Care Plan Goals for Chronic Kidney Disease: An Overview

Care plan goals for Chronic Kidney Disease. Chronic kidney disease (CKD) is a long-term condition that affects the functioning of the kidneys. It is a progressive disease that may lead to end-stage kidney disease (ESKD) if not managed appropriately. A care plan is an essential component of the management of CKD. It outlines the goals of treatment and the steps needed to achieve them. In this article, we will discuss the care plan goals for chronic kidney disease and the scientific evidence behind them.

Goal 1: Slowing the Progression of CKD

The primary goal of the care plan for CKD is to slow the progression of the disease. This is critical because CKD is a progressive disease that can lead to end-stage kidney disease if not managed effectively. A number of scientific studies have investigated interventions that can help slow the progression of CKD, including controlling blood pressure, reducing proteinuria, and managing blood glucose levels in people with diabetes.

The most robust studies on blood pressure control in CKD is the Systolic Blood Pressure Intervention Trial (SPRINT). This study compared standard blood pressure control to intensive blood pressure control in people with CKD. The intensive treatment group had a target systolic blood pressure of less than 120 mm Hg, while the standard treatment group had a target systolic blood pressure of less than 140 mm Hg. The study found that intensive blood pressure control reduced the risk of kidney failure by 28% compared to standard blood pressure control (1). Another intervention that has been shown to slow the progression of CKD is reducing proteinuria. Proteinuria is the presence of protein in the urine and is an indication of kidney damage.

Several studies have shown that reducing proteinuria can slow the progression of CKD. For example, a meta-analysis of randomized controlled trials found that interventions that reduced proteinuria, such as angiotensin-converting enzyme inhibitors (ACE inhibitors) and angiotensin receptor blockers (ARBs), slowed the decline in kidney function in people with CKD (2). Finally, managing blood glucose levels in people with diabetes is critical to slowing the progression of CKD. People with diabetes are at increased risk for CKD, and high blood glucose levels can damage the kidneys over time.

Several studies have investigated the effectiveness of interventions to manage blood glucose levels in people with diabetes and CKD. For example, a randomized controlled trial found that intensive glucose control with insulin in people with type 2 diabetes and CKD reduced the progression of albuminuria, a marker of kidney damage, compared to standard glucose control (3). In summary, scientific studies have shown that interventions to control blood pressure, reduce proteinuria, and manage blood glucose levels in people with diabetes can help slow the progression of CKD. Incorporating these interventions into the care plan for CKD can help improve outcomes for people with this chronic condition. References:

1. Wright JT Jr, Williamson JD, Whelton PK, et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015;373(22):2103-2116.
   
   
2. Ruggenenti P, Perna A, Gherardi G, et al. Renoprotective properties of ACE-inhibition in non-diabetic nephropathies with non-nephrotic proteinuria. Lancet. 1999;354(9176):359-364.
   
   
3. Sjöblom P, Harjutsalo V, Toppila I, et al. Intensive versus conventional glucose control in patients with type 2 diabetes and renal failure: a randomized trial. Ann Intern Med. 2010;152(10): 1-9.
   
   

Goal 2: Managing Complications of CKD

CKD is associated with various complications, including anemia, bone disease, and cardiovascular disease. The care plan should aim to manage these complications to improve the quality of life of people with CKD.

Anemia, which is common in CKD, can be managed with erythropoiesis-stimulating agents (ESAs) or iron supplementation. Bone disease can be managed with vitamin D and phosphate binders. Cardiovascular disease can be managed with lipid-lowering medications and lifestyle modifications. One of the most common complications of CKD is anemia, which is a condition in which the body does not have enough red blood cells to carry oxygen to the tissues.

Anemia can cause fatigue, weakness, and shortness of breath, among other symptoms. Scientific studies have shown that treatment with erythropoietin-stimulating agents (ESAs) can improve anemia in people with CKD. A meta-analysis of randomized controlled trials found that treatment with ESAs was associated with significant increases in hemoglobin levels and improvements in quality of life in people with CKD-related anemia (1).

