Chronic Kidney Disease

Department of Health and Human Services with respect to the issue of chronic kidney disease suggests that this condition has the potential to have considerable health ramifications for specific groups as well as overall public health. At a time when other chronic conditions such as cardiovascular disease are being reduced, the incidence of chronic kidney disease is increasing. Further, the data demonstrates the individuals over the age of 75 are more susceptible to this condition. Given that almost one-third of the American population is poised to turn 65 chronic kidney disease represents an emerging health threat that must be addressed.

In an effort to improve health outcomes in this area, Department of Health and Human Services has developed its Healthy People (HP) 2010 initiative. This initiative sets specific targets for improving health based on the unique needs of the condition. For instance, in the case of chronic kidney disease, research demonstrates that there is no effective cure and that current treatment options are both expensive and do not markedly improve overall quality of life. As such recommendations for prevention and aggressive treatment of kidney disease are the focus of intervention. By focusing on these specific areas DHHS believes that health improvements can be garnered.

In an effort to understand the impact of HP 2010 goals and objectives for chronic kidney disease, this investigation considers a review of the initial goals and the outcomes that have been measured during the Midcourse Review. Through a careful review of the data problems with operationalizing data and outcomes are discussed along with some of the challenges that remain for improving overall public health with respect to the treatment and prevention of chronic kidney disease.

Selection and Overview

Focus Area and Its Parameters

In order to begin this investigation, it is first necessary to delineate the specific focus area, its parameters and how it fits into the overall U.S. Prevention Agenda. For the purposes of this investigation, chronic kidney disease has been selected. According to the Department of Health and Human Services (DHHS) (2000) Healthy People 2010 report, chronic kidney disease represents one of the most challenging obstacles for modern health care. At a time when other chronic diseases such as heart disease are declining in total number, the occurrence of chronic kidney disease is increasing (DHHS, 2000). A review of statistical data indicates that the individuals of all ages are susceptible to this condition; however individuals over the age of 75 are the most frequently diagnosed group with this condition. Although dialysis and kidney transplantation provide notable alternatives for improving patient outcomes, the treatments are not a panacea. Both do not restore complete health and both are expensive to undertake. DDHS argues that the growing number of patients with chronic kidney appears to coincide with an increase in the number of patients with type II diabetes.

Considering chronic kidney disease in the context of the overall U.S. Prevention Agenda, it seems reasonable to argue that improving outcomes in this area would be directly linked to the desire to effectively prevent health care complications with the final goal of improving overall health for the individual (Midcourse Review, 2006). By preventing the condition, it is possible that health care providers can effectively improve quality of life for patients by ensuring that patients do not fall prey to the development of a chronic condition which could markedly impede their ability to function. This would have an overwhelming impact for both those at risk for developing the condition as well on improving overall public health.

Two Goals of HP2010

DHHS (2000) reports that there are two overarching goals of HP 2010. These include: increase quality and years of healthy life and eliminate health disparities. Although these goals are aimed at improving the overall health of the population, this appears to be a notable challenge in the context of chronic kidney disease. Considering the first goal of DHHS -- i.e. To increase quality and years of life -- DHHS (2000, Chronic Kidney Disease) notes that presently treatment for chronic kidney disease does not dramatically improve the quality of life for most patients with this condition. Dialysis and renal transplantation both represent notable challenges for health care providers. Further, this condition can have a devastating impact on the overall health of the individual. Thus, in order to effectively meet this objective, DHHS will have to consider more preventative measures as a central means to reduce the onset of kidney dysfunction. Only by addressing this area will it be possible to reduce the negative health consequences that are associated with this disease.

The second objective noted by DHHS is to reduce health disparities overall. The data provided by DHHS (2000, Chronic Kidney Disease) clearly indicates that there are notable disparities with regard to ethnicity in addressing this disease. Specifically, African-Americans are more likely to develop chronic renal failure than their white counterparts. Overall health initiatives have sought to improve minority access to health care in recent years. However, African-Americans continue to remain an underserved population. Given that renal failure often has no direct symptoms, increasing awareness and developing prevention campaigns for these vulnerable populations will be a significant challenge for reducing the health disparities that have been reported with respect to this condition. In total, chronic kidney disease appears to represent a clear challenge for improving public health in terms of these two objectives.

Why this is a Population of Significance

With a basic review of the current state of chronic kidney disease elucidated, it is now possible to consider the reasons why this population is of significance for efforts to improve public health. According to the original DHHS (2000) Health People 2010 report approximately 10 million individuals over the age of 12 have some form of kidney disease. Further, DHHS reports that most of the new cases of kidney failure are reported in individuals over the age of 75. Finally, DHHS notes that there are notable disparities in the diagnosis of this condition based on ethnicity. When these specific issues are examined in the context of population trends for the United States, the importance of addressing this condition becomes quite clear.

According to the U.S. Census Bureau (2006) "In 2006, the oldest of the baby boomers, the generation born between 1946 and 1964, will turn 60 years old (Oldest baby...). The Bureau goes on to report that this population includes more than 78 million Americans or almost one-third of the population. As approximately one-third of the population becomes poised to reach the 75 and over demographic, it is reasonable to assume that the number of individuals developing chronic kidney disease will increase dramatically. The growing number of ethnic minorities living in the U.S. is also a critical issue for concern. Specifically, Mather (2007) reports that in 2006 the United States Census Bureau reported that the total number of ethnic minorities living in the U.S. toped 100 million for the first time. Although these individuals are not equally dispersed across all age groups, again changes in the demographics of the general population warrant concern as more individuals will be susceptible to developing chronic kidney disease.

Objectives and Sub-Objectives of the Population Focus Area

The next issue that must be addressed in the context of this investigation is a description of all of the objectives and sub-objectives for this population focus area. A review of the HP2010 goals developed by DHHS (2000, Chronic Kidney Disease) indicates that the central goal for this condition is as follows: "Reduce new cases of chronic kidney disease and its complications, disability, death and economic costs" (p. 4-9). In order to achieve this goal, DHHS has developed eight sub-objectives that include the following:

4-1: Reduce the rate of new cases of end-stage renal disease: DHHS reports that current rate of increase in this condition is 6% per year, with the number of cases increasing 5 to 8% per year. Thus, if efforts are not made to reduce the total number of ESRD cases a significant number of deaths will result as a consequence of this condition.

4-2: Reduce deaths from cardiovascular disease in persons with chronic kidney failure: Cardiovascular disease is a leading cause of death for patients with chronic kidney disease. As such, reducing the number of patients with cardiovascular disease should improve outcomes for patients with chronic kidney disease.

4-3: Increase the proportion of treated chronic kidney failure patients who have received counseling on nutrition, treatment choices and cardiovascular care 12 months before the start of renal replacement therapy: This measure is intended to improve overall health outcomes for the patient by improving other areas of health that can impact outcomes of chronic kidney disease.

4-4: Increase the proportion of new hemodialysis patients who use arteriorvenous fistulas as the primary mode of vascular access: Fistulas have demonstrated to improve health outcomes for the patient and are recommended as a first line of defense for improving outcomes for patients receiving dialysis.

4-5: Increase the proportion of dialysis patients registered on the waiting list for…