Evidence-Based Practice Project: Finding the Evidence

Evidence-Based Practice Project: Finding the Evidence

                         Whilst the impact of Chronic kidney disease on cerebrovascular is less well understood, it is extensively associated with increased risk in cardiovascular events (Sandsmark et al., 2015). This paper hypotheses renal function severity on stroke risk prediction independent of other vascular risk factors. The formulated PICOT question herein is, does the Proteinuria or Albuminuria patients undergoing multivariable analysis have higher chances of experiencing stock in chronic renal insufficiency cohort when the nurse is a primary adherent of multidisciplinary as opposed to when the nurse involved is a secondary adherent in multivariable analysis with no specialized training? This is crucial in determining the safety of chronic kidney disease patients and the mortality rate related to the malady.

The article examines the actual predictor of stroke risk in Chronic Kidney Disease through the hypothesis of renal function severity independent of other vascular risk dynamics. The study examines subjects in the Chronic Renal Insufficiency Cohort research to analyze stroke events reported by participants and the adjustments made by a vascular neurologist. Its findings largely correlate patients with proteinuria and albuminuria have an increased risk of stock as opposed to the overall glomerular filtration rate. At the same time, treatment did not decrease stroke risk in subjects with albuminuria (Sandsmark et al., 2015). Therefore, the research concludes that albuminuria and proteinuria are more advanced predictors of stroke than estimated glomerular filtration rate in patients with chronic kidney disease.

The reliability- the consistency of measure according to Melnyk & Fineout-Overholt (2017), of this article is unquestionable with inter-rater reliably showing a consistent judgment. The qualitative research article examined a population of 3939 subjects enrolled in the Chronic Renal Insufficiency Cohort (CRIC) research, which is a prospective observational cohort. It uses stroke events reported by the participants and adjustments made by two vascular neurologist nurses performing either primary or secondary roles for comparison and outcome purposes (Sandsmark et al., 2015). Further, the study uses a cox proportional hazard model to compare and contrast measures of baseline renal function with stroke events and performs a multivariable analysis to adjust critical covariates.

With content validity conducted, the extent of measure covering the construct of interest (Kärkkäinen, 2019) i.e., the relationship between proteinuria and albuminuria and Stroke risk, the study is extensively valid. With the 3939 subjects enrolled, 143 new stroke findings were observed in an average span of 6.4 years. Subjects with worse baseline dimensions of renal function with estimated glomerular filtration rate and overall albuminuria or proteinuria experienced high stock risk. When an adjustment was made for variables known to affluence the risk of stock, overall albuminuria or proteinuria, rather than the estimated glomerular filtration, was highly associated with increased stroke risk (Sandsmark et al., 2015). Furthermore, blockers of renin-angiotensin system treatment did not decrease the risk of stroke in individuals with albuminuria.

Nonetheless, during the study, there were relatively few stroke cases observed during the Chronic Renal Insufficiency Cohort with precluding analysis of differential associates of proteinuria with subtypes of stroke. Additionally, the incidence of stroke in the subject population reported was similar to other studies of stroke in patients with kidney dysfunction. Medication and medical history were self-reported by individual subjects, and thus medical compliance, indication, and effectiveness were not conducted. The study used medication data collected at the first study visit and did not include changes in dose titration and medication (Sandsmark et al., 2015). However, the study findings support the growing body of evidence that proteinuria is a measure of cardiovascular risk, extending the findings to include albuminuria and proteinuria.

Daza, Vernooij, Salas, Osorio & Cuchí (2019) state that, for the early diagnosis of Chronic Kidney Disease, the clinical practice guidelines recommend to study the Chronic Kidney Disease in Patients with systematic arterial hypertension and diabetes mellitus. Besides, most clinical practice guidelines recommend that patients with cardiovascular diseases, family history of end-stage kidney disease, and systematic diseases should be investigated. To evaluate the presence of Chronic Kidney Disease, clinical practice guidelines recommend analyzing the glomerular filtration with serum creatinine-based formula and measure albuminuria. To avoid the progression of Chronic Kidney Disease, the clinical practice guidelines recommend stabilizing arterial pressure and using angiotensin II receptor blockers or angiotensin-converting enzyme inhibitors. Most of the clinical practice guidelines recommend controlling proteinuria, lipids, avoid smoking, and stabilize weight.

According to De Nicola & Minutolo (2016), People with Chronic Kidney Disease often do not notice any symptoms or feel ill, and the only way to find out if one has Chronic Kidney Disease is through specific urine and blood tests. Approximately, 30 million people, about 15 percent of adults are estimated to suffer from Chronic Kidney Disease, and surprisingly, 48 percent of them with severely reduced kidney functions and neither aware nor in kidney dialysis (De Nicola & Minutolo 2016). Once diagnosed, Chronic Kidney Disease is addressed through medical treatment and lifestyle changes, such as making healthier decisions on food and drinks. Having chronic kidney disease increases the chances of having a stroke or heart disease.

In order to examine the PICOT question; does the Proteinuria or Albuminuria patients undergoing multivariable analysis have higher chances of experiencing stock in chronic renal insufficiency cohort when the nurse is a primary adherent of multidisciplinary as opposed to when the nurse involved is a secondary adherent in multivariable analysis with no specialized training?, it is crucial to analyze Chronic Renal Insufficiency Cohort process. Besides, a basic understanding of Chronic Kidney Disease, its treatment comes hand in hand. Any patient diagnosed with the disease should seek medication, and the recommended Clinical Practice Guidance adhered.

Reference

Daza, J. C., Vernooij, R. W., Salas, K., Osorio, D., & Cuchí, G. U. (2019). Quality assessment of clinical practice guidelines for chronic kidney disease: a systematic review. BMC nephrology, 20(1), 192.

De Nicola, L., & Minutolo, R. (2016). The worldwide growing epidemic of CKD: fact or fiction?. Kidney International, 90(3), 482-484.

Kärkkäinen, A. M. (2019). Nursing students’ vocation for nursing profession-A detailed literature review.

Melnyk B., & Fineout-Overholt E. (2017). Evidence-based practice in nursing & healthcare. New York: Lippincott Williams & Wilkins.

Sandsmark, D. K., Messé, S. R., Zhang, X., Roy, J., Nessel, L., Lee Hamm, L., … & Kusek, J. W. (2015). Proteinuria, but not eGFR, predicts stroke risk in chronic kidney disease: a chronic renal insufficiency cohort study. Stroke, 46(8), 2075-2080.