Assessment of contributing factors of end stage renal failure for adult patients

Objectives: The study aimed to assess contributing factors of end stage renal failure for adult patients and to identify relationship between contributing factors with demographic characteristics. Methodology : A descriptive study was carried out of Al-Shahid Ghazi Hariri Teaching Hospital, Al-Yarmook teaching hospital, Al-Karama teaching hospital, and Baghdad teaching hospital for the period from 22\2\2012 to 25\6\2012. Non – probability, purposive sample of (60) adult patients with end stage renal failure. Questionnaire form was constructed for the purpose of the study. It consisted of two parts:


INTRODUCTION
End stage renal disease (ESRD), progressive, irreversible deterioration in renal function in which the body`s ability to maintain metabolic and fluid and electrolyte balance falls resulting in uremia or azotemia.The incidence of ESRD has increase by almost 8% per year for the past 5 years (1) .In the united states, more than 280.000 patients with chronic renal failure (CRF) (65%) are receiving hemodialysis, more than 120.000 (28%) have functioning renal transplant; and more than 24.000 (7%) are receiving peritoneal dialysis (2) .Conditions that cause ESRD include systemic disease such as diabetes mellitus (leading cause; hypertension; chronic glomerulonephritis; pyelonephritis; obstruction of urinary tract; heredity lesion as in poly cystic kidney disease; vascular disorders; and infection (3) .Diabetes mellitus and hypertension account for the largest of cases (76.2%) followed by glomerular disease (8.9%).In patient younger than age 40 years, chronic kidney disease is most commonly caused by focal segmental glomerulosclerosis, systemic lupus erythematosus.The national kidney foundation has been active in recent years in preventive and managing chronic kidney disease at all stage.Currently, the foundation kidney disease quality initiative has a site goal the development of clinical practice guideline to manage patient in earlier stages of kidney disease by showing disease progression, detecting, treating complication, and managing cardiovascular.chronic kidney disease has also been a focus of healthy people 2010 initiative since 2000 (4 ,5) .Incidence 200 cases per 1 million person in U.S prevalence of ESRD estimated 2010: 650.000 in U.S. (2002 (6) .Diabetes, hypertension, and primary glomerulonephritis are three most common attributed cases of ESRD, cause of ESRD in Word Wide registries (7) .. The incidence and prevalence of ESRD increase with age, peaking in the eight decade, with mean age around 60 to 64 years (8) .For all these reasons and because of the importency of these problems the researcher study contributing factors of end stage renal failure for adult patient.The objectives of the study are to assess demographic characteristics for adult patient with end stage renal failure, and to assess contributing factors for adult patient with end stage renal failure, and then to find out of the relationship between contributing factors with demographic characteristic.

METHODOLOGY:
Descriptive study was carried out to assessment of contributing factors of end stage renal failure for adult patients.The study was initiated from 22\2\2012 to 25\6\2012.The present study carried out in Al-Shahid Ghazi Hariri Teaching Hospital, Al-Yarmook Teaching Hospital, Al-Karama Teaching Hospital, and Baghdad Teaching Hospital.A purposive "non probability" sample of (60) adult patients end stage renal failure who admitted to the hospital.A questionnaire was designed & constructed by the researcher to measure the variables underlying the study.Such a construction was employed through review of literature and related studies.Questionnaire consisting of (2) parts, whereas the first part was demographic data of subjects which contains (6) items (Age, gender, marital status, educational level, resident and occupation).The second part was contributing factors which consisted of (18) items, these items rated and scored as, (2 for yes) and (1 for no).Validity of questionnaire was response through panel of (10)  experts.Test-Retest reliability was determined through a computation of Pearson Correlations for the contributing factors of end stage renal failure (r=0.86).The data were collected through the utilization of developed questionnaire and interview technique for adult patients with end stage renal failure.The Interview with each patient took approximately (20) minutes.The data collection carried out during 1\3\2012 to l\5\2012.The researcher used the appropriate statistical means in the data analysis which include Descriptive data analysis (frequency and percentage) and inferential data analysis (Mean of scores and Pearson correlation coefficient).Whereas mean of score less than (1.25) was considered low (L), from (12.5-1.75) was considered moderate (M) and greater than (1.75) was considered high (H).The data were analyzed through the use of statistical package of social Sciences (SPSS) version 16.0This table shows that the mean of score are high on items (

RESULTS
) and low on the remaining items.Correlation is significant at the (0.01) level.
This table shows that there is strong positive relationship between age with poly arthritis and between resident with smoking and there is strong negatives relationship between kidney surgery with occupation.

DISCUSSION
The findings of the study show that the majority (45%) of the age group were more than 46 years old.
The results of present study agreed with Weatheral who stated that in western countries, the incidence of chronic of renal failure is highest in the elderly in Caucasians (30-60) years old.In United Kingdom the incidence increases six fold to tenfold from age (30-50) year (9) .The findings of the study show that the majority (70%) of the gender were females.
The results of the study disagreed with the study of Al-Saadie who indicated that the sample were males (62%) (9) .The findings of the study show that the majority (85%) of the marital status were married.
The results of the study was in agreement with the study of Al-Ani who indicated that the majority of the recipients of transplant 103(68.7%)were married and also Al-Saadie shows that they are married (73.2%) (9,10) .The findings of the study show that the majority (40%) of the educational level from study sample were not read and write.
The results agreement with Al-Ani who stated that the level of education for patients with transplant were low (10) .
The findings of the study show that the majority (40%) of the occupation were housewives.This results was agreed with Al-Saadie who indicated that (36.6%) of women were housewives (do not work) (9) .The findings of the study show that the majority (60%) of the resident were urban.
The results of the study are disagreement with Al-rubaiee who indicated that the populations of kidney stone were living in Baghdad city more than living in governorates (11) .
The findings of the study show that the mean of score are high on items (Diabetic nephropathy, Poly cystic disease, Chronic pyelonephritis, Nephrolithiasis, Nephritic syndrome, Poly arthritis, Un control hypertension, Drug toxicity, Trauma to the kidney, and Smoking) and low on the remaining items.
The results of the study are in agreement with Burrower-Hudson who stated that cause of ESRD indicated systemic disease such as diabetes mellitus, hypertension, glomerulo nephritis, pyelonephritis, arthritis of the urinary tract, heredity, lesions, polycystic kidney disease, vascular disorders, infection, and medications or toxic agents (12,13) .
The findings of the study show that there is strong positive relationship between age with poly arthritis that mean increase in age increase in poly arthritis and strong positive relationship between resident with smoking that mean increase smokers in urban more than rural and there is strong negatives relationship between kidney surgery with occupation that mean the patients employee less have kidney surgery.

RECOMMENDATION:
Based on the conclusions, the study recommended the following:-1-Heath education should be given to patient and his family about detecting from anther diseases 1-Establish strategies for identifying and treating patients within a context of comprehensive follow-up care, for the presence of environmental support and the offer of planned counseling.2-Providing centers for end stage renal failure under treatment for giving various services to help patients with good life in home and community 3-Carrying out nursing care programmed on patients with end stage renal failure.4-Carrying out quality of life studies to evaluate the patients with end stage renal failure.

Table ( 1) Distribution of age for (60) adult patients with end stage renal failure.
This table shows that the majority (45%) of the age group were more than 46 years old.