More Kidney Patients Avoiding Dialysis on Path to Transplant
15% of transplants now "pre-emptive"
New York, NY (October 26, 2009) — More and more people with failing kidneys are skipping dialysis and going directly to transplant, new national data shows.
These "pre-emptive" kidney transplants still represent a fraction of the total number of kidney transplants performed every year. But new data from the U.S. Renal Data System (USRDS) show that fraction is growing. Fifteen percent of all transplants performed in the U.S. in 2007 were pre-emptive, according to USRDS's 2009 annual report. That's up from 9 to 10 percent in the early 1990s.
"This is a big step up in pre-emptive transplants and speaks to efforts that have been undertaken by all parties within the transplant community to address early transplantation," said Bryan Becker, MD, National Kidney Foundation President. "There has really been a big shift in making pre-emptive transplantation a much greater reality for patients in the U.S."
Kidney specialists have known for years that patients with chronic kidney disease will do better if they have transplants before they need to go on dialysis, or after only a short period on dialysis (typically six months or less). Analysis of large datasets from the early 2000s1 shows that the shorter the amount of time a patient is on dialysis before transplant, the better the prognosis for the transplanted organ—and the patient. When a patient can go directly to transplant and avoid dialysis, the transplanted organ is more likely to start working fast, and to function well. 2Pre-emptive transplantation can also slash medical costs; Medicare spends about a third less on patients who go straight to transplant.
"More and more, the entire healthcare community is recognizing dialysis and transplantation as treatments for kidney failure, but not necessarily ones that have to be done in sequence," said Becker.
Efforts must continue to promote awareness of pre-emptive transplantation among people with kidney disease and potential living donors, he added.
"It is important to make the public aware of this improvement in transplant efficiency," Dr. Becker said. "We should continue to examine factors that led to this trend and work to enhance them further."
1Meier-Kriesche HU, Port FK, Ojo AO, Rudich SM, Hanson JA, Cibrik DM, Leichtman AB, Kaplan B. Effect of waiting time on renal transplant outcome. Kidney Int. 2000 Sep;58(3):1311-7. 2Keith DS, Cantarovich M, Paraskevas S, Tchervenkov J. Duration of dialysis pretransplantation is an important risk factor for delayed recovery of renal function following deceased donor kidney transplantation. Transpl Int. 2008 Feb;21(2):126-32. Epub 2007 Oct 17.
The National Kidney Foundation recently embarked on a comprehensive action plan to improve the transplantation system in the U.S. and end the wait for a kidney transplant within 10 years.
This END THE WAIT! initiative is a virtual call-to-arms designed to put in place tested and proven actions relating to education, financial and medical practice.
One of the major End the Wait! Recommendations is Improving Outcomes of First Transplants by educating patients with stage 4 chronic kidney disease (CKD) about the opportunities for and benefits of early transplantation and by changing medical practice to ensure that every Stage 4 CKD patient is evaluated for a transplant prior to the initiation of dialysis.