How Home Health Care Can Help Chronic Kidney Disease (CKD) Patients at Home

Kidney Disease Defined

Kidney diseases are disorders that affect the kidneys; the two organs that remove waste products, produce certain hormones, and regulate the level of chemicals in blood. Unless dramatic changes are made to diet and lifestyle, kidney disease can progress to a point where the kidneys can no longer function efficiently enough for an individual to survive without either a kidney transplant or hemodialysis (also refered to as HD or dialysis). This life threatening failure of the kidneys is call end-stage renal disease or ESRD.

Kidney Disease Facts

  • 10% of the population worldwide is affected by chronic kidney disease (CKD), and millions die each year because they do not have access to affordable treatment.
  • According the 2010 Global Burden of Disease study, chronic kidney disease was ranked 27th in the list of causes of total number of deaths worldwide in 1990, but rose to 18th in 2010.
    • This degree of movement up the list was second only to that for HIV and AIDs.
  • Treatment for kidney failure consumes 6.7% of the total Medicare budget to care for less than 1% of the covered population.
  • In people aged 65 through 74 worldwide, it is estimated that one in five men, and one in four women, have CKD
  • Chronic kidney disease is a worldwide health crisis according to the World Health Organization.
  • Chronic kidney disease can be treated.
  • With early diagnosis and treatment, it’s possible to slow or stop the progression of kidney disease.
  • The overall prevalence of chronic kidney disease (CKD) in the general population is approximately 14 percent.
  • High blood pressure and diabetes are the main causes of CKD.
  • Almost half of individuals with CKD also have diabetes and/or self-reported cardiovascular disease (CVD).
    • More than 661,000 Americans have kidney failure.
    • Of these, 468,000 individuals are on dialysis,
    • Roughly 193,000 live with a functioning kidney transplant.
  • Kidney disease (called the “silent disease”) often has no symptoms in its early stages and can go undetected until it is very advanced.
  • Compared to Caucasians, ESRD prevalence is about 3.7 times greater in African Americans, 1.4 times greater in Native Americans, and 1.5 times greater in Asian Americans.
  • Each year, kidney disease kills more people than breast or prostate cancer.
    • In 2013, more than 47,000 Americans died from kidney disease.

Kidney Disease Risk Factors

  • Diabetes
  • High blood pressure
  • Heart and blood vessel (cardiovascular) disease
  • Smoking
  • Obesity
  • Being African-American, Native American or Asian-American
  • Family history of kidney disease
  • Abnormal kidney structure
  • Older age

Other Contributors to Worsening Symptoms and a Poor Prognosis

  • Fluid retention, which could lead to swelling in your arms and legs, high blood pressure, or fluid in your lungs (pulmonary edema)
  • A sudden rise in potassium levels in your blood (hyperkalemia), which could impair your heart’s ability to function and may be life-threatening
  • Heart and blood vessel (cardiovascular) disease
  • Weak bones and an increased risk of bone fractures
  • Anemia
  • Decreased sex drive, erectile dysfunction or reduced fertility
  • Damage to your central nervous system, which can cause difficulty concentrating, personality changes or seizures
  • Decreased immune response, which makes you more vulnerable to infection
  • Pericarditis, an inflammation of the sac-like membrane that envelops your heart (pericardium)
  • Pregnancy complications that carry risks for the mother and the developing fetus
  • Irreversible damage to your kidneys (end-stage kidney disease), eventually requiring either dialysis or a kidney transplant for survival

Kidney Disease Symptoms

Signs and symptoms of chronic kidney disease develop over time if kidney damage progresses slowly. Signs and symptoms of kidney disease may include:

  • Nausea
  • Vomiting
  • Loss of appetite (anorexia)
  • Fatigue and weakness
  • Sleep problems (insomnia)
  • Changes in how much you urinate
  • Decreased mental sharpness
  • Muscle twitches and cramps
  • Swelling of feet and ankles (edema)
  • Persistent itching
  • Chest pain, if fluid builds up around the lining of the heart
  • Shortness of breath, if fluid builds up in the lungs (dyspnea)
  • High blood pressure (hypertension) that’s difficult to control

Signs and symptoms of kidney disease are often nonspecific, meaning they can also be caused by other illnesses. Because your kidneys are highly adaptable and able to compensate for lost function, signs and symptoms may not appear until irreversible damage has occurred.

Enter Home Health

Because of the progressive nature of CKD, your doctor may refer you to home health care services to try to achieve any number of individualized goals to improve your current status. This most often happens after a recent hospitalization as your physician will try to help you to improve by establishing goals and expected outcomes on those things that may have caused you to go to the hospital, such as dyspnea (shortness-of-breath) for example.

Possible Goals and Outcomes for a CKD Patient

“By the end of the projected episode of care, the patient and/or family/caregiver will:”

  1. Maintain functional continence
  2. Inspect dwelling for potential fall risks and make the dwelling safe for patient ambulation
  3. Examine the patient’s medications and assist patient with the current medications to take and a schedule for taking them. Removing drugs that have been discontinued from the medication regimen
  4. Choose foods congruent with renal diet regimen
  5. Verbalize signs and symptoms of UTI (urinary tract infection)
  6. Teach therapeutic exercise to improve strength and coordination as needed for self-care for ADLs (activities of daily living)
  7. Instruct in the use of adaptive techniques and assistive devices for maximum independence in ADLs (activities of daily living) and personal hygiene associated with ESRD
  8. Initiate plan for renal diet and teach appropriate food/fluid choices
  9. Therapeutic exercises for strengthening and endurance retraining as needed for daily functioning

A Multidisciplinary Approach

The CKD patient will need assistance, training and therapy from skilled nursing, physical therapy, occupational therapy, perhaps a dietary consult, perhaps involvement of a medical social worker and the services of a home health aide.

Benefits of Home Health Care

Yes, it is the obvious…you get all of your treatment and care in the comfort of your own home.   You avoid trips to the doctor’s office and avoid trips to a rehabilitation facility. Your also being taught on  how to navigate and ambulate around your own home, so the education and training are more relevant and effective.

Some Home Health Care agencies, like TLC, also offer non-medical home care services (sitter services) as well. So if you’re working and can’t be there for your loved one 24/7, we can provide someone to keep an eye on them and provide a variety of services for them to meet their needs when you’re not home.

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An Interdisciplinary Approach

Different members of the home health care team will focus on different aspects of your care at your home that ties to their areas of expertise.

Skilled Nursing – Your RN might focus on  goals #1, #2, #3 and #6.  Additionally, the nurse will conduct a safety inspection of the home to ensure that the patient is safe and not a fall risk due to exposed electrical cords running across the floor for example. The nurse will also conduct a prescription reconciliation to make sure that only the currently prescribed drugs are being taken and that a schedule of what to take daily and when to take it is also provided.

Physical Therapy – Your PT might focus on goal #5

Occupational Therapy – Your OT may focus on goal #4

And if you are struggling with any aspect of your activities of daily living (ADLs), the home health aide will be utilized to assist with things like bathing, feeding or dressing for example.

Your team will assess your progress during your treatment episode and report to your physician on how you are doing and what progress is being made.

Benefits of Home Health Care

Yes, it is the obvious…you get all of your treatment and care in the comfort of your own home.   You avoid trips to the doctor’s office and avoid trips to a rehabilitation facility. Your also being taught on  how to navigate and ambulate around your own home, so the education and training are more relevant and effective.

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