Combating CKD in the geriatric population

How to Combat the Development of Chronic Kidney Disease in the at-risk Geriatric Population?

Introduction

Chronic Kidney Disease (CKD) is the 9th leading cause of death in the U.

S. and affects over 31 million adults as well. The geriatric population account for about one-third of this population. Until the risk factors are further investigated as well as the role that aging and nutrition intervention plays in the development of CKD it will be difficult to lessen its occurrence in the U.S. geriatric population.

Review of Literature

Risk Factors that are Associated with Chronic Kidney Disease

To figure out how to combat the development of Chronic Kidney Disease in the at-risk geriatric population first one has to examine what makes someone at risk for this. As relates to Chronic Kidney Disease many factors can cause someone to develop the disease, some factors are nonmodifiable and some are not modifiable. As a part of this research paper m more information will be provided on each of these factors that could contribute to CKD which could negatively alter health parameters, overuse taxpayers’ dollars, and also lessen the quality of life of the patients that end up with CKD especially those who experience End-Stage Renal Disease and will need Renal Replacement Therapy.

Nonmodifiable factors are factors that people can not control or alter. Some nonmodifiable factors that can contribute to developing CKD include genetics, family history, gender, and ethnicity. There have been studies that show that CKD had a heritable component that identifies susceptibility loci for multiple health parameters such as glomerular filtration rate (GFR), and cystatin C (eGFRcys) estimated GFR determined by serum creatinine (eGFRcrea) and their genome associations with CKD.

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Most of these genome associations with CKD have to do with a mutation in different genes that can increase one’s chances of CKD. One of the major mutations is known as an autosomal recessive pattern of inheritance (APOLI). This mutation when observed in studies has shown a 10-fold higher chance of not only developing CKD but ESRD as related to focal glomerulosclerosis and a 7-fold higher chance of developing ESRD as a result of hypertension. There have also been studies conducted in Taiwan that showed that there are mutations in several genes associated with the renin-angiotensin system (RAAS) that have been seen in many patients that developed CKD whereas the controls in the study who did not have these mutations did not end up developing CKD. This information shows that there is omorethan likely a link between RAAS genes and CKD.

Many patients who end up developing CKD typically have a family history of this disease. A study put on by Song et al. between the years of 1995 and 2003 observed dialysis patients and asked them to complete a survey that asked questions about their family history and the development ESRDof. The exclusion criteria excluded patients who developed ESRD due to hereditary disorders and urologic causes and even then 23% of those patients had close relatives who had ESRD as well which shows that family history plays a part in the development of CKD.

Many Nephrology journals and registries have shown that ESRD occurs more frequently in men. According to a study conducted in Okinawa, Japan 107,192 subjects aged 18+ years (56,070 women and 51,122 men) there was a 10-year follow-up showed that there was a 1 out of 41 chance that a male subject developed ESRD.

Many studies conducted in Atomerica have shown that there is an increased risk to develop ESRD in African Americans when compared to Caucasians. Since African Americans are considered salt-sensitive there is a 5-fold higher chance of developing hypertensive ESRD in blacks than Caucasians. After conducting a study it was discovered that there is a higher lifelong risk of ESRD in 220-year-old black women (7.8%) and men (7.3%) compared to white women (1.8%) and men (2.5%) of the same age.

Modifiable factors refer to factors that can be modified to change or improve a disorder. Some modifiable factors include socioeconomic status, smoking, nephrotoxins, acute kidney injury, and concurrent conditions such as Obesity, Diabetes Mellitus, and Hypertension.

Socioeconomic factors can be determined by occupation, income, education, wealth, or housing situation. A study conducted by Krop et al. showed that there was a 2.4-fold higher chance of developing CKD in those who had an income that was less than $16,000 when compared to those with an income of more than $35,000. It has also been demonstrated by NHANES that there is a two times higher prevalence of CKD in unemployed non-Hispanic blacks and Mexican Americans in America compared to their employed counterparts.

