Advantages and Disadvantages of Dialysis and Transplant

Kidney Dialysis

Dialysis involves the removal of wastes from the blood of a patient suffering from kidney failure. The two forms of dialysis are:

Haemodialysis – when a machine cleans the patient’s blood, acting as an artificial kidney; it requires access to a large blood vessel with fast blood flow

There are three main ways access to a large blood vessel is created:

- An Arterio-Venous Fistula (AVF): the patient undergoes a small operation to join an artery and a vein together, so that the blood from the flows into the patient’s more superficial vein, making it larger and stronger for dialysis

- A prosthetic/artificial graft: if the patient’s blood vessels cannot make a fistula (e.g. small, weak or damaged veins), their artery and vein can be joined together by soft tubing during surgery

- A vascular access catheter: a temporary tube placed into a large vein belonging to the patient, consisting of 2 channels: one to redirect the blood into the dialysis machine and the other to return the clean blood

Advantages	Disadvantages
Minimal participation in the treatment (staff performs dialysis at centre) No external access required No equipment/supplies or home supports required	Patients are required to adhere to specific schedules Patients must travel to the dialysis centre Strict diet control and fluid control Complications may arise e.g. low BP, lightheadedness, shortness of breath, cramps, nausea and vomiting Access can become infected or develop blood clots

Peritoneal dialysis (PD) – a PD catheter (a soft plastic tube) is inserted into the patient’s body around their abdomen, with a part of the tube staying outside of the body. Dialysis fluid moves in and out of the body through this catheter to clean the patient’s blood.

Advantages	Disadvantages
More flexible scheduling – the exact timing of the procedure can be altered PD can be performed at home Less strict diet and fluid control than haemodialysis No daytime exchange (daytime dwell) if patient chooses to have dialysis at night	Infection – the PD catheter is a potential site for the entry of bacteria into the body Requires someone be trained in the use of equipment at home Increased risk of hernia (weakening of abdominal muscles) Permanent external catheter – changes to body image Possible weight gain due to glucose absorption from dialysis fluid

Kidney Transplant

A patient with kidney failure receives a new kidney from a living or deceased donor. When a donor kidney becomes available a patient is chosen with the best blood and tissue match. However, lifelong treatment with immunosuppressant drugs will be required if the kidney donor is not related. Receiving a kidney from an identical twin or a close relation provides the best possibility for the kidney to not be rejected.

Advantages	Disadvantages
Quality of life and survival often improved compared to the use of dialysis Patients are free of the time- and energy-consuming nature of dialysis Regular dietary requirement Fewer visits to the clinic	Shortage of kidney organs available – the average wait for a deceased donor kidney about 4 years Risks associated with surgical procedure e.g. infection, bleeding, damage to other organs Lifetime treatment regimen of immunosuppressive medications, with possible side effects Patient must satisfy a number of factors to be a possible transplant candidate Risk of transplant rejection

Conditions that exclude a patient from being eligible for a kidney transplant include:

- old age

- severe heart or vascular disease

- untreated current infection

- active or recently treated cancer

- chronic illness that results in a life expectancy of less than a few years

- Poorly controlled mental illness (psychosis)

- Severe obesity (a body mass index greater than 40)

- Inability to remember medications

- Active drug or alcohol abuse

- Positive for HIV

Maria Nguyen

Sources:

www.kidney.org.au

http://www.uptodate.com/patients/content/topic.do?topicKey=kidn_dis/6131

http://www.sintmaartenmedicalcenter.org/old/kidneys.html