posted 01/09/03
The longer patients on
dialysis wait for kidney transplants once they develop "end-stage" kidney
failure, the poorer their outcomes.
The findings by researchers at
the University of Florida reinforce the value of transplants over dialysis for
these patients and show the importance of placing them on transplant lists as
early as possible, said Dr. Bruce Kaplan, medical director of the kidney and
pancreas transplantation program at the Shands Medical Center in Gainesville,
Fla., and co-author of the study.
"Dialysis keeps you alive, but you do not get the same benefit as
transplantation," said Dr. Kaplan, also a professor of medicine and of
pharmacology and therapeutics at the university's College of Medicine.
In
2000, nearly 420,000 Americans with kidney failure were on dialysis, a
mechanical means of filtering waste products from the bloodstream several times
a week — a function that kidneys normally perform around the clock. About
96,200 of those were newly diagnosed cases of kidney failure, Dr. Mario Assouad,
a nephrologist at Baylor College of Medicine in Houston, said in a telephone
interview.
Dr.
Kaplan, said most patients on dialysis have end-stage renal disease, the most
advanced form of kidney failure, usually caused by diabetes or high blood
pressure. With end-stage renal disease, kidney function is usually no more than
10 percent or 15 percent and the patient will die relatively quickly without
dialysis or a transplant, he said.
Patients with so-called "chronic" renal disease have kidney function in the 50
percent range, which does not warrant dialysis, Dr. Kaplan said.
The
Florida report found that patients on dialysis who await a transplant for two
years have a three times greater chance of losing their new kidneys than those
who wait less than six months.
Dr. Kaplan's team theorizes that those on dialysis the longest were sicker
at the time of the transplantation and thus would not do as well as those who
were on dialysis for a short time.
Dr. Assouad said the findings make sense to him.
"There is 22 percent mortality in the first year of dialysis and 60 percent
mortality in five years," he said. "For patients on dialysis, the longer the
wait, the more complications they develop. They need blood transfusions" and
other treatments.
About
50,000 Americans now await kidney transplantation, a figure expected to double
by 2010, says the Richmond-based United Network for Organ Sharing.
However, only a fraction received transplants. In 2001, 14,149 kidney
transplants were performed, said Dr. Assouad, also a representative of the North
American Society for Dialysis and Transplantation.
"Not
only is the quality of the donor organ you get important — and living-donor
organs are often ideal — if you wait long enough, recipients will not be able to
take advantage of the great quality organ they're getting because their health
will have deteriorated," Dr. Meier-Kriesche said.
Nevertheless, Dr. Kaplan said, patients should realize that even if they
have to wait years for a transplant, the surgery "still confers tremendous
benefit over dialysis."
Most patients who undergo kidney transplantation have waited up to three
years for donor organs, he said. He pointed out that other scientists have shown
that even after waiting three years, patients live an average of 10 years longer
if they undergo transplantation.
Source: Diabetes In Control Dot Com.
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