Dialysis

Dialysis is a process that removes waste products and excess fluid that accumulate in the blood as a result of failure of the kidneys to function. It is not a cure for ESKD. It only substitutes for some functions of the kidneys like removing some waste products and excess water from the body.

There are 2 forms of dialysis: hemodialysis and peritoneal dialysis. Hemodialysis (with the artificial kidney) can be performed at a dialysis unit or at home (Dialysis@home service provided by Narmada Kidney Foundation). Peritoneal dialysis is generally done daily at home. Due to lack of confidence in performing dialysis at home, a large majority of patients (>90%) in our country choose hemodialysis at a dialysis unit. Standard hemodialysis treatment involves a 4 hours procedure 3 times a week.

The dialysis treatment is very expensive. The direct cost of dialysis and other medicines that a dialysis patient needs turns out to be approximately Rs. 25,000 per month. In addition to this direct cost, there is an indirect cost, which many patients fail to realize  (decreased working capacity and hence decreased income generation, loss of time, energy and money of dialysis patient and the person assisting the dialysis patient, cost of treating various complications that a dialysis person is prone to).

Transplant

This is a process in which a healthy human kidney is implanted into a patient with ESKD. The kidney can come from a non-living (deceased) donor or a living donor (usually a close blood relative). Since one healthy kidney is enough to maintain a normal state of health, a living donor can donate one of his / her two kidneys.

The Transplantation of Human Organs Act passed in 1994 has made it possible to perform transplant with kidneys obtained from deceased donor if the family of the deceased person consents. A deceased donor is usually one who is “brain dead”. Over the last 15 years there has been a gradual progress in deceased donor kidney transplant. However, the progress is too slow and large majority of kidney transplants performed in our country are with living donors.

A living donor has to be willing and must have a compatible blood group. He/she is subjected to extensive evaluation to ensure that he/she is healthy and fit to donate. If on evaluation it is found that the donor is not fit to donate, he/she is not accepted. A recipient is often reluctant to accept kidney from a family member thinking that it will affect the donor’s health. It must be realized that if there is any chance of donor’s health getting affected by donating kidney, doctors will not accept that donor.

A living donor usually returns to routine 2 weeks after operation. The post surgical pain will persist for some more time depending upon the pain tolerance of the person. With laproscopic surgery the severity and duration of pain is significantly less. Over a period of time the donor returns to completely normal lifestyle and there are no restrictions on the diet or activity. This has been substantiated in long-term follow-up of living donors. 

The cost of transplant involves

1. An initial expense of Rs 50,000 to 60,000 for evaluating the donor’s suitability
2. Transplant surgery (approximately Rs 250,000-300,000)
3. Post-transplant regular check-up and medicines. This is approximately Rs 15,000 to 20,000 per month in the first year after transplant. Thereafter this progressively comes down and by 5 years it becomes Rs 2000 – 3000 per month. This remains life-long.

Dialysis vs Transplant

Dialysis is a partial treatment while kidney transplant provides all the functions of the kidneys. A dialysis patient has to spend long hours on dialysis while a transplant patient loses no such time. Thus the life of a dialysis patient is restricted in various ways while a transplant patient enjoys a normal quality of life.

The cost involved with regular dialysis is much more than with transplant. Besides actual cost, the ability of a dialysis patient to generate income progressively falls. On the other hand, a transplant patient can generate income almost like a normal person.

Because dialysis is a partial treatment, the survival on dialysis is significantly shorter than after transplant.

Pic: homes.bio.psu.edu