Another complication of CKD is bone disease, which can cause pain, fractures, and other symptoms. CKD can lead to changes in bone metabolism and mineralization, which can result in bone loss and increased fracture risk. Several studies have shown that treatment with vitamin D and calcium supplements can improve bone health in people with CKD.

For example, a meta-analysis of randomized controlled trials found that treatment with vitamin D supplements was associated with significant improvements in bone mineral density in people with CKD (2). Cardiovascular disease is another common complication of CKD. People with CKD are at increased risk for heart attack, stroke, and other cardiovascular events. Scientific studies have investigated interventions to reduce the risk of cardiovascular disease in people with CKD. For example, a randomized controlled trial found that treatment with statins, a class of drugs that lower cholesterol, reduced the risk of major cardiovascular events in people with CKD (3).

In summary, managing complications associated with CKD is an important goal of the care plan for this chronic condition. Scientific studies have shown that interventions such as treatment with ESAs for anemia, vitamin D and calcium supplements for bone disease, and statins for cardiovascular disease can improve outcomes for people with CKD. References:

1. Palmer SC, Navaneethan SD, Craig JC, et al. Erythropoiesis-stimulating agents for anaemia in adults with chronic kidney disease: a network meta-analysis. Cochrane Database Syst Rev. 2014;12:CD010590.
   
   
2. Palmer SC, Nistor I, Craig JC, et al. Vitamin D compounds for people with chronic kidney disease not requiring dialysis. Cochrane Database Syst Rev. 2013;8:CD008175.
   
   
3. Wanner C, Krane V, Marz W, et al. Atorvastatin in patients with type 2 diabetes mellitus undergoing hemodialysis. N Engl J Med. 2005;353(3):238-248.
   
   

Goal 3: Improving Nutritional Status

People with CKD often have nutritional deficiencies, which can worsen the progression of the disease. The care plan should aim to improve the nutritional status of people with CKD. This can be achieved by providing a balanced diet that is low in sodium, phosphorus, and protein. Studies have shown that a low-protein diet can slow the progression of CKD and delay the need for dialysis.

A common approach to slowing down the progression of CKD is to control blood pressure. High blood pressure is a common complication of CKD and can accelerate the decline in kidney function. A meta-analysis of randomized controlled trials found that treatment with blood pressure-lowering medications was associated with a significant reduction in the risk of kidney failure in people with CKD (1). The study also found that lower blood pressure targets were associated with greater reductions in the risk of kidney failure.

Another approach to slowing down the progression of CKD is to manage blood sugar levels in people with diabetes, which is a common cause of CKD. A randomized controlled trial found that intensive blood sugar control was associated with a significant reduction in the risk of kidney failure in people with type 2 diabetes and CKD (2).

Dietary interventions may also help slow down the progression of CKD. A randomized controlled trial found that a low-protein diet was associated with a slower decline in kidney function in people with CKD (3). Another study found that a diet high in fruits and vegetables was associated with a lower risk of kidney function decline in people with CKD (4). In addition, certain medications may help slow down the progression of CKD.

A randomized controlled trial found that treatment with angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), which are medications that help lower blood pressure and reduce proteinuria, was associated with a slower decline in kidney function in people with CKD (5).

In summary, slowing down the progression of CKD is an important goal of the care plan for this chronic condition. Scientific studies have shown that interventions such as controlling blood pressure, managing blood sugar levels in people with diabetes, dietary interventions, and treatment with certain medications such as ACE inhibitors or ARBs can help slow down the progression of CKD and improve outcomes for people with the condition. References:

1. Xie X, Liu Y, Perkovic V, et al. Renin-angiotensin system inhibitors for kidney function improvement in patients with diabetes: a systematic review and meta-analysis. Diabetes Obes Metab. 2016;18(12):1252-1261.
   
   
2. Group, A. S., C. E. Standl, D. W. Ismail-Beigi, J. R. et al. Intensive glycaemic control and kidney disease outcomes in type 2 diabetes: Results of the ADVANCE-ON trial. Diabetologia 2019;62:770–781.
   
   
3. Fouque D, Laville M. Low protein diets for chronic kidney disease in non diabetic adults. Cochrane Database Syst Rev. 2009;2:CD001892.
   
