Posted: May 25th, 2022
Studies conducted over decades have concluded that there is a significant link between diabetes mellitus and cardiovascular disease. For instance, the most common form of diabetes is type 2 diabetes, which involves both the impairment in insulin resistance and the defective secretion of insulin by the pancreas. The development of diabetes often comes with a number of cardiovascular complications including “coronary heart disease (CDC), stroke, peripheral arterial disease, nephropathy, retinopathy, and possibly neuropathy and cardiomyopathy.” (Grundy 1999)
Specifically both diabetes type 1 and type 2 are considered to be risk factors for atherosclerotic coronary heart disease. “Moreover, myocardial ischemeal due to coronary atherosclerosis commonly occurs without symptoms in patients with diabetes.” (Grundy 1999) In other words, patients with diabetes are more likely to be stricken with congestive heart failure. But it is not only the risk of heart failure that diabetes sufferers are at risk from, another risk of heart disease is stroke. Studies have concluded that “mortality from stroke is increased almost 3-fold when patients with diabetes are matched to those without diabetes.” (Grundy 1999) And those with diabetes are more likely to suffer irreversible brain damage with carotid emboli than those without diabetes.
Overall, there has been established a definitive link between diabetes and heart disease. Not only does diabetes increase the likelihood of a person’s arteries becoming clogged as well as the odds of suffering a heart attack, but it also increased the chance of suffering a stroke as well as the severity of damage.
There are a number of factors that can lead to kidney disease including genetic factors, as well as environmental conditions and lifestyle choices. For instance, the most common genetic cause of kidney disease is polycystic kidney disease (PKD). A while a person’s environment can also have a significant influence on the development of kidney disease, the most common cause of kidney disease is a person’s lifestyle. This includes whether or not the person is physically active or not, what kind of diet the person eats, how much an alcohol person drinks, does the person engage in the use, or abuse of drugs. The kind of diet a person has, as well as the amount of physical exercise they engage in can be a determining factor in obesity. According to studies some “66.3% of Americans are over-weight, obese, or morbidly obese.” (Hunt 2011, p26)
Ali, the subject of the case study, has not been identified as being overweight, or obese, but is a smoker as well as a heavy drinker. And as he drinks at least six cans of beer a night, it is unlikely that he gets much physical exercise either. “Abundant evidence has been published that smoking hastens the progression of kidney disease, especially in men.” (Walser 2004, Chapter 6) But it is not only Ali’s smoking that is a factor in his development of kidney disease, he also drinks heavily, and will drink at least six beers a night. The effects of heavy alcohol consumption on kidney disease has also been researched and the indications of this research is “that heavy alcohol intake harms the kidneys.” (Walser 2004, Chapter 6) Finally, the subject of this case study, Ali, was diagnosed with hypertension over 15 years ago and has been taking an increasing amount of medication ever since. The fact that he has had to increase his dosage over time, as well as he has continued smoking and heavily consuming alcohol is an indication that he has not been successful in coping with it. Since “control of blood pressure is now known to be one of the most important features in the treatment of chronic kidney disease, and may in fact stop progression altogether,” the failure of Ali to control his hypertension is most likely the major cause of his development of kidney disease. (Walser 2004, Chapter 5)
Question # 3
Ali was diagnosed with hypertension fifteen years ago yet still continued to drink heavily and smoke. He has not performed the necessary reformation of his lifestyle in order to minimize the negative effects on his health. He is now 67 years old and has recently been short of breath, has periods of nausea and vomiting, and is generally lethargic. While Ali has not been taking care of himself, his body has continued to steadily deteriorate causing the failure of his kidneys.
When Ali visited the doctor, his doctor conducted a number of tests to determine how well his kidneys were functioning. One way to determine kidney function is to test the patients Glomerular Filtration Rate (GFR). The GFR “is the best test to measure your level of kidney function and determine your stage of kidney disease.” (“Glomerular Filtration Rate”) GFR levels should be above 90 if a person has normal functioning kidneys, 60-89 if they have mild kidney damage, 30-50 if their damage is moderate, 15-29 indicates a severe case of kidney damage, and anything below 15 indicates that the patient’s kidneys have failed. (“eGFR.”) Ali’s GFR level of 11 is a clear indication that he has entered the stage at where his kidneys have failed and no longer are able to perform their function of purifying the blood.
His unusually high levels of creatinine, close to 500, is also an indication that his kidneys have failed. Creatinine is a byproduct of muscle use that normally is purified from the blood by the kidneys, the level of creatinine can be used as a measure of kidney function. Ultimately Ali is suffering the symptoms of nausea, vomiting, shortness of breath, and tiredness because his kidneys have failed to purify the toxins from his blood.
Normal human metabolism creates a certain amount of waste which ends up in the blood and needs to be removed. This is the function of the kidneys, to remove approximately 2 quarts of waste products from the blood each day. (“The Kidneys”) This waste eventually becomes urine, which is stored in the bladder until discharged through urination. When a person’s kidneys fail their body can no longer purify the blood and the waste products of metabolism gradually build up. Dialysis is an artificial way to duplicate the function of the kidneys by removing waste products from the blood.
While there are several types of dialysis, including hemodialysis, peritoneal dialysis, hem filtration, hemodiafiltration and intestinal dialysis, hemodialysis is the most common and involves allowing a person’s blood “to flow, a few ounces at a time, through a special filter that removes wastes and extra fluids.” (“Treatment Methods”) This is accomplished by creating a shunt from the radial artery to the cephalic vein with the connection through the dialysis machine. For this procedure to duplicate the function of the kidneys, it must be performed for 3 to 5 hours three times per week; and this schedule must be strictly adhered to.
“eGFR.” Lab Tests Online, Available from http://labtestsonline.org/understanding/analytes/gfr/tab/test
“Glomerular Filtration Rate (GFR)” National Kidney Foundation Available from http://www.kidney.org/kidneydisease/ckd/knowgfr.cfm
Grundy, Scott. Et al 1999, “Diabetes and Heart Disease: A Statement for Healthcare
Professionals from the American Heart Association” AHA Scientific Statement.
Available from http://circ.ahajournals.org/content/100/10/1134.full
Hunt, Walter, Ronald D. Perrone 2011, Kidney Disease: A Guide for Living, Baltimore
Maryland, John Hopkins UP.
“The Kidneys and How they Work” National Kidney & Urologic Diseases Information
Clearinghouse (NKUDIC) Available from http://kidney.niddk.nih.gov/kudiseases/pubs/yourkidneys/%20//%20kidneys
“Treatment Methods for Kidney Failure: Hemodialysis” National Kidney & Urologic
Diseases Information Clearinghouse (NKUDIC) Available form http://kidney.niddk.nih.gov/Kudiseases/pubs/hemodialysis/%20//%20how
Walser, Mackenzie, Et al. 2004 Coping with Kidney disease: a 12 step program,Wiley & Sons, New Jersey.
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