea etc. are critically affecting the patients body. Similarly, in case of Robert, dialysis is recommended to manage his critical conditions, symptoms and consequences of the stage -5 CKD. The dialysis will manage Roberts condition by minimising his uremia, electrode imbalance and removal of waste products from his body. The dialysis will remove waste, salts, and excess of water that will minimise uremia and stop the vomiting and nausea of Robert also improve his GFR rate. Dialysis leads to a safe management of chemicals like potassium, bicarbonate, sodium etc. in the blood providing electrode imbalance in the body. In the case of Robert dialysis will help to overcome his tiredness by providing electrode imbalance initiating strength to his body (Chambers, Germain Brown, 2010). Further, Zhang et al. (2012) studied that dialysis also minimises the blood pressure, therefore, it will also help to manage the hypertension condition of Robert. Dialysis perfectly functions as artificial kidney where a special fluid containing clean water and the chemical is used to clean the waste, toxins, salts, water from the blood of the patient in a manner like normal kidney functions (Evolve Trial Investigators, 2012). In this manner dialysis will play a major role to minimise the stage -5 CKD conditions and symptoms as well as hypertension of Robert. References Chambers, E. J., Germain, M., Brown, E. (2010).Supportive care for the renal patient. Oxford University Press. Appel, L. J., Wright Jr, J. T., Greene, T., Agodoa, L. Y., Astor, B. C., Bakris, G. L., ... Gabbai, F. B. (2010). Intensive blood-pressure control in hypertensive chronic kidney disease.New England Journal of Medicine,363(10), 918-929. Etgen, T., Chonchol, M., Forstl, H., Sander, D. (2012). Chronic kidney disease and cognitive impairment: a systematic review and meta-analysis. American journal of nephrology,35(5), 474-482. Evolve Trial Investigators. (2012). Effect of cinacalcet on cardiovascular disease in patients undergoing dialysis.N Engl J Med,2012(367), 2482-2494. Fox, C. S., Matsushita, K., Woodward, M., Bilo, H. J., Chalmers, J., Heerspink, H. J. L., ... Tonelli, M. (2012). Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without diabetes: a meta-analysis.The Lancet,380(9854), 1662-1673. Hallan, S. I., Matsushita, K., Sang, Y., Mahmoodi, B. K., Black, C., Ishani, A., ... Wetzels, J. F. (2012). Age and association of kidney measures with mortality and end-stage renal disease.Jama,308(22), 2349-2360. Jha, V., Garcia-Garcia, G., Iseki, K., Li, Z., Naicker, S., Plattner, B., ... Yang, C. W. (2013). Chronic kidney disease: global dimension and perspectives. The Lancet,382(9888), 260-272. Levey, A. S., Coresh, J. (2012). Chronic kidney disease.The Lancet, 379(9811), 165-180. 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.