There is evidence that smoking causes damage to many organ systems in the body and the renal system is no different. Smoking promotes oxidative stress, endothelial dysfunction, inflammation, prothrombotic shift, glomerulosclerosis, and atrophy of the tubules. Studies have shown that individuals who smoke that have no secondary conditions like diabetes had a higher serum Creatinine than those who smoked less or not at all. This reflects that smoking promotes CKD development.

At the same token alcohol and recreational drugs have shown to increase the chances of developing CKD due to being nephrotoxic. Exposure to heavy metals as well as excessive use of analgesics also promotes nephrotoxicity. Nephrotoxic substance weakens the kidneys and their abilities to perform their many functions for the body. When kidneys grow weaker and lose functionality that increases the chances of developing CKD and not only that but promotes premature staging of CKD.

A history of acute kidney injury has been shown to increase someone’s chances of developing CKD. AKI causes the histological repair to be impaired and it may increase the chance of focal tubulointerstitial fibrosis development. A study showed that patients who experienced AKI showed a 10-fold higher chance of developing ESRD within a year than those patients who never had an AKI episode.

Concurrent conditions such as obesity, uncontrolled Diabetes Mellitus, and Hypertension contribute to most cases of ESRD. Obesity can cause glomerular hypertrophy and hyperfiltration which exacerbate kidney injury by the increased wall tension of the capillaries and glomeruli as well as decreased podocyte density. A Swedish study that included native Swedes between 18 and 74 years old showed that individuals in the BMI category overweight and obese had a 3-fold higher chance of developing CKD as indicated by a much higher serum Creatinine in those individuals as compared to those in a normal BMI range.

Uncontrolled Diabetes whether Type 1 or Type 2 can damage the kidneys and lead to CKD, especially ESRD. It does this by advanced glycosylation end products, injury due to hyperfiltration, and reactive oxygen species. Eight percent of new cases of T2DM already show signs of proteinuria which is an early sign of CKD. After proteinuria occurs there is an a10-year risk of CKD development. Multiple studies have indicated that half of the people with T2DM will develop nephropathy and about 11% of those with nephropathy will experience loss of kidney function over time. This supports that Diabetes Mellitus contributes to the development of CKD.

Hypertension can increase intraglomerular pressure which leads to glomerulosclerosis and ultimately result in loss of kidney function (CKD). The MRFIT study supports this claim which showed an increased risk of developing ESRD as the stage of Hypertension progress. According to this study, there was a 1.9 risk of developing ESRD if one had normal blood pressure, a 3.1 risk for developing ESRD if one had Stage I Hypertension, 6.0 risk for developing ESRD if one had Stage II Hypertension, 11.2 risks for developing ESRD if one had Stage III Hypertension, and a 22.1 risk for developing ESRD if one had Stage IV Hypertension. Uncontrolled hypertension for more than 10 years greatly increases the chance of developing CKD, especially ESRD due to the reasons mentioned before. Due to this, the hypertension-CKD relationship has been established in the literature for many decades and more research stressing the importance of controlling Hypertension as a way of preventing CKD is very relevant and highly encouraged.

Age Association with Chronic Kidney Disease

The majority of cases of CKD and ESRD happen to be in the geriatric population. Aging plays a role in the declined functionality of many organ systems and the kidneys are no different. The decline begins in the middle-aged population and declines even further as age progresses. Research studies show several comorbidities exacerbate CKD as a result of aging so providing a medical intervention will need to be weighed based on pros and cons. It’s suggested that in the aging population that declines in organ system functions are expected to decline but prevention may lessen the occurrence of CKD and its complications which would eliminate the risky medical regimen intervention. Also, many older adults have retired and have a lower socioeconomic standing based on income which lessens the quality of food available to them and increases the chances of the risk factors of CKD and CKD itself. It is important to monitor patients aged 65+ for their kidney function by assessing GFR and serum creatinine to keep those levels within range for their age group. Monitoring could prevent further kidney damage and help preserve the functionality of the kidney in the geriatric population despite the role that age plays in CKD development.

