Page 20 - GHES-3-2

Global Health Economics and
Sustainability
Retrospective analysis of dialysis and kidney transplant

of America (USA) reported a record-breaking 25,498 2.1.3. Principles of HD
kidney transplants, a 3.4% increase from 2021. In 2023, HD operates on the principle of diffusion and ultrafiltration.
the USA reported 46,632 kidney transplants, an 8.7% The components of HD are displayed in Figure 1.
increase from 2022 and a 12.7% increase from 2021
(Ferhatoğlu et al., 2019). 2.2. PD

Liyanage et al. (2022) observed substantial variation PD is a renal replacement therapy used for patients with
in chronic kidney disease (CKD) prevalence (7.0–34.3%) stage 5 or terminal CKD, characterized by a significantly
across Asia, with an estimated 434.3 million people reduced glomerular filtration rate (GFR). Unlike HD, PD
affected across the eastern, southern, and southeastern uses the peritoneal membrane for the exchange of solutes
regions. The highest disease burden was observed in and water between blood in the peritoneal capillaries and a
China and India, accounting for 299.9 million cases dialysate solution instilled into the peritoneal cavity.
(Liyanage et al., 2022).
2.2.1. Peritoneal physiology
1.3. Objective of the review
The peritoneal membrane is a serous membrane lining
This review aims to compare QoL metrics (e.g., physical the abdominal cavity and covering the abdominal organs.
function, mental health, and social functioning) between It consists of a layer of mesothelial cells, a basement
dialysis and kidney transplant patients (Parker & Molzahn, membrane, and underlying connective tissue, including
2017), as well as analyze the economic impact and cost- blood vessels and lymphatics. The mesothelial cells form
effectiveness of dialysis versus kidney transplantation over a barrier between the peritoneal cavity and the underlying
a retrospective duration (Kiberd & Keown, 2014). The tissues, suggesting a crucial role in the permeability and
findings of this review could help healthcare providers function of the peritoneal membrane.
recommend the most effective treatment option based
The peritoneal membrane facilitates the exchange of
on the QoL (Miller & McLachlan, 2016) and improve solutes and fluids between the blood and the dialysate
patient outcomes and healthcare efficiency, benefiting both
patients and healthcare systems. through diffusion and convection mechanisms. During
PD, the membrane acts as a filter, allowing waste products
2. Dialysis and excess fluids to pass from the blood into the dialysis
fluid, which is then drained from the peritoneal cavity.
2.1. HD

HD is a therapeutic procedure that uses the extracorporeal 2.2.2. Application of PD
circulation of a patient’s blood to ameliorate azotemia, PD was initially utilized for acute kidney injury (AKI),
fluid, electrolyte, and acid-base abnormalities associated providing a means to eliminate toxins and maintain
with uremic syndrome(Ye et al., 2020). fluid balance in critically ill patients. At present, PD is

increasingly applied in various clinical settings. It serves as
2.1.1. Application of HD a long-term renal replacement therapy for individuals with
The most common application of HD is for patients with CKD, enabling home-based treatment and enhancing QoL.
CKD who have progressed to end-stage renal disease PD is particularly favored for pediatric patients due to its
(ESRD). HD reduces the workload on the heart and gentler nature and the convenience of home management.
prevents pulmonary edema (Shtepa et al., 2022). One of In addition, PD can help preserve residual kidney function
the most critical applications of HD is the management of more effectively than HD, leading to improved patient
hyperkalemia (excessive potassium in the blood), which outcomes. Furthermore, PD’s association with fewer
can cause dangerous heart rhythms. HD effectively lowers fluctuations in blood pressure and fluid balance makes
potassium levels, preventing life-threatening complications it suitable for patients with cardiovascular complications
(Shtepa et al., 2022). (Amerling et al., 2003).
2.1.2. Indications of dialysis 2.2.3. Indications of PD

Indications for dialysis or acute HD include failure of fluid PD is particularly suitable for patients with ESRD who
administration, diuretic or vasodilator therapy, inability to require long-term renal replacement therapy. In addition,
initiate adequate diuresis, failure of conventional therapy to PD can be used in cases of AKI, especially when HD is not
control the biochemical and clinical manifestations of acute feasible, and for patients with hemodynamic instability. For
uremia, life-threatening fluid overload, hyperkalemia, and patients who face difficulties establishing or maintaining
acidosis (Shtepa et al., 2022). vascular access for HD, PD offers convenience and

Volume 3 Issue 2 (2025) 12 https://doi.org/10.36922/ghes.4639