The prevalence of chronic kidney disease (CKD) in India is increasing rapidly. CKD is a progressive disease but is silent in its earlier stages. Data from the CKD registry which tracks the different stages of CKD at presentation to nephrologists reveals that the majority of the patients with CKD get diagnosed in Stage 4 or stage 5. For a patient with Stage 5 CKD there are only two scientifically validated treatments all over the world that will allow a patient to survive and live: one is Dialysis and the other is kidney transplant.
All other alternative therapies that you find in lay press, advertisements or social media are scientifically invalidated and can be considered a form of quackery. In my experience over the last 30 years, I am yet to see a patient of Stage 5 CKD recording on these unscientific and unvalidated treatments. On the contrary these weaken the patient and result in loss of precious time and money and lead to malnutrition and thereby result in poorer outcomes of these patients on dialysis or kidney transplant.
The most important question is as to which treatment is better; Dialysis or kidney transplant. This can be assessed after a detailed clinical evaluation but there is no doubt that for the vast majority of patients with Stage 5 CKD, kidney transplant is the treatment of choice.
As compared to Dialysis kidney transplant offers a better quality of life as well as better longevity. A kidney transplant patient can live a near normal life and be gainfully employed and hence can earn for himself as well support his own family. The only limitation is that he needs lifelong medications and do periodic blood tests and follow up with his nephrologist. In contrast, a dialysis patient is burdened to come to the hospital 3 times a week and spend at least 4 hours in the hospital.
Most dialysis patients are dependent on their families for this purpose. Research has also shown that the incidence of cardiac problems and infection are much higher in dialysis patients than kidney transplant patients. These need frequent admissions, adding to cost of treatment and poorer quality of life in dialysis patients.
The 5-year survival of patients on dialysis is about 20-30% even amongst best of the units whereas the 5 year survival of kidney transplant is 70-80%. So, kidney transplants also offer better longevity for CKD patients. The longest surviving patient on kidney transplant in India lived for 46 years after kidney transplant.
If we compare the costs too studies have shown that the cost of kidney transplant is equal to the cost of a year’s dialysis. In fact the best treatment if stage 5 CKD is a preemptive transplant which means directly going ahead with kidney transplant rather than going ahead with dialysis followed by kidney transplant as you can save on the extra expenses incurred on dialysis. This is an ideal scenario for a country like ours where treatment of stage 5 ckd is beyond the reach of the vast majority of the patient population.
Thus, there is no doubt the Kidney transplant is the preferred treatment modality for most patients with stage 5 CKD.
(Article Courtesy: Dr. Sanjeev Gulati, Executive Director, Nephrology & Kidney Transplant, Fortis Escorts, Okhla Road, New Delhi)
