End stage Kidney Disease and Transplantation
Chronic kidney disease (CKD) is an enormous global public health problem, affecting 10% of the population worldwide (1). Lack of access to high quality affordable treatment deprive of patients’ lives prematurely. As of 2015, more than 2 million people worldwide receive renal replacement therapy (RRT) in the form of dialysis, or having had a kidney transplantation to stay alive representing only about 10 % of people who actually rely on RRT to survive (1). CKD is increasing in most parts of the world and disproportionally more so in developing countries (2). In the 2015 Global Burden of Disease Study, kidney disease ranked as the 12th most common cause of death, accounting for 1.1 million deaths worldwide (1). During the last 10 years the overall CKD mortality has increased by 31.7%. According to several predictions about likely future increases in the dialysis population, the burden of providing maintenance dialysis in coming decades will be daunting (3-6). In the large US economy, treatment for ESRD consumes 6.7% of the total Medicare budget to care for less than 1% of the covered population (1). In a comparatively less economy, the annual cost of dialysis in Uruguay is close to $ US 23 million, representing 30% of the budget of the National Resources Fund for specialized therapies (1). In a small nation like Bermuda the annual cost of dialysis is staggering $ US 32 million.
Kidney transplantation is recognized as the treatment of choice for most patients with CKD that has progressed to end stage kidney disease (ESKD). The yearly mortality rate for patients in dialysis is close to 20% as compared to about 2,5% annually for transplanted patients. Thus, the life expectancy as well as the quality of life after kidney transplantation far exceed that of dialysis. The financial burden of dialysis dwarfs that of transplantation, making this the most attractive treatment option also from the perspective of health economy.
Furthermore, a broad literature document live donor kidney transplantation as the ultimate treatment option for ESKD. This procedure supplies the ESKD patient with an optimal organ function, providing the best prospects for a healthy and most often productive life for the patient. Live kidney donation, while inflicting a surgical procedure on the healthy donor, leads to no or minuscule lifetime consequences for the donor. To the contrary, many studies confirm that kidney donors remain healthier than their peers, and that many benefits psychologically from the action of helping saving the life of a dear relative or close friend. Live donor kidney transplants are planned elective surgical procedures with low morbidity and mortality to both donors and recipients.
Supporting live donor kidney transplantation is to encourage the best possible treatment for ESKD patients, while at the same time offering a significantly less expensive therapy.