Forbes India 15th Anniversary Special

Choosing between Dialysis and a Kidney Transplant

Dr. Ajay Kher, Director and Senior Consultant Nephrology, MBBS (AIIMS), FASN, Epitome Kidney Urology Institute, New Friends Colony, New Delhi

Published: Dec 26, 2022 08:36:37 PM IST
Updated: Dec 26, 2022 08:42:11 PM IST

Choosing between Dialysis and a Kidney TransplantKidney provides two main functions, cleaning the blood and removing salt and water from the body. There are two main kinds of kidney disease - Acute Kidney Injury and Chronic Kidney Disease. Acute Kidney Injury (AKI) is when the kidney has been normal but a sudden event causes reduction or decrease of the function of the kidney within a few days or weeks. In these conditions, if the cause is identified and treated the kidney function may improve and may even return to normal.

In Chronic Kidney Disease (CKD) the injury or damage to the kidney happens over time (months and years, most commonly due to diabetes and hypertension). In these conditions, it may not be possible to bring kidney function back to normal but with good control of risk factors and follow up it may be possible to slow or stop further damage to the kidneys.

For patients with chronic kidney disease (CKD), once the kidney function is less than 10-15%, then they may get symptoms such as nausea, vomiting, change in taste, decrease in appetite, loss in weight, itching, difficulty in thinking or concentrating, increase in potassium, increase in fluid or difficulty breathing. Once symptoms start, then the two options available are dialysis or kidney transplant.

Dialysis and kidney transplantation are treatments for severe kidney failure, also called kidney (or renal) failure, stage 5 chronic kidney disease, and end-stage kidney (or renal) disease. There are two types of dialysis: hemodialysis and peritoneal dialysis. When the kidneys are no longer working effectively, waste products, electrolytes (such as potassium, phosphorus, and acids), and fluid build up in the blood. Dialysis takes over a portion of the function of the failing kidneys to remove the fluid and waste products. Kidney transplantation can even more completely take over the function of the failing kidneys.

When will dialysis or kidney transplantation be needed?
As the kidneys lose their ability to function, fluid, waste products, and electrolytes begin to build up in the blood. A kidney transplant should be performed or dialysis should begin before kidney disease has advanced to the point where life-threatening complications occur. This usually takes many months or years after kidney disease is first discovered, although sometimes severe kidney failure is discovered for the first time in people who were not previously known to have kidney disease. Your doctor should discuss with you whether dialysis or transplantation is in your best interest and will improve your quality of life and/or life expectancy.

If you have advanced kidney disease and you plan to start dialysis, it is best to begin dialysis treatments before you get too sick and require ICU or critical care. Symptoms include nausea, loss of appetite, and loss of energy, vomiting, difficulty concentrating, and others. You and your doctor will decide when to begin dialysis after considering several factors, including your kidney function (as measured by blood and urine tests), overall health, and personal preferences. Most patients will have symptoms of kidney failure and thus generally plan to start dialysis when their kidney function is less than 10 percent of normal.

Reasons why you should consider kidney transplant over dialysis, if you are looking for better health for the long term:
Between dialysis and transplant, transplant is the better option for most patients as it will

  1. Increase your life expectancy: Patients with kidney disease can live many years with dialysis; however they are likely to live longer with a transplant. If we look at a 100 patients who start dialysis or transplant then at 10 years only 20 of them are still alive on dialysis while 80 of them are still alive with a transplant. 
  2. Improve quality of life: On dialysis there are many restrictions with regards to food and water intake. In addition, there are restrictions with regard to travel as it has to be planned around dialysis schedule or have to plan dialysis at the travel destination. With transplant most of these issues disappear. Also the overall well being that a person feels is better with a transplant than on dialysis. 
  3. Lower cost of treatment: With dialysis the monthly cost is around Rs 30-50,000 and will continue for the lifetime. With transplant there is a onetime large cost of the transplant but after a few months the cost is only of the medicines which average around Rs 5-10,000 per month. Hence, over the next few years, transplant is also cheaper than dialysis.
Get the facts on kidney transplantation before you start dialysis
There's no doubt about it: Getting a kidney transplant requires careful consideration. If you have the right information, it makes your decision that much easier. Considering the benefits of a successful kidney transplant (such as longer life expectancy) and the procedure's high success rates, one thing's for sure: Whether you are newly diagnosed or have been on dialysis for years, a transplant should be considered as an option and explored with your nephrologist.

Patients dealing with chronic kidney disease often begin dialysis before going through an evaluation to determine if they qualify for a kidney transplant. And sometimes, patients stay on dialysis not ever knowing that a new kidney may be a better option. Getting the right information about your options is key to not only your quality of life but also to your survival.

Dialysis, though a life-saving therapy, is a less-than-perfect option to treat kidney failure. The longer a patient stays on dialysis, the longer they are exposed to the chronic effects of kidney failure and dialysis, including issues such as heart problems, hardening arteries, chronic inflammation, and infections.

Once a patient is diagnosed with chronic kidney disease, they should follow up regularly with a nephrologist who should be proactive, pointing them toward a transplant evaluation once their kidney function declines to about 20 to 25 percent. It is important to know that you do not have to do dialysis before you get a kidney transplant. Patients who receive a new kidney before starting or after a short period of dialysis have better outcomes than patients who have been on dialysis for a long time. Patients who have spent no or minimal time on dialysis tend to be healthier and stronger, in part because their disease hasn't progressed, but also because dialysis is hard on the body. Kidney transplants are associated with several considerable benefits compared to dialysis. These include greater life expectancy, better overall health, and improved quality of life – including freedom from the severe restrictions of dialysis treatments.

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