End-Stage Renal Failure Rehabilitation of patien

End-stage renal disease (ESRD) is a life-threatening condition with a variable etiology. For the most part, ESRD occurs whenever some pathophysiologic process causes the kidneys to stop functioning. Unless treatment is provided promptly, ESRD's consequences can be severe.

The World Health Organization (WHO) has defined health as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity" (Kutner, 1994, p. 321). This general definition has served to delineate certain health care objectives for the chronic diseases. Traditionally, health care providers focused on the clinical aspects of an individual's disease. The WHO's definition of health, however, suggests that caregivers should broaden their emphasis (Levinsky & Mesler, 1994, p. 244).

The pathologic processes of end-stage renal disease follow an evolving course. In adults, ESRD tends to be caused by multisystem disease, diabetes, and hype

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blems common to renal patients include fear of the unknown, fear of death, lack of comprehension of the disease process, and both patient and family denial (Anderson & Levine, 1983, pp. 28-29). Yet another aspect of end-stage renal disease involves its vocational effects. Although early studies documented substantial rehabilitation (i.e., employment, active education, or activities as chief houseperson) rates, more recent reports have been somewhat less encouraging. It has been found, for example, that only 23% to 60% of dialysis populations are capable of physical activity beyond the level of self-care. Moreover, objective measures of quality of life have documented impairment with regard to physical activity. Patients tend to report difficulty in carrying out various activities relevant to job tasks. For instance, more than half of dialysis patients report problems with extensive walking, or lifting and carrying weights up to 25 pounds. In addition, other ESRD victims report vision difficulties (Kutner, 1994, p. 330). Such factors may be responsible for the fact that labor force participation among dialysis patients is only 37% that of the general population (Levinsky & Mesler, 1994, p. 237). Transplant patients tend to
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