Should Patients Remain on Intensive Hemodialysis Rather than Choosing to Receive a Kidney Transplant?

Abstract

Most dialysis patients would choose to receive a kidney transplant if possible. However, some patients who are receiving intensive hemodialysis (HD) have opted against transplantation and have chosen to remain on dialysis. In this paper, we examine studies that help to inform the decision between receiving a kidney transplant and remaining on intensive HD. There are no randomized trials directly comparing transplant to intensive HD. Database and prospective nonrandomized studies support a number of conclusions. First, compared to conventional HD, survival appears to be better with either transplantation or intensive HD. Survival appears to be similar between intensive HD and deceased donor kidney transplantation, but the best survival is reported with live donor transplantation. Secondly, people with a kidney transplant or receiving intensive HD report a higher quality of life than people on conventional HD. There is insufficient evidence to determine whether there are significant quality of life differences between these treatments. Finally, the costs of intensive HD compare favorably to those of conventional HD. Renal transplantation is more costly in the first year, but after about 2 years should be less costly than any form of HD. Based on these studies eligible intensive HD patients should be encouraged to pursue transplantation, especially live kidney donor transplantation. Individual concerns about the relative risks and benefits of renal transplantation may drive some patients to choose to stay on dialysis. Clinicians should explore the reasons behind such a decision to ensure that the patient is properly informed; however, appropriately reasoned decisions should be respected.

Effects of modality change on health‐related quality of life

“…Renal transplant is universally preferred over dialysis as a treatment modality because of the enhanced survival and reduced morbidity. However, with the growing interest in and access to more intensive hemodialysis treatments, reports have emerged of patients who opt against transplantation to remain on intensive dialysis . We have previously reported that changing to DHD does not change exercise capacity (as measured by peak oxygen uptake) or the physiologic determinants of exercise capacity, whereas there is a significant improvement in these physiologic measurements with receipt of a kidney transplant .…”

Reduced Expression of Inflammatory Genes in Deceased Donor Kidneys Undergoing Pulsatile Pump Preservation

“…Kidney transplantation (KT) represents the treatment of choice for patients with end-stage renal disease and provides survival benefit when compared with long term dialysis therapy, in terms of quality of life and life expectancy [1], [2]. With the goal of improving transplantation outcomes, donor and recipient selection criteria are evolving.…”

“…Furthermore, it is well-established that post-transplantation occurrences such as DGF and ACR are risk factors for poorer intermediate-term graft survival, increasing the burden of patients returning to dialysis therapy [2], [11], [14], [15]. According to UNOS data, the incidence of DGF is highest with DCD kidneys (44%), intermediate with ECD kidneys (33%), and lowest with SCD kidneys (21%) [2], [11], [14], [15].…”

“…According to UNOS data, the incidence of DGF is highest with DCD kidneys (44%), intermediate with ECD kidneys (33%), and lowest with SCD kidneys (21%) [2], [11], [14], [15].…”

Langzeitüberleben bei chronischer Niereninsuffizienz

“…1 Eine Stadienteinteilung der Nierenerkrankungen und chronischen Niereninsuffizienz ausschließlich auf Basis der errechneten glomerulären Filtrationsleistung (eGFR) ist nicht ausreichend. Daher wird diese rein hämodynamische Betrachtungsweise zunehmend durch weitere Parameter ergänzt wie die Proteinurie, Anämie, den sekundären Hyperparathyreoidismus, die arterielle Hypertonie und eventuell vorliegende Begleiterkrankungen [6,7,8]). …”