CHAPTER Table 1. Usually, the end stageCHAPTER Table 1. Usually, the end stage

CHAPTER
II

Review of
Related Literature

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            This chapter discusses ESRD and
explores the experiences of patients undergoing dialysis. The following
literatures explain and summarize the present findings regarding the several
impacts the disease has to a diagnosed person.

End
Stage Renal Disease (ESRD)

            Kidneys are responsible in filtering
waste and excess water from blood. However, they could malfunction that may
result to CKD. This may then develop into the fifth and final stage or ESRD
over time. This indicates that kidneys no longer operate well (below 10-15% of
normal ability) enough to meet the daily body processes (healthline, 2017).

            In the Philippines, about 7,000 patients die yearly due
to kidney diseases 2. It is consistently among
the top 10 causes of morbidity (7th) and mortality (8th) 13. The disease has been linked to the complications
induced by other illnesses such hypertension (22%) and diabetes (41%) 2,13. In Negros Occidental for instance, it has been
reported that kidney disease due to poor diabetes control and HPN was the sixth leading cause of death in 2016 13.

Chronic kidney disease is progressive.
It is measured through glomerular filtration rate (GFR) (healthline, 2017) as displayed in Table 1.
Usually, the end stage is reached after 10-20 years from the diagnosis. The pace
of advancement is highly dependent on the treatment provided in relation to
diet and dialysis as advised. Dialysis has been used since the 1940s for the
treatment of kidney problems (healthline,2015).
It works through the use of a machine (replacing kidneys) to filter and purify
the blood. It is typically recommended when the level of

 

Stage

GFR (ml/min/1.73 m2)

