Nephrologist’s Note features timely information provided by physicians in the greater tri-state area.
Joseph Frascino, M.D.,
Nephrologist, Teaneck, N.J. |
When is the best time to get a kidney transplant? As soon as possible. A recent study of a large number of people who received kidney transplants suggests that there is a significant advantage to bypassing dialysis altogether or receiving a transplant shortly after dialysis treatments begin.
The research proves what nephrologists have recognized for a long time—that less time spent on dialysis results in better short- and long-term outcomes for transplantation. Released late last year, the study involved people with end stage renal disease (ESRD) from all over the United States who received kidney transplants during the ten year period between 1988 and 1998.
Dialysis is a mixed blessing. It is a proven treatment for sustaining life, but it is not a total therapy. Some biological processes associated with kidney disease cannot be controlled by dialysis and result in progressive disease that is harmful to the patient. While dialysis removes toxins from the blood, it doesn’t prevent bone disease, neuropathy, protein malnutrition that results in muscle wasting, over stimulation of the immune system, and stress on the heart. Even the need for vascular access can result in infections that compromise the health of a patient with chronic illness. All of these side effects, although controllable to varying degrees, can be avoided if patients bypass dialysis, or at least receive a transplant within a short time after they begin dialysis.
Under the most ideal circumstances, people with the first symptoms of renal insufficiency are referred to a nephrologist for specialized care. Patients who are in relatively good health, aside from their renal disease, are well served to explore the option of living kidney donation among their family and friends early in their disease process. Unfortunately, many people do not see a nephrologist until there is an emergency need for dialysis. Yet, even in these cases, nephrologists can present the transplant treatment option as soon as possible, so patients can make an educated choice and proceed with plans for a transplant if they choose that option.
Today, the percentage of people who receive kidney transplantation as a pre-emptive treatment remains small, but thanks to an increased awareness of living organ donation, the numbers are growing.
It has been said that the best measure of seamanship lies in the ability to avoid situations that demand it. Why not then, whenever possible, transplant immediately to avoid the known risk of morbidity associated with even the most well structured and “seaworthy” dialysis regimens?
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