Provide the rationale for cardiovascular disease and type 2 diabetes as major risk factors for chronic kidney disease.

Cardiovascular disease is a major risk factors for chronic kidney disease. Reduced changes in kidney function is evidenced by lessened glomerular filtration rate and presence of albumin in urea. These are potential cardiovascular risk factor. Impaired kidneys lessen the production of hormone erythropoietin (EPO) that helps in red blood cell production from the bone marrow. Impaired kidney functions leads to anaemia, which can cause left ventricular hypertrophy. This leads to cardiac cell death via apoptosis and worsen cardiac condition. Reduced amount of EPO in renal insufficiency causes cardiac stress through tachycardia and also raised stroke volume. Reduced blood flow within the renal system and fluid retention add further stress to the heart. Inflammation plays a major role in commencement and progression of atherosclerotic process that is a type of inflammation. It is evident that ESRD patients provide serological evidence of activated inflammatory responses because of various causes like reduced renal clearance of cytokines (pro-inflammatory), accumulation of glycation end-products, co-morbidities and other relevant factors associated with dialytic procedure, for example: membrane bioincompatibility, contaminated dialysate and vascular access infections (Adejumo, Okaka, Madumezia, Okwuonu, & Ojogwu, 2015).

Diabetes damages small blood vessels inside the human system. When blood vessels in the kidneys are injured, it fail to properly purify the blood and the system retains more salt and water than it should. This further gives rise to swelling of ankle, weight gain and high protein build up in urine, as seen in Robert’s case. Diabetes may also damage the nerves, which could further obstruct emptying the bladder (Li et al., 2015). The pressure causing from full bladder provide back pressure and injure the kidneys. If urine with elevated sugar level remains in the bladder for longer time, it can cause infection due to rapid bacterial growth.