Health of kidneys

1

?90

normal
kidney function, first signs of kidney disease appear

2

60-89

slightly
reduced kidney function

3A
3B

45-59
30-44

noticeably
reduced kidney function

4

15-29

extremely
reduced kidney function  

5

<15 ESRD, established renal failure Table 1. Condition of kidneys at each stage of ESRD 25   waste products in the body turns out of control. Treatment Cost of ESRD Dialysis uses artificial devices to carry out the function of the kidney at about 15%, just sufficient to sustain life. This is conducted for two to three times a week over the entire lifetime. Patients without sufficient dialysis become malnourished, weak, and unable to work, hence the need for regular dialysis treatment to prevent further complications and additional expenses. About P25,000 - P46,000 monthly or P300,000 - P552,000 yearly is needed to cover the expenses for adequate dialysis treatment (chdphilipines,2015). This excludes the maintenance medication cost of about P20,000 monthly (chdphilipines,2015). Due to the high cost, the government could not allocate budget for free treatment. In fact, about only 73% of Filipino patients 2 were able to receive sufficient treatments in 2007. In NKTI (specialty health facility for kidney transplant and kidney-related diseases) and other regional and provincial hospitals having dialysis facility, the accommodated patients are classified into two: pay patients (priority) who cover for all the expenses and service patients (wait for days to acquire slots) who avail of the discounts on hospital fees. In 2015, 73% were pay patients and only 27% were service patients in NKTI. On the other hand, in Bacolod, only 46% of the patients recommended for dialysis were able to commence the treatment in 2002. Of which, 96% didn't receive adequate treatment due to financial incapacity. In a bigger picture, more than 500 million people (about 10% of the adult population) 2 suffer from different forms of renal diseases. About 1.5 million of them are reliant to either dialysis or kidney transplant. These treatments carry such huge financial burdens that most patients who receive kidney treatments are those residing in Germany, United States, Japan, Brazil, and Italy (ChrishaAneMagtubo, Oct 2016, MIMS Today).      Facing ESRD Depression attacks 44% of the newly diagnosed ESRD patients (Prescott, 2006). Suffering from kidney disease and becoming dependent on dialysis can be troublesome for many patients. It is important to know that the emotions of pain, helplessness, denial, and anger felt due to the diagnosis are completely normal. They go through this process so as to ultimately reach the point of acceptance. The process might be different for every patient; that is, some patients may experience denial more deeply while others undergo depression. Nonetheless, acceptance is a big step towards learning on how to properly manage and deal with the changes experienced in the life as a patient (Renalife, 2012). ESRD Struggles and Coping It is a natural tendency for patients who go through a life threatening condition to feel anxious, frightened, and uneasy over what the future holds for them 14 (EdrenINFO, Emma Farrell,2016). All what has been planned needs to be modified then life seems to be uncertain. Nevertheless, proper handling of the condition and restructuring of perceptions towards the disease may lead to positive outcomes.  Curtin et al. 5 have presented the transformational experience of patients and found a connection between the quality of life (QOL) and personal control and freedom. For instance, prolonged preparation for the treatment may lead to limited freedom (due to lifestyle restrictions), and consequently, to disappointment and dissatisfaction. Furthermore, immunosuppressant drugs taken to prevent organ rejection and processes to make a point of access for dialysis through a catheter, neck line, or fistula could alter the body appearance. This may result to impaired self-image and weakened self-esteem. Consequently, limited freedom and control could greatly influence social and family relationships, hence the need to shift their attention on practical and sensible ways of coping 5. Every patient employs different coping strategies to manage the disease as influenced by personality, culture, religion, socioeconomic and moral support, and the specific type of stressful conditions (Christensen et?al., 1995) (Folkman& Lazarus, 1988). Some patients hold on to their faith through active involvement in religious activities and gatherings as they offer a support network and help in contextualizing their condition ISRN Nephrology, Volume 2013 (2013)). Furthermore, the use of more active and less passive coping mechanisms has been linked with diminishing symptoms of depression in patients (Bardwell et?al., 2001). This could be attributed to the improved interpersonal and treatment control, better perception on the disease, and greater support they receive from family and friends (Ibrahim et?al., 2011c). On the other hand, the use of self-blame or behavioral disengagement as coping mechanisms quickly relegates patients into depression. This is due to the feeling of being a burden and the cause of many inconveniences 9.     Accepting ESRD             Acceptance is classified into three main components: behavioral, emotional, and cognitive. It is reached when a patient is fully aware of the condition (acknowledges its existence and permanence) and has come to terms with the illness as reflected on the appropriate behaviors and complete adaptation to the different aspects of life (Wright and Kirby 37). With acceptance, patients would display positive feelings and limited negative thoughts toward the situation. Intensive studies have also focused on the link between acceptance and locus of control (coping strategy for stress in dialysis). Keogh and Feehally 37 have reported that the level of acceptance is lower among dialysis patients. This is associated to demographic characteristics, such as ethnic background and age (Oxford Academic, NDT,2013). Synthesis of Related Studies             End stage renal disease is the fifth and final stage of CKD wherein kidneys only function 10 - 15% of their normal ability. A person with ESRD has a GFR of less than 15. When the condition turns out of control, dialysis may be required. The treatment makes use of artificial devices so as to replace kidneys in filtering and purifying the blood. In the Philippines, the number of patients undergoing dialysis is dramatically increasing. The treatment is typically conducted for two to three times a week over the entire lifetime. However, the treatment is costly, making it unaffordable for most of the patients.             Moreover, dealing with the disease could become problematic for the patients. This could even lead to depression that brings further complications and added burden not only to the ill individual but to the family as well. Limited freedom and control brought about by lifestyle restrictions and impaired self and body image is linked to the diminished QOL. Thus, psychological support should be provided to the patients, especially by their family. This could be through shifting their attention on practical and sensible ways of coping. Every patient employs different coping strategies to manage the disease as influenced by personality, culture, religion, socioeconomic and moral support, and the specific type of stressful conditions. However, proper handling of the condition and restructuring of perceptions towards the disease is the key to produce positive outcomes. These are all achieved when the patients have reached acceptance.