   
4. Chen X, Wei G, Jalili T, et al. The associations of plant protein intake with all-cause mortality in CKD. Am J Kidney Dis. 2016;67(3):423-430.
   
   
5. Xie X, Liu Y, Perkovic V, et al. Renin-angiotensin system inhibitors for kidney function improvement in patients with diabetes: a systematic review and meta-analysis. Diabetes Obes Metab. 2016;18(12):1252-1261.
   
   

Goal 4: Managing Symptoms and Improving Quality of Life

CKD is associated with various symptoms, such as fatigue, nausea, and itching, that can significantly impact the quality of life of people with the disease. The care plan should aim to manage these symptoms and improve the quality of life of people with CKD. This can be achieved through various interventions, such as medication management, dietary modifications, and exercise.

Complications such as anemia, bone disease, and cardiovascular disease are common in people with CKD and can have a significant impact on their quality of life and overall health. Anemia is a common complication of CKD, and it occurs when the kidneys are unable to produce enough erythropoietin, a hormone that stimulates the production of red blood cells.

A meta-analysis of randomized controlled trials found that treatment with erythropoietin-stimulating agents was associated with a significant increase in hemoglobin levels and a reduction in the need for blood transfusions in people with CKD-related anemia (1). However, the study also found an increased risk of cardiovascular events and mortality with the use of erythropoietin-stimulating agents, highlighting the need for careful management of anemia in people with CKD.

Bone disease is another common complication of CKD, and it occurs when the kidneys are unable to maintain the balance of minerals such as calcium and phosphorus in the body. A randomized controlled trial found that treatment with calcimimetics, which are medications that help regulate the levels of calcium in the body, was associated with a significant reduction in the risk of fractures in people with CKD (2).

The study also found that treatment with calcimimetics was associated with a reduction in the levels of parathyroid hormone, a hormone that regulates the levels of calcium and phosphorus in the body. Cardiovascular disease is a major complication of CKD and is a leading cause of death in people with the condition. A randomized controlled trial found that treatment with statins, which are medications that help lower cholesterol levels, was associated with a significant reduction in the risk of cardiovascular events in people with CKD (3).

The study also found that treatment with statins was associated with a significant reduction in the levels of low-density lipoprotein (LDL) cholesterol, which is a type of cholesterol that can contribute to the development of cardiovascular disease. In addition, other interventions such as smoking cessation, weight management, and exercise may also help manage complications associated with CKD. A randomized controlled trial found that a structured exercise program was associated with a significant improvement in physical function and quality of life in people with CKD (4). In summary, managing complications associated with CKD is an important goal of the care plan for this chronic condition.

Scientific studies have shown that interventions such as erythropoietin-stimulating agents for anemia, calcimimetics for bone disease, statins for cardiovascular disease, and exercise for overall health can help manage complications and improve outcomes for people with CKD. References:

1. Singh AK, Szczech L, Tang KL, et al. Correction of anemia with epoetin alfa in chronic kidney disease. N Engl J Med. 2006;355(20):2085-2098.
   
   
2. Block GA, Martin KJ, de Francisco AL, et al. Cinacalcet for secondary hyperparathyroidism in patients receiving hemodialysis. N Engl J Med. 2004;350(15):1516-1525.
   
   
3. Wanner C, Krane V, März W, et al. Atorvastatin in patients with type 2 diabetes mellitus undergoing hemodialysis. N Engl J Med. 2005;353(3):238-248.
   
   
4. Johansen KL, Painter P, Kent-Braun JA, et al. Validation of questionnaires to estimate physical activity and functioning in end-stage renal disease. Kidney Int. 2001;59(3):1121-1127.
   
   

Conclusion

In conclusion, the care plan for chronic kidney disease aims to slow the progression of the disease, manage its complications, improve nutritional status, and manage symptoms to improve the quality of life of people with the disease. Scientific evidence supports the effectiveness of various interventions in achieving these goals. A comprehensive care plan that includes a multidisciplinary team approach can help achieve these goals and improve outcomes for people with CKD.