Chronic kidney disease (CKD) is increasingly becoming a concern worldwide. The disease can progress into kidney failure, the condition in which the kidneys are unable to perform their functions. The main role of kidney is to filter the blood to remove waste products and toxins from it. There are two main treatment options for patients with kidney failure

Dialysis: A machine is used to remove the waste and extra fluid from the blood. Dialysis can be performed in two forms - peritoneal dialysis and haemodialysis. Peritoneal dialysis can be further classified into two main forms: continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD).

Kidney transplant: This is an operation to place a healthy kidney from another person, called a donor, into the patient’s body. The donor for kidney can be a living person such as healthy relative, spouse, friend, or anonymous, or a person who has recently died, known as a deceased kidney donor.

Dialysis can be a temporary treatment for some people. A kidney transplant is long-term solution for end-stage renal disease or kidney failure. 

While both these treatments option have certain advantages and disadvantages, a successful kidney transplant are expected to live longer than patients treated with dialysis. Patients who have a kidney transplant are also known to have better quality of life compared to those on dialysis. There is no dependency on dialysis schedule and kidney transplant recipients can enjoy most activities such as work, travel freely, and live without restrictions for diet and fluid.

Pros and cons of kidney transplant

Kidney transplant is a recommended when both the kidneys of a patient fail to work and the person suffer through complications of kidney failure. A patient who has a living donor can have pre-emptive kidney transplantation, i.e. undergo a transplant even before beginning dialysis treatment. It prevents further deterioration of patient’s health and allows the donor and recipient to undergo surgery as per their convenience. 

Advantages: 

A successful kidney transplant not only reduce the risk of death, but also improves the quality of patient’s life. After kidney transplantation, patients do not need to have hours of dialysis treatment, which is liberating. Normally, patients start on dialysis as soon as they are diagnosed with kidney failure, till the time they have transplant surgery.

Another advantage of transplantation is cost-effectiveness. It is one time surgery and requires only one payment, which is fairly less than the overall cost of dialysis over several years. The relatively lower cost kidney transplant in India than other countries, makes it an even more lucrative option and further adds to the benefits. 

The improvement in the quality of life after transplant in contrast with dialysis are:

  • Freedom from regular schedule of dialysis

  • No dietary restrictions 

  • Feeling better or more normal

  • Travel is easier

  • Comfortable return to working

  • Easy to get successful pregnancy

However, not everyone is eligible to undergo Kidney transplantation and there might be some disadvantages that a patient has to consider. It is a major surgical procedure with risks during as well as after the surgery. These risks and complications of the surgery include infection, blood loss, and damage to the surrounding tissues or nerves. 

After kidney transplantation, the patient has to take anti-rejection medications almost life-long. The frequent monitoring for organ rejection is required. The immunosuppressive drugs may have significant side effects, such as more prone to severe infections, diabetes, and some cancers.

Dialysis 

Haemodialysis involves use of machine to create a circuit where blood is pumped from the bloodstream into the device which is then filtered for waste and excess water, and then sent back to the body. It is not a painful process, but may take four to five hours.

Peritoneal dialysis occurs inside the patient’s body. It involves the use of body's peritoneal membrane (in the abdomen), a fine layer of tissue that lines peritoneal cavity, as a filter. This membrane has a rich blood supply and covers some organs such as stomach, liver, spleen and intestines.

The disadvantages of dialysis include low blood pressure during treatments. It is the most common complication and is accompanied by side effects such as light-headedness, breathlessness, abdominal pain, nausea, or vomiting. 

Many patients who have hemodialysis in a medical centre may not be able to work that day or choose not to work as dialysis due to time required for travel and the treatment. However, some facilities offer overnight hemodialysis treatments for patient, which may allow them to manage both work and have hemodialysis.

To summarize, there are several advantages of kidney transplant over dialysis. It is best to discuss this a surgeon before making a decision. According to studies, dialysis can help patient achieve 10 to 20 percent of the kidney function while a transplanted kidney is able to perform over 50 percent of functions. This is why transplant recipients can see significantly improved health. Most recipients feel more energetic after their transplant surgery and can resume their daily activities more easily. Life expectancy also increases as a kidney transplant may last for 15-20 years, depending on the care taken by the patient.

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