Which is best treatment for stage 5 CKD : Dialysis or Kidney Transplant
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Dr Sanjeev Gulati
World Kidney Day is an annual global campaign dedicated to raising awareness about the importance of kidney health and reducing the burden of kidney disease worldwide. It is being celebrated on 12th March this year. Chronic Kidney Disease (CKD) has become a common but underdiagnosed problem. Inspite of recent advances in diagnosis and management, kidney disease related mortality continues to increase yearly and is projected to be the 5th leading cause of death by 2040.
Recent studies have shown that the prevalence of CKD is increasing. A population based screening study was conducted in 50000 people all over the country by Indian Society of Nephrology which shows that currently 20-30 out of 100 people are having CKD and most of it is undiagnosed. This shows alarming increase in prevalence of CKD to 20-30%.
CKD a progressive disease starting from stage 1 and it progresses to Stage 5 CKD. If diagnosed early we can slow down the progression and prolong the life of the kidneys.
In the early stages 2 simple test can hep diagnose CKD (1) Urine albumin creatinie ratio (2) eGFR in stage 5 CKD there are only 2 treatments available : dialysis and kidney transplant. There is no other treatment that allows patient to survive and all other treatments that you may see on social media are unscientific and unvalidated therapies being prescribed by quacks.
There is also no doubt that kidney transplant is better than dialysis both in terms of cost as well as long term outcomes. At present kidney donation can either be done by family members or you can be wait listed for a cdaveric organ from brain dead donors. Recently there have been prelimnary results from USA about the use of genetically engineered kidneys in CKD patients with encouraging results. In india there are very low organ donation rates and the 1 year survival of dialysis is about 75% and 5 year survival is 20%. Also these patients have to continue coming for dialysis indefinitely. They often require admissions to hospitals because of infections or cardiac problems In contrast 1 year survival for kidney transplant is >99% and successful kidney survival is 95 %. At 5 years the kidney survival is 80% and patient survival 95 %. This is more than 4 times better than dialysis and at a much lower cost. Moreover kidney transplant is the only treatment that allows a person to get back to his normal lifestyle and work. A transplant patient can complete his studies, work and support himself as well as his family and have very satisfying family and social life and be a useful member of the society rather than being dependent on his family members for support.
Hence every patient of Stage 5 CKD should plan for a kidney transplant preferably get a pre-emptive transplant (transplant without dialysis). This not only has better outcomes but also comes at a lower cost.
Healthy lifestyle choices can help to improve your overall health and thereby lower your risk of developing kidney disease and heart disease. Thus it is buy and and get two free. The following healthy lifestyle choices are a great way to start:
• Don’t smoke ! If you smoke, quitting now is the most important step you can take for your health !
• Maintain a healthy blood pressure, cholesterol and blood sugar levels
• Maintain a healthy weight. Check with your doctor to learn more about body mass index and to find out what’s right for you. Obesity and being overweight increases your risk of developing Diabetes
• Eat a healthy diet. Avoid diet rich in simple carbohydrates, saturated fats and excess salt
• Drink plenty of water and fluids to keep hydrated, but only drink alcohol in moderation
• Try to get 30 mins of exercise, 4 to 5 times a week. Just a half-hour of walking each day will make a big difference. Regular Yoga has also been found to be beneficial and it also acts a stress buster.
For more information on kidney diseases please see my YouTube channel Dr Sanjeev Gulati Kidney Clinic. The writer is Chairman, Nephrology and Kidney Transplant, Fortis Hospitals and past President Indian Society of Nephrology
World Kidney Day is an annual global campaign dedicated to raising awareness about the importance of kidney health and reducing the burden of kidney disease worldwide. It is being celebrated on 12th March this year. Chronic Kidney Disease (CKD) has become a common but underdiagnosed problem. Inspite of recent advances in diagnosis and management, kidney disease related mortality continues to increase yearly and is projected to be the 5th leading cause of death by 2040.
Recent studies have shown that the prevalence of CKD is increasing. A population based screening study was conducted in 50000 people all over the country by Indian Society of Nephrology which shows that currently 20-30 out of 100 people are having CKD and most of it is undiagnosed. This shows alarming increase in prevalence of CKD to 20-30%.
CKD a progressive disease starting from stage 1 and it progresses to Stage 5 CKD. If diagnosed early we can slow down the progression and prolong the life of the kidneys.
In the early stages 2 simple test can hep diagnose CKD (1) Urine albumin creatinie ratio (2) eGFR in stage 5 CKD there are only 2 treatments available : dialysis and kidney transplant. There is no other treatment that allows patient to survive and all other treatments that you may see on social media are unscientific and unvalidated therapies being prescribed by quacks.
There is also no doubt that kidney transplant is better than dialysis both in terms of cost as well as long term outcomes. At present kidney donation can either be done by family members or you can be wait listed for a cdaveric organ from brain dead donors. Recently there have been prelimnary results from USA about the use of genetically engineered kidneys in CKD patients with encouraging results. In india there are very low organ donation rates and the 1 year survival of dialysis is about 75% and 5 year survival is 20%. Also these patients have to continue coming for dialysis indefinitely. They often require admissions to hospitals because of infections or cardiac problems In contrast 1 year survival for kidney transplant is >99% and successful kidney survival is 95 %. At 5 years the kidney survival is 80% and patient survival 95 %. This is more than 4 times better than dialysis and at a much lower cost. Moreover kidney transplant is the only treatment that allows a person to get back to his normal lifestyle and work. A transplant patient can complete his studies, work and support himself as well as his family and have very satisfying family and social life and be a useful member of the society rather than being dependent on his family members for support.
Hence every patient of Stage 5 CKD should plan for a kidney transplant preferably get a pre-emptive transplant (transplant without dialysis). This not only has better outcomes but also comes at a lower cost.
Healthy lifestyle choices can help to improve your overall health and thereby lower your risk of developing kidney disease and heart disease. Thus it is buy and and get two free. The following healthy lifestyle choices are a great way to start:
• Don’t smoke ! If you smoke, quitting now is the most important step you can take for your health !
• Maintain a healthy blood pressure, cholesterol and blood sugar levels
• Maintain a healthy weight. Check with your doctor to learn more about body mass index and to find out what’s right for you. Obesity and being overweight increases your risk of developing Diabetes
• Eat a healthy diet. Avoid diet rich in simple carbohydrates, saturated fats and excess salt
• Drink plenty of water and fluids to keep hydrated, but only drink alcohol in moderation
• Try to get 30 mins of exercise, 4 to 5 times a week. Just a half-hour of walking each day will make a big difference. Regular Yoga has also been found to be beneficial and it also acts a stress buster.
For more information on kidney diseases please see my YouTube channel Dr Sanjeev Gulati Kidney Clinic. The writer is Chairman, Nephrology and Kidney Transplant, Fortis Hospitals and past President Indian Society of Nephrology