Nutrition Interventions that can Prevent Chronic Kidney Disease

When trying to figure out how to combat the occurrence of CKD in the geriatric population the main focus should be on notes making changes when it comes to modifiable risk factors. Registered Dietitians could make a note and even speak on limiting and/or ceasing the excessive consumption of alcohol as well as smoking and taking nephrotoxic drugs but for one, elaborating further on that is out of our expertise, and for two; the largest percentage of the population with CKD had another concurrent disease thatleadsd to the progression to CKD. Since that is the case, when looking at nutrition prevention the focus should be on making improvements in BMI as well as controlling Diabetes and Hypertension. Having a weight reduction as small as 5-10% can show improvements in Glucose levels which is important in controlling Diabetes, improving lipid profiles which is important for cardiovascular health and it aids with lessening the BMI which combats obesity. Also, limiting protein can help reduce the risk of developing CKD by preserving the filtering ability of the kidneys. The American diet is a high protein diet which overtime can incapacitate the kkidney’sabilities due to the protein being large molecules if too much protein is consumed the kidneys have to work harder to filter that protein so it can be excreted by limiting the amount of protein to each person’s RDA it can conserve the kidneys functionality by reducing the amount of stress being placed on the kidneys. A study in Mexico has been done that shows that supplementation of probiotics such as LCS has shown improvements in urea levels which indicates the preservation of kidney function. Due to this research probiotics are now shown to have a role in improving renal health in people with CKD and those without CKD. Overall, no one nutrition intervention can work for every person but nutrition plays a large role in preventing CKD in at risk individual-risk

Identify Purpose

The purpose of this study is to identify ways to combat the development of Chronic Kidney Disease in at-risk older adults that are 65+ years old.

List of Research Questions

1. What risk factors are associated with Chronic Kidney Disease?
2. How is aging associated with Chronic Kidney Disease?
3. How can nutrition prevent the development of Chronic Kidney Disease?

• Definitions
• Geriatric
• Chronic Kidney Disease
• End-Stage Renal Disease
• Renal Replacement Therapy
• Glomerular Filtration Rate
• Cystatin C
• Serum Creatinine
• Autosomal Recessive Pattern of Inheritance
• Glomerulosclerosis
• Renin-angiotensin System
• Salt-sensitive
• Acute Kidney Injury
• Nephrotoxic
• Prothrombotic Shift
• Focal Tubulointerstitial Fibrosis
• Assumptions

It is assumed that aging is a risk factor for developing CKD however that is not the case. Aging has been proven to affect the functionality of the kidneys but most organ systems don’t function as efficiently with age. Just because a large percentage of the geriatric population ends up developing CKD that does not mean all individuals over 65 years of age will experience CKD even though they may experience some decline in kidney function.

Limitations

Although there were several studies done on my research topic there were some limitations. When it came to discussing risk factors for developing Chronic Kidney Disease there were a lot of studies conducted to support the link between CKD and Diabetes Mellitus, Hypertension, and Obesity but several studies did not occur using the U.S. population which I feel is important because the U.S. has one of the highest incidence and prevalence of CKD in the world. So figuring out how to lower the occurrence of CKD in our population could help our country have a better understanding of how our diet plays a part in not only developing CKD but the risk factors associated with CKD. Another issue is there were not many recent studies done on the geriatric population and CKD prevention but were more so focused on CKD management in the geriatric population. I feel that this is an issue because it is better to be proactive instead of reactive. I feel if more research focused on preventing CKD in the geriatric population then the public would have fewer occurrences of CKD and all complications that arise from CKD which will relieve financial pressure for providing healthcare.

Methodology:

Research Design

Causal-Comparative is the research design that would be used because I am choosing to take two groups: One at-risk group that is the control that won’t receive nutrition counseling and one at-risk group that will receive nutrition counseling. I am trying to see if nutrition counseling will have a positive effect or improve health parameters such as BMI, waist circumference, GFR, and serum creatinine. These improvements could help prevent the development of CKD which is the main focus of the study.

Population Description

The population will be older adults that are patients at Green Clinic in Ruston, LA, aged 65+ that have been diagnosed with obesity, hypertension, and Diabetes Mellitus that have not been diagnosed with CKD.

References

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