End stage renal disease (ESRD) affects over 660,000 Americans and accounted for $30.9 billion, representing 7.1% of all Medicare spending. Without life-saving renal replacement therapy, the outlook for ESRD patients would remain bleak. In 2013, 88.2% of all incident cases began renal replacement therapy with hemodialysis, 9.0% started with peritoneal dialysis, and 2.6% received a preemptive kidney transplant. On December 31, 2013, 63.7% of all prevalent ESRD cases were receiving hemodialysis therapy, 6.8% were being treated with peritoneal dialysis, and 29.2% had a functioning kidney transplant.1 Chronic dialysis prolongs the ESRD patient’s lifespan but it does not sufficiently replace a normal functioning kidney. The milieu of chronic renal insufficiency leads to accelerated cardiovascular disease, increased infections and diminished survival. One-, two- and five-year survival for patients initiating dialysis in 2007 was 76.4%, 64.4% and 40.4%, respectively. Overall mortality rates among ESRD (dialysis and transplant) patients continue to decline, with steeper declines in more recent years. Since 1996, the net reduction in mortality was 30% for all ESRD patients, including 28% for dialysis patients and 40% for transplant patients.1
In comparison to chronic dialysis therapy, renal transplantation presents a survival benefit. In a landmark study, Wolfe and colleagues analyzed mortality rates in cohorts of all dialysis patients, patients on the transplant waiting list and recipients of primary deceased-donor renal transplants. Relative to patients on the waiting list, deceased-donor renal transplantation was associated with lower mortality rates across all ages, genders, races and ESRD causes.2 In addition to improvements in mortality, the restoration of normal kidney function from successful renal transplantation also improves patients’ overall well-being and quality of life and is cost-effective compared to dialysis.
1.1 Key words
Kidney transplant; End-stage renal disease; Dialysis; Donor nephrectomy; Organ donation; Histocompatibility; Immunosuppression
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