Page 22 - GHES-3-2

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

condition, lifestyle, and therapeutic goals. In general, PD is 19,000 people received successful kidney transplants
preferred over HD in the following aspects: between 1983 and 2006. In the following 9 years,
(i) Cost-effectiveness: In most healthcare systems, almost 2,700 people with functional transplants died.
PD is cheaper than HD, requiring less specialized Cardiovascular disease was the major cause of mortality,
staff, equipment, and space for its administration accounting for 34.6%, followed by infections (19.5%). The
(Stachowska-Pietka et al., 2015). 1 year following kidney transplantation is particularly
st
(ii) QoL: Studies have demonstrated that in most hazardous, with deadly infections exceeding 30%
situations, patients with PD have improved QoL (Dasdelen & Grebe, 2017).
compared to those on HD. This can be attributed to Cancer is another common cause of mortality and morbidity
the greater flexibility, independence, and fewer dietary among kidney transplant recipients after cardiovascular
and fluid restrictions offered by PD (Alscher, 2005). disease. Oncogenic viruses, immunosuppressive medications,
(iii) Contraindications: For patients with severe peripheral and alterations in T-cell immunity can contribute to the
vascular disease that precludes the creation of reliable increased risk of new and recurring malignancies in transplant
vascular access, HD may not be feasible. Patients with recipients (Au et al., 2018).
severe cardiovascular conditions, such as unstable
angina or recent myocardial infarction, may face risks 3.3. Preparation
that make HD unsafe or less effective. A lack of suitable 3.3.1. Patient selection
vascular access or inadequate blood flow can serve as a
contraindication (Murdeshwar & Anjum, 2020). From the moment, a patient is diagnosed with ESRD, the
selection of potential candidates is strongly dependent
3. Kidney transplant on collaboration within a multidisciplinary team, led by

Kidney transplantation has greater survival rates than established protocols and standard practices (Marroquin,
dialysis. In the USA, post-transplantation results have 2019). Obesity (body mass index > 30 kg/m²) is linked
improved over time, with current 1-year allograft and to poor wound healing and a higher risk of developing
patient survival rates over 90% (Wang et al., 2016). diabetes following transplantation. According to a
According to studies, kidney transplantation is associated systematic review and meta-analysis, obesity is associated
with a lower death rate and a higher QoL than chronic with delayed graft function (relative risk [RR]: 1.41) and
dialysis treatment (Tonelli et al., 2011). an increased risk of death from cardiovascular disease
(RR: 2.07), particularly in patients who underwent a
3.1. Indication kidney transplant before 2000 (Tepel et al., 2022a, Tepel
et al., 2022b).
The prevalence of ESRD is increasing, with diabetes and
hypertension being the leading causes. Additional causes 3.3.2. Donor selection
of CKD and ESRD include pre-renal (e.g., chronic or
acute ischemia), intrinsic renal (e.g., glomerulonephritis Determining the best living or deceased donor for a
patient with ESKD is an important decision for kidney
and focal-segmental glomerulosclerosis), and post-renal transplant programs. Personalizing donor kidney selection
(stones, tumors, strictures, or neurogenic bladder, leading for a given recipient might provide significant long-term
to increased pressure, kidney damage, and eventually renal benefits, especially when numerous donors are available.
failure) factors. Patients with stage 4 CKD, characterized
by GFR < 30 mL/min/1.73 m , should be referred to a The relative probability of transplant failure (return to
2
nephrologist for further management and consultation on dialysis or patient mortality) for Expanded Criteria Donor
kidney failure and treatment options, including transplant (ECD) kidneys was predicted to be 1.7 times higher than
that of Standard Criteria Donors (SCD). The Kidney
(Abramyan & Hanlon, 2024).
Donor Profile Index (KDPI) was introduced in 2014 as a
3.2. Contraindications more objective assessment of graft quality, replacing the
ECD and SCD classifications. The KDPI is derived from
The contraindications of kidney transplantation are key the Kidney Donor Risk Index (KDRI), which represents
factors that may disqualify a patient from being a viable the percentage of donors in a reference population
candidate.
(as determined annually by the Organ Procurement and
Despite ongoing progress in diagnostic and therapeutic Transplantation Network) with a KDRI score equal to
procedures, infections remain a serious and sometimes or lower than the donor’s. The KDPI is calculated using
fatal complication among kidney transplant recipients. factors, such as donor age, ethnicity, creatinine levels,
According to the United States Renal Data System, over history of hypertension or diabetes, cause of death,

Volume 3 Issue 2 (2025) 14 https://doi.org/10.36922/ghes.4639