Treatment For Kidney Disease

Hi all!

I am Dr. Suraj Gupta. I am a Nephroologist and a kidney transplant specialist. I practice in Narayana super-speciality Hospital and my clinic is located in Gurgaon. Today I will talk briefly about end-stage kidney diseases and the option of treatment for such patients. End-stage kidney diseases or CKD (chronic kidney diseases), this is a stage where kidney stops functioning or the kidney function is to the minimum where it requires some form of renal treatment. At this stage, there are two options available for any patient. Either to go for dialysis or opt for the kidney transplant. Dialysis vis-a-vis transplant, there is a significant survival difference as well as the quality of life difference.

Compared to dialysis, renal transplantation offers significant survivability of about 15 to 16 years. Any patient especially in younger age somebody if you take an individual who is at the age of around 30 to 40 years, if he gets a suitable donor, the survival is almost 15 years more than what he can live on dialysis and the quality of life if you compare is significantly better. The person can resume the normal life. The person can start working as a normal individual and the same individual does not have to visit a dialysis unit twice or thrice in a week. So the quality of life is significantly better. Even in the case of an elderly individual if someone is, say 50 or 60 years old, even for them the survival is significantly better. The survival vis-a-vis dialysis is almost 7-8 years. And these are all western data. The quality of dialysis, the kind of flexibility, acceptability for dialysis which India has. Everyone does twice or thrice a week dialysis.

If we see that, the survival would be much better because we're almost giving an individual a normal kidney so he regains almost a normal kidney function and can live a normal healthy life. This is what transplantation can offer to you but yes it is not always possible for an individual to have transplantation. There are certain problems, either the donor is not available, the matching donor is not available or the person is too sick or has other illnesses like any other organ failure like heart failure or any liver disease which excludes the person from having the kidney transplant. For such individual dialysis is a very good modality of treatment provided the dialysis is done well, provided adequate dialysis is done and providing dialysis is started early.

There are two kinds of dialysis which are available - either it is a Peritoneal Dialysis or it is a Hemodialysis. Peritoneal dialysis can be done very well at home. You can do exchanges, water exchanges, fluid exchanges three times or four times in a day and individual can very well do it on their own. They do not need to go to the hospital. It can be done independently and once in a month or if any complication gets developed at that time they need to visit a hospital and consultant their nephrologist. Hemodialysis is in fact by all means and in-center dialysis. Majority of hemodialysis is done in-centre. So they need to visit a dialysis unit where they are connected to a unit machine.

They have to sit there for 4 hours and do hemodialysis, and almost for 4 hours thrice in a week. This dosing is very important. 12 hours in a week is the minimum amount required, the minimum duration required for any individual. Because reducing the amount/duration of dialysis per week would have serious consequences on the quality of life as well as the survivability of the individual. This is what we can do for any patient who has already reached this stage but still all said and done, transplantation is probably the best modality to treat any individual who reaches a stage of renal failure because obviously, we would be replacing the diseased kidney with a normal functional kidney. So that is what is my message is- start treatment if someone reaches a stage where they need treatment, the Kidneys are not functioning. They should reach the nephrologist at the earliest. Choose wisely, start whatever the option you have and get enrolled in a good program where you follow either transplantation or dialysis whatever the option you have.

Thank you!