Individuals with a Family History of Hypertension and the Effect Diet and Exercise has on Preventing End Stage Renal Disease

Abstract

Individuals with a family history of hypertension are at a higher risk for developing chronic kidney disease which can lead to end stage renal failure. By utilizing a good diet and committing to proper exercise, one can not only reduce their risk of getting hypertension but they can also minimize their chances of getting chronic kidney disease. An all encompassing healthy lifestyle will also help address the comorbidity diseases that can come along with chronic kidney disease, such as obesity, diabetes, and hypertension.

Keywords: CKD, Hypertension, ESRD, Nutrition, Exercise

Significance and Background

There are many factors that exist that can lead to chronic kidney disease that can and does result in end stage renal disease. One factor that can lead to hypertension is ones weight and fitness level. In the year 2010, kidney disease moved from 27^th to 18^th in the leading causes of death worldwide. According to the World Health Organization, hypertension is responsible for 12.8% of all total global deaths. The increasing prevalence of chronic kidney disease and hypertension begs one to ask the question; can one do anything to prevent the outcome of enduring end stage renal failure?

Purpose

No matter what is found in one’s family history, it is important to inform medical professionals that are monitoring and addressing ones health in order for them to gain a full and comprehensive understanding of one’s potential health status. Chronic kidney disease, obesity, diabetes, heart disease, and hypertension are increasing across the globe, not just in the United States. Many patients have comorbidity, which simply means that they have two or more of these health problems existing simultaneously. Comorbidity, in regards to renal failure, can increase the likelihood that one will require treatment for renal failure.

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Understanding how diet and exercise can have an impact on a person who has a family history of hypertension is important for nursing. In addition, it is important to understand how diet and exercise can impact or prevent an outcome such as end stage renal failure. Nurses hold an important position with their patients, one of trust and guidance. The comprehensive understanding of the potential impacts and benefits of diet and exercise can help patients not only understand a condition they have been diagnosed with, or that they could potentially be diagnosed with in the future; nurses also are providing information that allows the patient to take the power of decision making in regards to their long-term health and potential prognosis in their futures. Gaining an understanding in this regard allows patients to make fully informed choices and decisions, and nurses advocate for self-care. Self-care begins with education and understanding.

Methods

While searching for the four studies required to fully analyze this topic the search parameters began with looking for studies that specifically utilized participants who had a family history of hypertension. From there the hope was to locate a study that examined the effects of diet and exercise on these specific participants in relation to preventing end stage renal disease. However, no such studies were located after many hours of searching. Instead, studies and papers were located that spoke on the long-term effects of variables such as hypertension on chronic kidney disease.

Study #1 Research Study in the USA

The first article is titled Obesity, Hypertension, and Chronic Kidney Disease. This article examines comorbidity in relation to chronic kidney disease. The authors of this article examined weight relation to chronic kidney disease, as one of the variables of comorbidity. The authors stated that obesity increases ones chances of developing hypertension, diabetes, and other conditions that can contribute to the development of chronic kidney disease (Hall, 2014).

The numbers given by the authors are shocking. They state that throughout the worked there are 1.4 billion people that would be considered overweight, and 500 million people who would be considered obese (Hall, 2014). The two main causes for chronic kidney disease are hypertension and diabetes, both of which one is at higher risk for developing if one is overweight or obese.  Weight gain can and does raise the blood pressure.

It is estimated that 10% of people over the age of 20 have chronic kidney disease and 25% of people over the age of 60 (Hall, 2014). Chronic kidney disease patients also can expect a higher mortality rate than their peers who do not have chronic kidney disease; in fact they are nearly 60% more likely to pass away prematurely in comparison to their non-CKD peers. Being overweight or obese is contributing to these high numbers. Therefore, one can understand that diet and exercise could certainly help prevent chronic kidney disease.

“Ectopic deposition of lipids into nonadipose tissues, such as the kidney, often occurs in obesity” (Hall, 2014). Nonadipose tissues would be loose connective tissue. Lipids are fats. Lipids that are depositing themselves onto organs instead of connective tissue begin to impair the function of those organs in which they are depositing themselves onto.

Study #2 Research Study in the USA

The second article is titled Efficacy of Dietary Interventions in End-Stage Renal Disease Patients- A Systematic Review. The authors of this article examined research studies that addressed comorbid conditions such as hypertension, CVD, CKD, and diabetes mellitus and their association with end stage renal disease. They studies that were examined all contained participants that were diagnosed with chronic kidney disease and were all in various stages of end stage renal disease and were diagnosed with a comorbid condition (Nazar, 2016).  The participants also included patients who had end stage renal disease and were currently awaiting a kidney transplant.

