Case Managers Can Help Clients Reduce Risk Factors, Avoid Complications
In the back wall of a human’s abdominal cavity are two small organs. Each is the size of a computer mouse. These organs – kidneys – filter all the blood inside the body every 30 minutes to remove toxins, excess fluid, and waste material. They also secrete hormones to help regulate blood pressure and stimulate red blood cell production and other chemicals crucial to life.
In the U.S., 30 million people live with chronic kidney disease (CKD), also known as chronic kidney failure. Risk factors include including diabetes, high blood pressure, heart disease, or having a family member with kidney disease. People over age 60 are also at greater risk.
Early detection and management of health conditions than can lead to kidney disease is vital. Both help prevent progression leading to kidney failure, and ultimately the need for a transplant or dialysis. Care managers can be invaluable to people who are at risk for kidney disease or are already experiencing it.
How Kidney Disease Affects the Body
When kidneys begin to fail, waste products and toxins are not being adequately filtered and removed from the body. The additional toxic load can cause trouble sleeping, skin conditions, muscle cramps, nausea, and vomiting. Some people experience swelling in the feet and ankles, as well as fluid in the lungs, making breathing difficult.
Complications from CKD produce system-wide symptoms. Some of the more common include anemia, heart disease, high calcium levels, and bone disease. There are five stages of CKD beginning with mild damage in Stage 1 to complete failure in Stage 5.
For those with CKD, heart disease is the reason for the vast majority of deaths. This is a vicious cycle as high blood pressure causes CKD and CKD causes high blood pressure, which in turn triggers heart disease and premature death.
CKD and end-stage renal disease represent a significant public health problem and a major reason for poor quality of life. For many people living with CKD, the focus of medical care is to delay progression the disease, which then postpones the need for dialysis or kidney transplant as long as possible.
Challenges of Dialysis and Transplant
Dialysis, although lifesaving, is not without side effects. It can trigger fatigue, low blood pressure, nausea, and dizziness. Some people experience muscle cramps in the lower leg during the procedure, while others report itchy skin caused by a buildup of minerals between dialysis sessions.
Other side effects associated with hemodialysis includes difficulty falling asleep or staying asleep, loss of libido, erectile dysfunction, dry mouth and anxiety. Another, sometimes fatal, side effect on hemodialysis is sepsis, which can lead to multiple organ system failure and death.
The impaired immune system of those suffering with CKD increases their mortality risk by more than 50%, studies show. Transplant is often the last resort for people with end-stage kidney disease, but its presents its own challenges including the need lifelong immunosuppressant medications and the potential for organ rejection.
Managing the risk factors and health conditions that contribute to kidney disease should remain the primary goal. Lifestyle changes such as eliminating smoking, maintaining a healthy weight, controlling diabetes, and reducing high blood pressure, can all help to slow the progression of the disease.
Case Management Reduces Costs, Stress
It often takes a village to manage kidney disease. In addition to a nephrologist, teams may include a pharmacist who ensures proper dosing based on the patient’s level of kidney function, a dietitian who can help with a nutritional plan, friends and families who can offer encouragement and support, and a care manager who can provide resources, coordinate services, and troubleshoot problems.
Effective care management in the community that integrates challenges into planned interventions can significantly improve outcomes for people with CKD, while reducing costs and alleviating stress for the delivery system, patients, and families.
The U.S. Preventive Services Task Force has found integrating diverse clinical and community strategies can improve health outcomes for people with CKD. In one literature review assessing quality of life, researchers found case management interventions were most effective when they included a greater number of components affecting the patient.
SOURCES
American Kidney Fund, Chronic Kidney Disease (CKD). American Kidney Fund.
American Kidney Fund. Life After Transplant. American Kidney Fund.
Center for Disease Control and Prevention (December 12, 2019) Chronic Kidney Disease Basics. Center for Disease Control and Prevention.
Fishbane, S., Hazzan, A., Halinski, C., Mathew, A. (February 2015). Challenges and Opportunities in Late-Stage Chronic Kidney Disease. Clinical Kidney Journal. 8(1):54
Flanagan, S., Damery, S., Combes, G. (September 29, 2017) The Effectiveness of Integrated Care Interventions in Improving Patient Quality of Life for Patients with Chronic Conditions. Health and Quality of Life Outcomes. 15(188)
National Kidney Foundation. About Chronic Kidney Disease. National Kidney Foundation.
National Health System (June 14, 2018) Dialysis: Side Effects. National Health System.
Ockene, J., Edgerton, E., Teutsch, S., Marion, L., et.al. (March 2007) Integrating Evidence-Based Clinical and Community Strategies to Improve Health. American Journal of Preventive Medicine, 32(3):244
Shuler, S. (October 31, 2019) Are You Meeting the Challenges of Chronic Kidney Disease? Arkansas Physician Newsletter
University of Michigan. Chronic Kidney Disease. Michigan Medicine.