I. INTRODUCTION

A. Overview of the Case

End-Stage Renal Disease (ESRD) is the complete or almost complete

failure of the kidneys to work at a level needed for day-to-day life. ESRD is a

progressive, irreversible deterioration in renal function in which the body's

maintenance of the metabolic, fluid and electrolyte balance fails; thus, it's a

condition where there is a complete or near-complete failure of the kidney to

perform its function. These patients may make urine but not filter out the waste

products, or urine production may cease. Dialysis or a kidney transplant is

required to survive. (Williams, 2003)

The incidence and prevalence of ESRD continue to grow worldwide.

According to data collected from 120 countries with dialysis programs, at the end

of 2005 about 1, 900, 000 people were receiving renal replacement therapy

(RRT). Among these, individuals, 1, 297, 000 (68%) received hemodialysis and

158, 000 (8%) received peritoneal dialysis; although an additional 445, 000 (23%)

were living with a kidney transplant. Worldwide, the highest incidence and

prevalence rates are reported from the USA, Taiwan, and Japan. In America, 34%

of cases ESRD each year are caused by diabetes, 25% by hypertension, 16% by

glomerulonephritis, and 4% by kidney cysts. (Renal Data Report, ANS, 1999)

CKD is more common among women than men. More than 35% of people aged

20 years or older with diabetes have CKD and more than 20% of people aged 20

years or older with hypertension have CKD. ESRD incident rates are more than

three times higher for African Americans than for Caucasians.

Kidney disease is on the rise and is an important cause of death in the

Philippines. ESRD being the top 10 killer in the Philippines as of 2007 and is

increasing that its morbidity and mortality rate is predicted to double by year

2010, according to DOH. Statistics show that kidney disease among the Filipinos

is shooting up every year. About 31% of them have the most advanced stage of

the disease. The main cause of kidney disease seems to be the increasing diabetic

conditions among the Filipinos. It is seen that about 55% of Filipinos develop

kidney disease when they suffer from diabetes. However, as cited in the

Philippine Renal Registry of 2008, diabetes is a primary cause of ESRD at 41

percent, followed by inflammation of kidney with 24 percent, and high blood

pressure at 22 percent. Today, diabetes mellitus and hypertension have been a

central cause in increasing the risk of ESRD which together account for almost

60% of dialysis patients. It is said that a Filipino is having the disease hourly or

120 Filipinos per million populations per year. (Manalo & Diaz, 2010)

Furthermore, we chose the case of the patient because its condition affects

many areas in the body which gives us the opportunity to investigate the

following areas that are affected. By this, it allows us to learn more of the

different complications that are related to the client’s condition. Through this

case, we were able to apply our knowledge, enhance our skills in providing proper

nursing care interventions and enhance our attitude in giving holistic care to our

patients.