Holistic vision of the patient with chronic kidney disease in a universalistic healthcare system

Abstract

Chronic kidney disease (CKD) is an increasing public health problem. Aging is one of the leading causes, particularly in Western countries, but several comorbidities, such as hypertension and diabetes are involved in its pathogenesis. Thus, the treatment of CKD patient is very complex and requires an integrated strategy. In this context, the holistic approach to the CKD patient and not to the disease itself should be the answer. General practitioners, specialists, voluntary associations, and nonprofit organizations, in addition to the family of the patient, all contribute to the patient care. Moreover, due to the low sensitivity of creatinine values in the early stages of renal failure, its diagnosis often occurs in the advanced phases of the disease. Therefore, the health costs for CKD patients are hardly sustainable by health systems. The reorganization of economic and epidemiological data through new models is necessary to allow the sustainability of the system and to ensure medical care for all patients. In this review, we aim to deal with all the issues about patient care, standards of care, and the impact of chronicity from a global perspective in light of the current state of the Italian healthcare system.

Scale of Assessment of Self-Care Behaviors with Arteriovenous Fistula in Hemodialysis: A Psychometric Study in Brazil

“…End-stage renal disease (ESRD) is a public health problem in several regions of the world, most often associated with the United States of America and Europe (Clementi et al, 2020). However, evidence shows that this disease is increasing in developing countries, especially in India, Mexico, Asian countries, Chile, and Brazil, among others (Neves et al, 2020).…”

Investigating the Effect of a Structured Intervention on the Development of Self-Care Behaviors With Arteriovenous Fistula in Hemodialysis Patients

“…End-stage kidney disease (ESRD) is a public health problem in developed or developing countries, especially in the United States, Europe, Brazil, and in some countries in Asia (Enrica & Manjula Kurella, 2016;Clementi et al, 2020). Portugal is among the European countries with the highest incidence and prevalence of ESRD with 235.9 and 1577.9 per million population (pmp) in 2010, and 226.49 and 1661.9 pmp in 2011 (Coelho et al, 2014;Clementi et al, 2020). Patients with this disease need a vascular access to undergo hemodialysis (HD) treatment.…”

Nephrosclerosis impacts time trajectory of renal function and outcomes in elderly individuals with chronic kidney disease

“…It is simplistic to consider the burden from each of these conditions independently. Renal function decline could be slowed down if other comorbidities are effectively managed and particularly if these are detected early enough to avoid renal failure 24-26. The European Renal Best Practice Group Guideline recently included overall strategies for older and frail patients and advised regularly screening for functional impairment and malnutrition to recognize patients that could take advantage for more intensive care 27.…”

“…Renal function decline could be slowed down if other comorbidities are effectively managed and particularly if these are detected early enough to avoid renal failure. [24][25][26] The European Renal Best Practice Group Guideline recently included overall strategies for older and frail patients and advised regularly screening for functional impairment and malnutrition to recognize patients that could take advantage for more intensive care. 27 In our study, it is interesting to point out that elderly patients with CKD due to NS manifested a significantly worsen renal function at baseline, as compared with others (eGFR: 41±17.1 vs 70.8±28.2 mL/min/1.73 m 2 , p<0.001).…”