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Choosing between dialysis and transplant

Dr. Ajay Marwaha, MBBS, MD, DNB (Trained) (Nephrology, Dialysis, Kidney Transplant), Renal Transplant Specialist, Director, MD Shrimann Superspeciality Hospital, Jalandhar

BRAND CONNECT
Published: Dec 29, 2022 07:03:51 PM IST

Choosing between dialysis and transplantThe possibility of renal failure may be discussed by the doctor if the kidney disease worsens. It is easier to take control of your care if you discuss your treatment options with your doctor before you need one of them, and you make a decision before you do. Your overall health and lifespan will improve with treatment. Severe kidney failure can be treated with dialysis and kidney transplantation.

It takes time to understand the treatment you select and adjust to the idea that you need it. Every type of treatment has benefits and drawbacks. Your daily life will be significantly impacted by the treatment you choose. You can select the best treatment option for you by being knowledgeable about the variations among them.

Why dialysis or kidney transplant is needed?
Fluid, waste materials and electrolytes start to accumulate in the blood as the kidneys' capacity to work declines. Before kidney disease has progressed to the point that life-threatening problems appear, dialysis or a kidney transplant should be carried out. 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.

Hemodialysis

Hemodialysis can replace part of your kidney function. In hemodialysis, your blood goes through a filter outside your body and filtered blood is returned to your body. Hemodialysis:
•    Filters your blood to remove harmful wastes and extra fluid
•    Helps control blood pressure
•    Helps balance important minerals, such as potassium, sodium, and calcium in your blood

Advantages and disadvantages of dialysis?
The principal advantage of dialysis is, therefore, that unless someone receives a transplant first, it is a life-saving treatment. It will also reverse the symptoms and treat the complications of kidney failure. Hemodialysis often involves only a few hours of treatment per day and does not typically involve daily treatments. With in-center hemodialysis, a nurse or patient care technician handles getting access to the blood stream for treatments, so patients don't need to learn much about the dialysis process itself.

The disadvantages of dialysis include the fact that it can never be a better option than natural native kidney function and that it only serves to replace natural kidney function. The most frequent complication of hemodialysis is low blood pressure during treatments, which can also cause lightheadedness, shortness of breath, cramps in the abdomen, nausea, and vomiting. For these potential issues, there are treatments and preventive measures available. Additionally, the access can become blocked or infected, necessitating surgery or other operations to clear it. Many patients who receive hemodialysis in a center are either unable to work or choose not to work due to the time required for travel and dialysis treatments.

Which patients would benefit from dialysis the most?
Dialysis is only more appropriate when patients are unable to undergo kidney transplantation because, for the majority of patients, a kidney transplant would be the recommended course of treatment. For a variety of medical conditions, including malignancy, serious heart disease, chronic infection, dementia or poorly controlled mental illness or simply because they are not physically fit enough, which naturally gets worse with age, patients may not be candidates for transplantation.

Kidney transplantation
The preferred course of treatment is typically considered a kidney transplant. There is strong evidence that patients with end-stage renal failure who have a successful transplant have improved survival rates, are less likely to be admitted to the hospital, and experience additional issues that are related to dialysis, like bone disease.

Advantages
The preferred treatment option for many persons with end-stage renal disease is kidney transplantation. A successful kidney transplant can prolong life and can lower mortality risk. Additionally, recipients of kidney transplants are prevented hours of daily dialysis. If a patient is suitable for a kidney transplant, they should ideally receive one before beginning dialysis.

Disadvantages
A significant surgical treatment like a kidney transplant includes risks both during and after the operation. Infection, bleeding, and organ damage are the procedure's risks. Even death can happen, although this happens very rarely. You will need to take medications and undergo regular monitoring for the rest of your life after a kidney transplant to reduce the possibility of organ rejection.

Which patients would benefit from kidney transplantation the most?
For all individuals who do not have conditions that prohibit their appropriateness, transplantation frequently would be the primary option. Patients will find it simpler to go back to work, travel, and lead busy lives with less intervention as a result. In particular, it implies that women who are of childbearing age can have healthy pregnancies, which is practically impossible on dialysis.

Which therapy is best?
Despite the benefits and drawbacks of each treatment, research suggests that those who have a successful kidney transplant live longer than people who receive dialysis. In addition, many transplant recipients claim that their quality of life is superior to that of dialysis. Patients who have had kidney transplants appreciate being able to resume their jobs, travel more easily, and live without dietary or hydration restrictions.
Compared with dialysis, kidney transplant is associated with:
•    Better quality of life
•    Lower risk of death
•    Fewer dietary restrictions
•    Lower treatment cost

However, a kidney transplant may provide a greater risk for some kidney failure patients than dialysis.

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