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 “Nobody is doing fine on dialysis to the point where a transplant
wouldn’t be better for them,” senior author Dr. Dorry Segev told
Reuters Health. “Transplantation is the better form of renal
replacement.”
A kidney transplant doubles a recipient’s life expectancy, said
Segev, a transplant surgeon at the Johns Hopkins Hospital in
Baltimore, Maryland.
His group’s study, published in the Clinical Journal of the American
Society of Nephrology, showed a gap in dialysis patients’ knowledge
about the benefits of transplants over dialysis, Segev said.
Researchers surveyed 348 patients being treated at 26 Baltimore-area
freestanding dialysis centers, asking whether a dozen potential
concerns constituted reasons they would not pursue a transplant. The
average age was 56 and half the patients had been on dialysis for at
least two months.
Overall, more than 68 percent of the patients told researchers “I’m
doing fine on dialysis.”
The older the patient, the more likely they were to report feeling
fine on dialysis, the study found.
Less educated patients were more likely to report being content with
dialysis than those with higher degrees, the study found.
Almost a quarter of patients had not seen a nephrologist (a doctor
who specializes in kidney disease) before starting dialysis – and
these people were almost twice as likely to report that no one had
discussed a possible transplant with them.
Nearly 30 percent of participants reported feeling uncomfortable
asking a friend or relative to donate a kidney, the study found. The
authors say such reluctance to ask friends and relatives to donate
kidneys is consistent with prior studies.
Also consistent with prior studies, the researchers found that women
tended to be more fearful about transplants than men, with 26
percent of women saying they feared a transplant compared to less
than eight percent of the men.
Women do just as well after a transplant as men, if not better,
Segev said. “That’s another area where we need to work on education
and assurance,” he said.
In sum, he said, the study points to a lack of education for
renal-failure patients about the benefits of kidney transplants.
“This is another set of evidence that we have a problem in how well
we are educating people at the time of their kidney disease,” he
said. “We really need to find a better way to educate people about
transplantation.”
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Jesse Schold agreed. He has done similar research at the Cleveland
Clinic but was not involved with the current study.
“The preponderance of research shows that transplantation doubles
life expectancy, improves quality of life and reduces healthcare
costs,” he told Reuters Health.
“It’s certainly interesting and to most people would be relatively
startling” to realize how many patients aren’t pursuing
transplantation because they say they’re doing fine, he said.
“Given the overwhelming evidence that transplantation is a better
treatment modality, it certainly suggests that more education may be
appropriate.”
Schold stressed the need for patients suffering from renal failure
to see nephrologists and learn about transplants soon after they are
diagnosed with renal problems.
Prior research found that kidney-disease patients who are
African-American or lack private health insurance are less likely to
be matched with donor organs before they need dialysis (see Reuters
Health story of January 31, 2013 here: http://reut.rs/1tKdUU2).
Almost 66 percent of the current study participants were
African-American. Some 24 percent of them reported feeling
uncomfortable asking someone to donate a kidney, compared to 41
percent of other participants.
Americans who receive kidneys from unrelated live donors tend to be
white, highly educated and live in wealthier neighborhoods,
according to an earlier study (see Reuters Health story of April 9,
2012 here: http://reut.rs/ZoGvFw).
A kidney is one of the few organs people can give away and go on to
live a healthy life.
Since the 1990s, advances in immune-suppression have made it safer
to receive an organ from someone who’s not a relative. Less-invasive
surgical techniques also make it easier to donate.
SOURCE: http://bit.ly/1uzgihR Clinical Journal of the American
Society of Nephrology, online September 11, 2014.
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