End Stage Renal Disease - Treatment Options: Dialysis Versus Transplant

Abstract

Treatment option for patients with end stage renal disease (ESRD) include dialysis and kidney transplantation. Patients with ESRD are at an increased risk for cardiovascular events, mortality and hospitalization. Kidney transplantation is considered to be the preferred method of treatment for patients with ESRD. With all treatment options there are desired and undesired effects. Compared to ESRD a patient after kidney transplantation lives longer, has better quality of life and incurs fewer costs. Also, certain parameters of chronic kidney disease (CKD) are better managed, or even halted, after Kidney transplantation include anemia, calcium phosphorus metabolism, and vascular calcification and undesired effects of Kidney transplantation include increased risk of infections, malignancy, fractures, obesity. Although mortality is significantly improved after kidney transplantation compared to dialysis but still transplant recipients carry 2-3 times higher mortality risk than general population. When comparing CKD with CKD after transplantation, rate of decline of estimated glomerular filtration rate was significantly lower in CKD after transplantation. However, they still could not benefit from long term allograft survival due to increased risk of mortality. Kidney transplant recipients are a unique subset of patients with multiple traditional risk factors as well as risk factors related to the transplant. Proper management and appropriate preventive health measures may improve long term patient and allograft survival.