Forbes India 15th Anniversary Special

Opinion: Choosing between dialysis and a kidney transplant

Dr. Siddharth Mavani, MD, DNB, Nephrology, Director of Nephrology and Kidney Transplant, CIMS Hospital (Marengo Group), Ahmedabad

Published: Dec 12, 2022 04:57:41 PM IST
Updated: Dec 21, 2022 02:59:39 PM IST

If your doctor ever diagnoses you with chronic kidney disease, he/she will give you two options to choose from. The first option is to undergo dialysis for the rest of your life, while the other option is to undergo a 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 while you still feel well and have only mild symptoms of kidney failure. Such symptoms include nausea, loss of appetite, 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 approximately 10 percent of normal.

Reasons why you should consider kidney transplant surgery over dialysis if you are looking for better health for the long term:
1. Increases your life expectancy: What you may not know is that people on dialysis treatment have a severely reduced life expectancy. For instance, if you are 30 years old when dialysis starts, the treatment will keep you alive at most for 15 more years. Therefore, you may not even survive until your fifties with dialysis treatment for your damaged kidneys.

However, if you transplant a healthy kidney your life expectancy increases by 30 to 40 years. Keep in mind that kidneys from living donors are better and will help you live longer.

2. Eliminates the need for undergoing dialysis: If you choose dialysis over transplant surgery, you will need to undergo the treatment daily. This is not only costly but also affects your quality of life. For instance, a patient on dialysis will need to make special arrangements if he/she wants to go on a vacation with family so that his treatment continues even during the trip. With a kidney transplant surgery, once you recover from the operation, you can live a normal life, without the need for daily treatment.

3. Lower cost of treatment: While you may think kidney transplant surgery is the costlier option between it and dialysis, you would be wrong to assume so. In kidney transplantation surgery, you pay a hefty amount at the time of the operation. However, in the case of dialysis, you pay smaller sums over very long periods. When you add up these small sums over 10-15 years of dialysis, you will find that transplantation is the cheaper option. If you are young and have a long life ahead of you, kidney transplantation should be the first and foremost choice of treatment for chronic kidney disease. You can undergo dialysis while you wait for a donor and then receive a healthy organ.

Quality of life: Kidney Transplant Compared to a Life on Dialysis
Many patients are concerned about their quality of life as a patient on dialysis compared to life with a new, functioning kidney. The results from many studies have shown that patients who have been living with a transplanted kidney for 10 years demonstrate a greater likelihood of still being alive than those on dialysis. For every 10 patients receiving a new kidney, eight will still have that kidney working three years after the operation. So, considering survival alone, individuals receiving a new kidney do better than those on dialysis. But there are many other benefits to receiving a new kidney for an individual suffering from kidney failure.

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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