Chronic Kidney Disease (CKD) Literature Review

Introduction

The purpose of this literature review is to address the reasons why chronic kidney disease (CKD) can be a death sentence for African Americans (AAs) and explain how implementing health education programs can be an efficient and effective added intervention. This literature review will specifically define all the aspects of CKD, ESRD; CKD’s final stage, describe what standpoint AAs can take to advocate for themselves, then finally, discuss the newly developed kidney education program, Kidney Knowledge for Care (KKC). An educational intervention that provides helpful resources for AAs who are willing and ready to learn about CKD. As KKC is in its early stages of production, this proposed educational intervention for CKD is currently available online but provides an excess of beneficial health information for non-professional individuals and virtual support groups. Researchers explain that it is vital for patients to become their own advocates by going to doctors’ visits but in order to see change; they must educate themselves to ensure they are taking all the measures needed to live a healthy life. To collect all the information needed to complete this article review, articles that solely analyze CKD as a whole, CKD within the AA population and the benefits of CKD self-education. Broad articles that discuss the disease on a global level and describe the scientific methods of CKD in detail will not be included in this review. The intent in reviewing the chosen articles is to explore the possibilities that education is a beneficial intervention for AAs exposed to CKD. 

Body of Evidence

Future partners of KKC, National Kidney Foundation (NKF), devotes an entire section on their website sharing information about AAs and CKD because AAs are “three times more likely to develop kidney failure (ESRD).”¹ The challenging question is why are AAs more susceptible to the disease than other cultures? According to data collected by researchers, medical professionals and kidney disease experts, diabetes is the main culprit behind AAs and CKD.¹ Diabetes is the number one contributing factor for AAs because type 2 diabetes is the most common form of diabetes amongst AAs.¹ So developing CKD can seem inevitable for AAs. If diabetes is not controlled properly, it leads to “high levels of blood sugar make the kidneys work overtime to filter the urine, which over time damages the kidneys and contributes to small amounts of protein (albumin) into the urine.”² Albumin in the urine is not bad but overtime when there is an abundance of albumin in the urine, it is a symptom that the kidneys are not functioning properly. The body benefits from healthy kidneys because they filter the blood, which keeps essential products within the blood like protein but removes excess waste and water creating urine.³ Therefore, when there is an abundance of protein in the urine that is a sign of kidney damage. The studied articles explain although diabetes is the most common contributing chronic disease for CKD in AAs, hypertension is another contributor.^1,3,4 The NKF shares “high blood pressure is the second leading cause of kidney failure among African Americans, and remains the leading cause of death due to its link with heart attacks and strokes.”¹ AAs are not only susceptible to the disease but are prone to developing ESRD, which is kidney failure and a death sentence without kidney transplantation. Evidence-based articles highlight these findings and stress when the signs and symptoms appear, a diagnosis is given and the genetic incidence rate is high, it is important to seek guidance from medical professionals.

Medical professionals as nephrologists and primary care professionals (PCPs) perform numerous kidney tests to determine the estimated glomerular filtration rate (eGFR), which defines whether a patient’s kidneys are functioning properly. ^1,2 The eGFR provides health professionals with the knowledge of the patient’s stage of CKD and what intervention options they should discuss with the patient.^1,2  Various articles and websites referenced for this review have also shared, medical professionals, discuss that CKD develops in stages and symptoms during the early stages of the disease can go unnoticed. ^1,2  The symptoms are known to vary but Angela C. Webster et al. lists a few as “pale skin, water retention, change in urine discretion, vomiting, loss of appetite, fatigue, weakness, confusion itching and cramping in the legs to excretion of protein and blood in the urine.”⁵ Another reason the symptoms go unnoticed is the confusion with other chronic health diseases. As mentioned earlier in the review, AAs develop CKD by other chronic diseases and ESRD, which is the final stage of CKD, is caused by type 2 diabetes.^1,4,6 This really contributes to patients overlooking CKD symptoms. Patients must closely monitor other chronic diseases, any new symptoms and follow kidney intervention protocols to keep the disease from progressing.

Depending on the stage of CKD, doctors will suggest a range of intervention options from “hemodialysis, peritoneal dialysis, kidney transplant, and/or conservative management.”⁷ Hemodialysis and Peritoneal dialysis are invasive procedures that filter a patient's blood through a machine outside the body.⁷ Kidney transplantation is another invasive procedure where a patient receives a kidney transplant from a live or deceased donor.⁷ The last form of treatment the National Institute of Diabetes and Digestive and Kidney Diseases recommends is conservative management.⁷ Conservative management is a form of self-management that allows people to change their diet by limiting proteins.⁷ Studies have shown researchers, physicians and kidney specialists to suggest self-management in certain scenarios specifically along with conventional medicine that they believe can benefit patients in all stages. Although some references say patients can live a healthy life only engaging in conservative management, most agree if a patient is aware of their CKD, engages in self-management behaviors and obtains health literacy, there is a greater chance of a healthier outcome.^7,8 However, in the event the disease progresses to (ESRD), those interventions are important but a patient must resort to dialysis treatment or kidney transplantation.^1,7 Amongst all interventions, health literacy is important in all stages and health programs that offer health education that will provide clarity for patients to make health decisions is what a patient needs. Kidney Knowledge for Care (KKC) is a health program that can provide this additional support for AAs suffering from any stage of CKD.

KKC is exceptionally important for AAs because while conducting a research study screening AAs about CKD and ESRD knowledge, researchers found “the majority of African American patients are unsure of the potential causes of CKD and ESRD.”⁹  KKC will address concerns as this and educate AAs. The program will acts as a glue to other treatments offered by medical professionals by providing education reinforcement to the kidney information given by their physician. KKC offers patient health literacy by supplying comprehensive evidence-based education resources and networking opportunities through an online chatroom that can lead to success when patients implement the received information in a timely manner. The resources offered through KKC address the information AAs receive from medical professionals but non-technically. Similar to what the National Kidney Foundation lists on their website, prevention methods offered by CKD are, CKD education as a whole and specifically for AAs, intervention resources and upcoming health program events.

Summary and Conclusions

AAs are not the only culture exposed to CKD but because of the common chronic health diseases within the culture, AAs are more susceptible. As the NKF stated on their website, “taking steps to live a healthy lifestyle can go a long way towards reducing risk, and early detection and treatment can slow or prevent the progression of kidney disease.”¹ AAs must address all of their health concerns to produce the best quality of life. Medical professionals suggest many interventions for CKD but before treatment can begin, the patient must agree with the chosen intervention. The first step in this process is for the patient to seek education rather than solely relying on someone else to provide education. When patients are unaware of the best treatment options to receive because the information received from their physician is not comprehensible and/or they feel vulnerable due to a new CKD diagnosis, there can be a sense of discouragement and confusion. However, when patients are actively involved in educating themselves and engaging in programs as KKC, there will be a sense of empowerment. They will know what questions to ask during doctor appointments and feel confident with their chosen interventions. KKC promotes health and connects patients with other patients who are facing the same struggles or can share a success story with others. Awareness is key and education creates awareness to those who are willing to devote effort in learning about CKD. One article stated, “Chronic Kidney Disease-Awareness is not associated with Health Literacy, or better Chronic Kidney Disease-Self-Management Behaviors”⁸ but another article discussed the importance of awareness. The article explained, “levels of awareness and knowledge among patients and providers must be improved to prevent CKD, its progression, and its many consequences.”¹⁰ Research has shown differing thoughts on patient and physician awareness but education about personal health status is not only beneficial for the patient but for family and friends as well. Education allows patients to become advocates for themselves with fewer feelings of worry and despair despite the potential outcome of CKD.