CHAPTER ONE

INTRODUCTION

1. BACKGROUND OF THE STUDY

Chronic kidney disease (CKD) and end-stage renal disease (ESRD) affect an increasing proportion of the population in the US. 1-3 The Third National Health and Nutrition Examination Survey (NHANES III) recently estimated the prevalence of CKD (defined as a serum creatinine level of > 1.5 mg/dL) in the US to be approximately 6.2 million,4 and the number of patients with ESRD is expected to almost double in the next 10 years.5

In general, the most common causes of ESRD are diabetes and hypertension (Fig. 1).5 A major risk factor for the development of type 2 diabetes is obesity.6 Therefore, it is thought that the dramatic increase in the incidence of ESRD that has been observed over the past 20 years is attributable to the epidemic of type 2 diabetes that has occurred during this time. At present, approximately 15.6 million Americans have diabetes, predominantly type 2 diabetes. A further 13.4 million have impaired glucose tolerance,7 and 50 million have hypertension.8 However, the prevalence of diabetes, hypertension, and obesity is significantly higher in African Americans than in whites, particularly in the Southeastern region of the US. In fact, the prevalence of hypertension in African Americans is among the highest in the world.9 As a result, the adjusted incidence of ESRD among African Americans in the Southeastern US has been estimated to be up to 15-fold greater than in whites.10 In addition, even when hypertension is well-controlled, there is a tendency for African Americans to suffer impairments in kidney function.11,12

Recently, the African-American Study of Kidney Disease and Hypertension (AASK) examined the role of the renin-angiotensin-aldosterone system (RAAS) and the use of angiotens in converting enzyme (ACE) inhibitors in the management of hypertension, specifically in African Americans.13 Preliminary findings have demonstrated that ACE inhibitor therapy can effectively improve blood pressure (BP) and significantly reduce the rate of rise of serum creatinine levels and time to ESRD. 14 In addition, the Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan (RENAAL) and Irbesartan Type II Diabetic Nephropathy Trial (IDNT) studies have reported the effect of angiotensin receptor antagonism on delaying the progression and development of diabetic nephropathy in hypertensive type 2 diabetics. These studies were performed in large populations with representative (A14%) African-American enrollment.15,16 These studies have demonstrated that blockade of the RAAS via angiotensin receptor blockade can also improve BP, and attenuate a rise in serum creatinine levels and the time to ESRD. However, the lessons learned from these latter studies can only be useful if patients are monitored aggressively, not only for BP and blood glucose, but also for early detection of proteinuria and deterioration in kidney function. This review will focus on the two main causes of the increase in the prevalence of ESRD, diabetes and hypertension. It will also discuss reasons for disparities between populations, highlight risk factors in the post-transplant period, explore factors contributing to suboptimal care in these patients, and propose steps to address these issues.

1. STATEMENT OF THE PROBLEM

Kidney is one of the most vital organs in human body; the functions of kidney involve filtering of the blood and removing waste products from the body. However poor feeding habits and lack of exercise can lead to diabetes and high blood pressure.

        Most of the kidney diseases recorded over the years have been linked to either high blood pressure or diabetes however the nature of the relationship between high blood pressure, diabetes and kidney function has not been ascertained hence a need for the study.

1.3 AIM AND OBJECTIVES OF THE STUDY

The study seeks to determine the effect of high blood pressure and diabetes on kidney function among older adults in Makurdi, Benue state. The objectives of the study are:

1. To determine the relationship between high blood pressure, diabetes and kidney function among older adults  
2. To examine whether diabetes influence high blood pressure among older adults in Makurdi L.G.A
3. To identify the factors affecting high blood pressure, diabetes and kidney function among older adults
4. To recommend ways to improve the kidney function among older adults  in Makurdi L.G.A

1.4 RESEARCH QUESTIONS

The following research questions guide the objectives of the study:

1. What is the relationship between high blood pressure, diabetes and kidney function among older adults?  
2. Does diabetes influence high blood pressure among older adults in Makurdi L.G.A?
3. What are the factors affecting high blood pressure, diabetes and kidney function among older adults?
4. What are the ways to improve the kidney function among older adults  in Makurdi L.G.A

1.5 STATEMENT OF THE HYPOTHESIS

H0: there is no significant relationship between high blood pressure, diabetes and kidney function among older adults

H1: there is significant relationship between high blood pressure, diabetes and kidney function among older adults

1.6 SIGNIFICANCE OF THE STUDY

The study on the effect of high blood pressure and diabetes on kidney function among older adults will be of immense help to the entire health centres in makurdi L.G.A towards creating awareness on the implication of high blood pressure and diabetes on kidney function. The study findings of the study will also establish a correlation between high blood pressure, diabetes and kidney function among older adults. The study will also serve as a source of information to health centres in Benue state and other researchers and contribute to the body of the existing literature on the effect of high blood pressure and diabetes on kidney function among older adults.

1.7 SCOPE OF THE STUDY

The study covers on the effect of high blood pressure and diabetes on kidney function among older adults with focus on health centres in makurdi L.G.A, Benue state

1.8 LIMITATION OF THE STUDY

TIME CONSTRAINTS: One the challenges experienced by the researcher is the issue of time; the research will simultaneously engage in departmental activities like seminars and attendance to lectures. But the researcher was able to meet up with the deadline for the submission of the project.

FINANCIAL CONSTRAINTS: Every research work needs funding; however lack of adequate funds might affect the speed of the researcher in getting materials for completion of the project

1.9 DEFINITION OF TERMS

BLOOD PRESSURE: Blood pressure is the force of your blood pushing against the walls of your arteries. Each time your heart beats, it pumps blood into the arteries. Your blood pressure is highest when your heart beats, pumping the blood

DIABETES: Diabetes is a disease that occurs when your blood glucose, also called blood sugar, is too high. Blood glucose is your main source of energy and comes from the food you eat. Insulin, a hormone made by the pancreas, helps glucose from food get into your cells to be used for energy. Sometimes your body doesn’t make enough or any insulin or doesn’t use insulin well. Glucose then stays in your blood and doesn’t reach your cells.

KIDNEY: The kidneys are a pair of bean-shaped organs on either side of your spine, below your ribs and behind your belly. Each kidney is about 4 or 5 inches long, roughly the size of a large fist. The kidneys' job is to filter your blood.