Kidney failure can happen in the acute (sudden) or chronic (over a period of time). While dialysis may be required for both types of kidney failures, a majority of the acute kidney failures will recover, and it is the chronic renal failures that will require a kidney transplant. From the time of first kidney transplant in humans which was performed in Boston in 1954, the science of organ transplantation has made huge progress, and today kidney transplantation is the standard of care for end-stage renal diseases. Kidney transplant has survival, quality of life, and financial benefits.
Medically, the overall survival of patients with kidney failure is much better after kidney transplantation as compared to long-term dialysis. In addition to their role in filtering waste products and toxins from the blood, kidneys have an important role to play in the synthesis of blood and metabolism of Calcium and Vitamin D. Dialysis is an effective way to filter waste products and toxins, but does not substitute the other functions of the kidneys. Hence, people on long-term dialysis have problems like anaemia and weak bones which are not seen in patients after transplant. For Haemodialysis, patients would be connected to a Dialysis machine 3 times a week. In addition to restricting the activities of the patient resulting in a compromised quality of life, this takes away important working hours and hence decreases the productivity of an individual. It is true that patients need to take medicines all their life after transplant, which will have cost implications. However, the costs of maintenance drugs come down significantly after the first 1.5 – 2 years and become similar to or even less than that of maintenance Haemodialysis. Additionally, many governments and insurance schemes provide financial support to patients for transplantation as well as post-transplantation medicines.
Presently, there are a large number of people with kidney failure in India who are on regular dialysis and, a vast majority of them are suitable for kidney transplantation. The most important thing to understand is that although dialysis and kidney transplant both are treatments for kidney failure, they are not substitutes for each other. For patients who are medically fit for transplantation and who have an active and productive life ahead for them, dialysis should be considered as a bridge to transplantation. The availability of dialysis as an option should enable the patients to undergo a kidney transplant at the right time with the right organ, rather than deter them from undergoing a transplant altogether.
Dr. Manish C. Varma MS (AIIMS), DNB, MNAMS
Transplant Surgeon and Hepato-Biliary-Pancreatic Onco-surgeon,
Apollo Health City, Jubilee Hills, Hyderabad
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