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Their examination of these existing studies allowed the authors to determine that there is a huge literature gap in regards to nutrition and end stage renal disease. The studies did not show if a change in nutrition anywhere along the path of CKD did anything to change or alter the outcome of end stage renal disease, including starting with nothing more than a family history of hypertension. Everyone who has chronic kidney disease started somewhere along the path of severity. Studies that show the correlation as well as potential causation are needed in order to understand the impact nutrition, as well as, exercise has on CKD and end stage renal failure.

Study #3 Research Study in the USA

The third article is an actual research study that began on 1971 and continued until 2009.  This study is titled The Association between Midlife Cardiorespiratory Fitness and Later Life Chronic Kidney Disease: The Cooper Center Longitudinal Study. In this study there were 17,979 participants. 14,384 participants were male and 3,595 participants were female. The mean age of the participants was 50 years old.

This study examined physical fitness and how it corresponded to the diagnosis of chronic kidney disease over the years (through the course of the study). The results showed 2022 cases of chronic kidney disease were found among participants who were described as moderately fit (Defina, 2016). Those participants who were moderately fit were at a 24% lower risk of contracting chronic kidney disease according to Defina. In addition, there was a 34% lower risk for participants was described at highly fit. This shows a positive correlation to the level of fitness and chances of having chronic kidney disease.

There were limitations in this study. Firstly, the participants were all well-educated Caucasians (Defina, 2016).  Because the study only included members of one race, the results can only be translated to members of that singular race. In addition, their socioeconomic background was not examined in regards to their physical fitness. It begs the question, if they are better educated are they financially better off than less educated peers? Does this impact physical fitness levels? Secondly, there were far more male participants than female which could have potentially skewed the data unfairly in regards to the outcomes of the female participants because the researchers had more data to examine from the male participants.

Study #4 Research Study in Italy

The fourth and final article was written in Italy and it is titled Nutrition and Physical Activity in CKD Patients. This is an article that discusses the need for a specific study to be conducted and examines the reasons why studying this specific topic is important. According to the authors, chronic kidney disease patients are at risk for protein-energy wasting, an abnormal body composition, and limited physical capacity (Cupisiti, 2014). Protein-energy wasting is also known as PEW. This means that CKD patients have a loss of body protein mass, as well as, fuel reserves.

According to this article, regular physical activity is mandatory in order to prevent the comorbidity variables that CKD patients can face. Those comorbidity variables are diabetes, obesity, and hypertension. PEW often causes impaired muscle strength and a decline in physical function (Cupisiti, 2014). In addition, without PEW occurring, physical activity is generally more difficult for CKD patients.

Proper nutrition and physical activity can help CKD patients in regards to preventing comorbid diseases from beginning but it can also help the overall well-being of the body because it is being properly fueled and conditioned. The authors of this article state at the end they are in the process of creating a study to collect the data needed to quantify the information they have researched. A study will provide the real-world applications of their scientific hypothesis.

Conclusion

For individuals with a family history of hypertension, what effect does diet and exercise have on the prevention of end stage renal failure? According to the research, diet and exercise will help prevent hypertension. Hypertension is one of the causes of chronic kidney disease, which leads to end stage renal failure. Diet and exercise can also address other medical issues that can also impact a person with hypertension and/or chronic kidney disease, which is obesity and diabetes.

Kidney disease is something that many people outside of the medical profession do not understand. Hypertension is often linked, in the general public’s mind, to heart disease and/or strokes. Very rarely does one hear hypertension and form the mental link to kidney disease. One way to combat this is to spread the knowledge so that it becomes common knowledge and the general public can understand the risk factors that are associated with chronic kidney disease and renal failure.

References

• Cupisiti, A. D. (2014). Nutrition and Physical Activity in CKD Patients. Kindey & Blood Pressure Research, 39: 107-113.
• Defina, L. B. (2016). The Association between Midlife Cardiorespiratory Fitness and Later in Life Chronic Kidney Disease: The Cooper Center Longitudinal Study. Preventative Medicine, 89: 178-183.
• Hall, M. d. (2014). Hypertension and Chronic Kindey Disease. International Journal of Nephrology and Renovascular Disease, 7: 75-88.
• Nazar, C. B. (2016). Efficacy of Dietary Interventions in End-Stage Renal Disease Patients- A Systematic Review. Journal of Nephropharmacology, 5(1): 28-40.
• NKF. (2019). Global Facts: About Kidney Disease. Retrieved from National Kidney Foundation: https://www.kidney.org/kidneydisease/global-facts-about-kidney-disease
• WHO. (2019). Global Health Observatory (GHO) Data. Retrieved from World Health Organization: https://www.who.int/gho/ncd/risk_factors/blood_pressure_prevalence_text/en/