Would Blood Work?


There are a number of interventions that are effective in treating (not curing) Chronic Kidney Disease (CKD). Many of the interventions, however, are based solely on how far along the CKD has progressed in specific patients. This is how it should be, of course, but such a scenario causes one to wonder exactly what particular intervention to use in order to lower the incidence of CKD overall. That's what this paper is searching for; a possible intervention that will be successful in lowering the overall rate of CKD in the United States. In order to achieve that objective, the different stages of CKD and the most prevalent interventions currently in use should be examined and understood.

The stages aren't necessarily named but are designated as stages; hence Stage One shows signs of mild kidney diseases with Glomerular Filtration Rate (GFR) otherwise known as kidney function at greater than 90% and stage two is the same thing but has kidney function between 60 -- 89%. It is in these two stages that perhaps the best interventions could take place. According to the National Kidney Center the physical symptoms of CKD begin to show themselves here but there are "few or no physical symptoms that you can feel" (National, 2014).

It seems likely that many of these "early stage" patients might actually be capable of taking some action or actions to stave off the onset of the disease in some form or other. The National Kidney Center also states that "blood work results will show abnormalities" (National, 2014) and those abnormalities are mainly "a slightly elevated serum creatinine" (National, 2014).

The problem with doing blood work to determine the slightly elevated levels, is that according to the National Kidney Center "by the time serum creatinine is elevated, the person may have lost 50% of kidney function" (National, 2014) and if that is true the individual patient will have already progressed to Stage 3.

Another study determined that "homoarginine predicts the risk of progression to dialysis and death in CKD" (Ravani, Maas, Malberti, Pecchini, Mieth, Quinn, Tripepi, Mallamacim Zoccali, 2013, p. 5). Testing for homoarginine seldom takes place before the third stage as well, and oftentimes is not tested for at all.

Finally, treatment for Stage 1 and Stage 2 CKD is much more effective than in later stages, and can often lead to a healthier lifestyle, as well as increased life expectancy for the patient. The National Kidney Center states that treatment may involve some mild dietary changes and a prescribed blood pressure medication (National, 2014) which is a lot less inhibiting and less expensive than the later interventions such as dialysis.

The question therefore is; do the interventions currently in vogue do as much as possible to lower the rate of CKD, and if these interventions are already as effective as they can be, then are there other interventions that can enhance their effectiveness?

Or, are there other medicines that could be added to the mix that could increase their efficacy? Additionally, would adding in the homoarginine testing, coupled with other blood work that is already being done, create a more effective diagnosis vehicle?

This paper will look at how homoarginine and other blood work are currently being used, and how often.

This paper will also seek to determine whether testing earlier or in conjunction with each other will be more effective in diagnosis than what it is now being done. Another aspect that will be studied will be how the tests are accomplished; whether they are presented in a positive, or a negative manner. A recent study determined that "perceptions are amenable to influences and that interventions might potentially be helpful in influencing them in order to improve outcomes" (Jansen, Heijmans, Rijken, Spreeuwenberg, Gootendorst, Dekker, Boeschoten, Kaptein, Groenewegen, 2013, p. 245). It may be worth considering adding a positive aspect to the interventions early on to determine whether such actions influence the patients in a healthy and positive manner, and if that translates into a lower incidence of CKD.

The incidence of CKD in America has increased since 2002 from approximately 18% to almost 27% of the older than 55 years-of-age category of both men and women. Such a large increase demands attention from those experts in the medical community that can intelligently address the issue. A Qaseem et al. report determined that chronic kidney disease can best be described as "abnormalities of kidney structure or function, present for more than three months, with implications for health" (p. 835). Determining why and how those abnormalities have grown so exponentially is a daunting task. Current literature suggests that American lifestyle(s) may have a lot to do with the incidence of CKD. The problem is that CKD is often a precursor to death. One recent study determined that "people with CKD are at risk of progressing to end-stage-renal-disease (ESRD)" (Lewis, 2013, p. 31). End-stage-renal disease oftentimes is a death sentence to the individual suffering from it. Assisting those individuals (even if not all of them can be helped) would be a considerate thing to do.

The health promotion objective of this paper is to lower the incidence of CKD in the United States. Accomplishing the paper's objective provides the opportunity to initiate earlier blood work and testing for many thousands of individuals and could contribute greatly to the lowering of incidence of CKD throughout America.

The intervention will work in the following manner; a random amount of participants will be recruited from a local medical clinic. The participants will be asked to take part in a study that provides them with a free screening for early-stage CKD. After receiving an affirmative from the individual(s), they will be asked to sign a waiver that spells out the exact specifics of the testing, what the participant's responsibilities include, as well as the responsibilities assumed by the researcher. The participant will then be asked to complete a questionnaire (assessment tool). The questionnaire will be both quantitative and qualitative in nature (mixed research). The quantitative part of the questionnaire will ask the participant for gender, age, height, weight, amount and duration of physical activities, and any drugs or medicines that the participant may be currently taking. The qualitative part of the questionnaire will seek to determine the nature of the participant's thinking and perceptions of medicines, doctors, treatments, and other medical related ideals. The participant will be asked to rank his/her thoughts according to a scale of 1 -- 5, with one being the least liked and five being the most liked.

The assessment tool used will be a Likert Scale which allows for quantitative analysis of qualitative information.

As one study recently states "there is growing recognition of the value of conducting qualitative research with trials in health research" (Drabble, O'Cathain, Thomas, Rudolph, Hewison, 2014, p. 1) and since this project not only seeks to determine whether early testing can be effective in lowering the incidence of CKD, but to also address a more positive approach during testing, it makes sense to determine whether participants are positive or negative in general towards medical treatments. Additionally, "mixed-method designs are particularly useful in circumstances that require insights at a deeper level than traditional quantitative survey research can offer- for example, understanding why clinical trial participants may or may not adhere to study protocols or use study products as instructed" (Penman-Aguilar, Macaluso, Peacock, Snead, Posner, 2014, p. 96).

One reason for gathering qualitative data is that studies have shown just how important it is that patients have positive thinking. "People who use positive thinking to repair negative mood rated cold water induced pain as less intensive and less unpleasant" (Kokonvei, Urban, Reinhardt, Jozan, Demetrovics, 2014, p. 589) and if that is true, then perhaps the power of positive thinking can also play a part in whether treatments for CKD are more effective or not. After all, the same Kokonvei et al. study showed that "from a clinical perspective, maladaptive emotion regulation refers to a persistent pattern of deficits, which may affect the full range of emotional processing, including experiencing and expressing genuine emotions" (p. 590).

Gathering the data will take place over a 5-day period at the clinic. Each patient that enters the clinic during that timeframe will be afforded the opportunity to participate, but will not be coerced or manipulated into doing so. The researcher wishes this to be a truly random exercise, and eliminating as much bias as possible. Of course, garnering information from individuals entering the medical clinic will in itself be a bias, since it will already be known that each patient will be there for a specific medical purpose.

The researcher will necessarily have to consider that bias during the course of the project, but it should not be an overwhelming concern. Bias is almost always a concern in every study conducted, and the researcher will bear in mind the natural bias towards showing that data reflects what the researcher desires it to reflect.

Once the data has been gathered, an analysis…