Abstract:
End stage renal disease (ESRD) is a major health problem resulting
in conside rably increased morbidity and mortality, in decreased
qual ity of life and in high costs from renal replacement therapy
(RRT) . There are almost a million people that owe their lives to
dialys is and currently there is a 5 yea r survival rate of chronic renal
failure (CRF) patients . Today optimization of dialys is must
guarantee the full time restitution t o . society of a totally
rehab ilitated individual. This study a ims at investigating the
indications for commencing RRT and the optima l timing for
commencing the therapy , derived from comparative investigations ,
and incorporat ing factors affecting renal failure patients. It includes
the benefits of screening high risk individua ls for renal d isease, and
the benefits of managing factors affecting renal function to pro long
the pretreatment phase . It also looks at the effectiveness and
opt imal timing for commencing a pre-end stage renal disease
(PESRD) program, and considers whether there is patient
imp rovement in patients managed before development of renal
failure . Finally the study aims at investigating a way to reduce the
financial aspect related to treatment.
The research was twofold. First ly it involved a screening of 100
indiv iduals at tht: risk of chronic kidney disease (CKD), whereby a
serum creat in ine va lue was taken and the glomerular filtration rate
(OFR) calculated . Secondly it incorporated a biochemical and
clinical assessment of 95 CRF patients , a month prior to RRT, at
commencement of RRT, at I month and 3 months after RRT.
The screening revealed a mean creatin ine for males 128.45 flmollL
and for females 108 .99 flmollL. Twen ty-four percent (24%) of
patien ts had a OFR of between 30 - 59 , 6% of patients had a OFR of
between 15 29, and 3% of pat ients had a OFR of < 15
ml / minlI.73m2. T his strongly ind icates the need to screen
individua ls at risk for renal failure . The second part of the study
revealed that at commencement the mean OFR was 6.7
ml/ minlI .73m2, uremia , malnutrition, anemia, hyperparathyroid ism,
hyperphosphatemia, and other electro lyte imbalances were present ,
all predisposing a patient to a poor clinical outcome , an inc rease in
morbidity and mortal ity, and a dec rease in the qual ity of life. From
the investigation of patients commencing dialysis it was determined
that the optimal timing for commenc ing RRT was at the first clin ical
evidence of deterioration in the presence of uremia and / o r
malnutrit ion despite medical in tervention . It was found that RRT
should not be postponed until creatinine falls within mandated
range , as postponement adversely affects the patient, and the
