Wednesday, March 11, 2009

World Kidney Day

Tomorrow, the 12th of March is World Kidney Day.


The Times of India had an article about what nephrologists are planning. As usual, the emphasis is on organ donation. Which is definitely not a bad thing. But two other things need increased focus.

One is the increasing number of people getting kidney disease. How does someone prevent kidney disease? What diabetics and people with hypertension, the highest risk groups for kidney disease should do to prevent getting kidney disease? The number of young people I see in dialysis units today is really alarming. It is clear that the number of people with CKD is increasing and that the average age of the CKD patient is falling. This needs to be addressed really soon.

The other thing that needs focus is the treatment modality. Dr. Peter Laird in an excellent post questions the designation of the transplant as the primary treatment modality in treatment of CKD.

A transplant is touted as the light at the end of the tunnel for a person with renal failure. It is packaged as the ultimate solution for all problems related to renal failure. The goal for everyone on dialysis seems to be a transplant. This is really not right.

A transplant is accompanied by so many complications and risks. I have seen people doing extremely well on dialysis (and I am not even referring to daily) go in for a transplant and then die. The issues are too complex and not understood enough. The number of parameters to monitor, what to do in case everything does not go on expected lines, dealing with the large number of possibilities, zeroing in on the right combination and dosage of drugs - there is no consensus or procedure to follow.

On the other hand, a convenient and suitable dialysis modality may be much, much better. There is no daily tension of watching what you eat and drink. None of the nervousness that follows anything even slightly out of the ordinary - a fever or a cough perhaps. Is my kidney being rejected? Not having to deal with this question every living moment of life.

I am not saying nobody should get a transplant. By all means, increase awareness about organ donation. Encourage transplants. But do not forget about better dialysis. Encourage people to try home dialysis if they are suitable. They might decide that they do not want a transplant.

I did.

5 comments:

IGA Nephropathy said...

I agree with what you have written except that I did not understand about watching what we eat/drink while on transplant. I thought that was the key advantage of transplant over dialysis (not that we can eat any junk...but in general).

Zach said...

As one who has just passed his 27th year with in-center hemodialysis, I agree.

A transplant is just another option of renal replacement therapy.

IGA Nephropathy said...

Amazing. 27 years !!! You really inspire me. I was wondering if I will live that long once I start Dialysis (with or without Dialysis).

Kamal Shah said...

Bhanu, what I meant when I said careful about what you eat and drink on a transplant, I meant the hygiene aspect, not the quantity. For example, you have to be extremely careful about eating uncooked food, eating outside etc.

Of course, you can drink all the fluid you ever wanted, provided it is from a trusted source.

-Kamal

Kamal Shah said...

Hi Zach,

You are really amazing. In-center for 27 years! I don't think I could last 27 days in-center!

Have you considered home hemo?

Kamal