Introduction

Kidney diseases rank as the number 10 killer in the Philippines causing death to
about 7,000 Filipinos every year, DOH reported (Chronic Kidney Disease, 2014, para
1). The DOH stepped up the advocacy on kidney disease prevention in observance of the
25th year of Kidney month with theme "25 Taong Pangunguna sa Serbisyo para sa
Kalusugan ng Bato ng Sambayanang Pilipino".

Chronic kidney disease (CKD), also known as chronic renal disease, is a

progressive loss of renal function over a period of months or years. Often, chronic kidney
disease is diagnosed as a result of screening of people known to be at risk of kidney
problems, such as those with high blood pressure or diabetes and those with a blood
relative with chronic kidney disease. Chronic kidney disease may also be identified when
it leads to one of its recognized complications, such as cardiovascular disease, anemia
or pericarditis.

High blood pressure is a leading cause of CKD. (High blood pressure, 2008, para
2) Over time, high blood pressure can damage blood vessels throughout your body. This
can reduce the blood supply to important organs like the kidneys. High blood pressure
also damages the tiny filtering units in your kidneys. As a result, the kidneys may stop
removing wastes and extra fluid from your blood. The extra fluid in your blood vessels
may build up and raise blood pressure even more.

The population of Filipinos aged 20 years and above in 2005 was 46,627,172. A
prevalence of 2.6% means that 1,212,306 adult Filipinos have CKD. (Ona, 2013).
Philippines have a total of 254 dialysis centers where most of the dialysis machines are
located in the National Capital Region with 41 % while Region 6 has only 5%. Iloilo and
Negros Occidental provinces have the most number of dialysis machines while the
provinces of Antique and Guimaras have none.

Anemia commonly occurs in people with chronic kidney disease (CKD)the

permanent, partial loss of kidney function. (Ona, 2013). Anemia might begin to develop
in the early stages of CKD, when someone has 20 to 50 percent of normal kidney function.
Anemia tends to worsen as CKD progresses. Most people who have total loss of kidney
function, or kidney failure, have anemia. The annual mortality rate per 100,000 people
from chronic kidney disease in Philippines has increased by 16.2% since 1990, an
average of 0.7% a year. Patient AR is very well part of the victims with this critical
condition.

Sepsis and septic shock can result from an infection anywhere in the body,
including pneumonia. Pneumonia can be community-acquired, meaning that a person
becomes ill with pneumonia outside of the hospital or a healthcare facility. Pneumonia
can also be caused by a healthcare-associated infection (HCAI). An HCAI is an infection
that is picked up by someone while he or she is in the hospital for a different reason, such
as surgery for an illness. (Sepsis and Pneumonia, 2013, para 1).

In the case of Patient AR, he was diagnosed with Septic Shock secondary to
Health Care Associated Pneumonia, Acute Respiratory Failure and Hypoxic Ischemic
Encephalopathy secondary to Post Cardiopulmonary Arrest, CAD, HCVD, CHF
Functional Class 3, Chronic Kidney Disease Stage 5 secondary to Hypertensive
Nephrosclerosis, Anemia secondary to Chronic Disease S/P AV Fistula Formation, S\P
Hemodialysis