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A Clinician's Perspective: Occupational Therapy For Persons With Renal Disease

A Clinician's Perspective: Occupational Therapy For Persons With Renal Disease
Ann Burkhardt, OTD, OTR/L, FAOTA
September 20, 2016

Ann Burkhardt: Welcome to everybody. I hope that I will be able to share things that are new to you. This webinar will provide OT clinician's perspective on intervention for persons with renal disease. It will review the disease process and clinical reasoning for treatment techniques and methods respective of the disease stage. It will include current evidence that supports the use of techniques in clinical practice.

Medical Conditions and Comorbidities Predisposing Someone to Kidney Disease

The most common of these is hypertension. About 30% of all adults over the age of 18 are dealing with hypertension, and it is an early sign that someone can develop both cardiac and renal disease. Type 2 diabetes is also another.  It causes problems with the micro circulation, and in terms of type 2 diabetes, the known prevalence is 9.3%. However there is a suspected 27.8% of people in the United States that are undiagnosed with type 2 diabetes. They have it, but are not aware that they have it. These people are at more risk because their diabetes is not controlled so the microvascular disease progresses unknown to their physician or themselves. Then the third group that has problems with renal failure have lupus. There are about 150 cases of lupus per 100 thousand people in the United States, and it is higher amongst African American women by a rate of about three to one over the general population. Lupus is an autoimmune disease that can affect almost any part of your body, most often your joints, skin, kidneys, heart, lungs, blood, or brain. Lupus nephritis is a term used when lupus causes inflammation in your kidneys making them unable to properly remove waste from your blood or control the amount of fluids in your body.

Hypertension and Kidney Disease

Kidneys are supplied with dense blood vessels, and thus high volumes of blood flow through them. Over time, uncontrolled high blood pressure can cause arteries around the kidneys to narrow, weaken, or harden. These damaged arteries are not able to deliver enough blood to the kidney tissue (American Heart Association, June 29, 2016).

There is also a debate, that keeps reemerging in the literature and you will hear periodically on the news, whether the high blood pressure medication just staves off the ill effect of having the underlying condition which is truly cardiovascular disease. If people, who have hypertension, do not adhere to their medication, science informs us they do have a significantly higher rate of heart attack and stroke. The other problem that people have is that, even with taking medications, the medication is only masking the effect of an underlying condition, making it a chronic condition.

Additionally there is still the issue of a lifestyle that needs to be redesigned. It is possible for people, if they gain control over their lifestyle and their habits, to reverse the affects of hypertension and to eventually be taken off of hypertension medicine at their doctor's recommendation. This is not something that someone should do on their own. It is always with under a physician's guidance. Lifestyle redesign inherent to a healthy lifestyle is probably the most effective method to working on the root cause of the issue, inclusive of genetic predisposition, and dietary, exercise and stress reducing habits. Occupational therapists are very involved in habits that our clients have and being aware of what needs to change. 

Habits That Can Cause Kidney Damage

Some of the habits that can cause damage to your kidneys include:

  • Insufficient water consumption
  • Smoking
  • Alcohol
  • Medications
  • High protein diet
  • Physical inactivity

Insufficient water consumption, or dehydration, stresses the renal function. Older adults tend to drink less than what their body needs because they do not want to have to use the bathroom. Smoking also causes microvascular disease. It also causes so many other issues with the body, predisposing someone to conditions such as lung cancer or heart disease. Microvascular disease can affect recovery from injury and surgery. Helping people to quit smoking is an important role that occupational therapists can play. Alcohol, over eight ounces daily, can suppress kidney function. It also causes release of water from the body and can lead to dehydration. Additionally there is a hormone that affects the kidney, and when you drink alcohol, that hormone is suppressed, so your body loses more fluid. Eight ounces is not a lot of alcohol if you think about it, and it has become a habit of many people in the United States to drink at least that amount of wine or beer on a daily basis, but it can be problematic for someone who is at risk for kidney disease. Medications, most chemically based, tax the organ's ability to filtrate out byproducts. People have to be careful if they are on certain medicines, and the doctor will test their blood and urine on a frequent basis if they are on a medication that can cause that type of a side effect. If someone has a risk for kidney disease, they need to speak to their doctor and pharmacist to be aware of which medications may cause problems. High protein diets can cause stress to the kidneys. Some people who are diabetic or are considering weight loss might turn to this type of diet. They need to be monitored by a physician so that they know whether or not their body is able to deal with the amount of protein that they are intaking. Finally, physical inactivity can generate kidney stones. There are some dietary things that could generate kidney stones as well. People, who are prone to developing stones, should probably avoid large amounts of calcium in their diet.

Other habits:

  • Sleeplessness
  • Over-consumption of salt and sugar
  • Delaying urinary release
  • Dietary deficiencies

Sleeplessness is another issue. Over recent years in the occupational therapy literature, there has been much research about sleep and helping people to sleep. For instance, Doris Pierce has done some work in occupational science on looking at sleep and sleep patterns. Sleeplessness increases toxins in the kidney that must be filtrated out. It puts an extra stress on the body because the individual is not allowing their body to shut down or rest. Sometimes this is related to anxiety and mood disorders. Anxiety and mood disorders are highly under diagnosed. People tend not to go for a diagnosis of a mental health condition because of the stigma. Sometimes they can control it using complementary and alternative medicine techniques, but it is something that definitely needs attention. Overconsumption of salt and sugar is another bad habit. 

ann burkhardt

Ann Burkhardt, OTD, OTR/L, FAOTA

Ann Burkhardt OTD, OTR/L, FAOTA is currently a Professor and the Program Director of the Occupational Therapy Doctorate Program in the College of Health & Wellness at Johnson & Wales University. She is a practicing Occupational Therapist with over 35 years’ experience. Her area of specialty clinical focus has been working with adults with neurological diseases and related impairments.

Ann has published books and articles on a variety of topics and has presented locally, nationally, internationally. She has a record of accomplishment for developing new clinical and academic programs.

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