What are the pros and cons of undergoing kidney dialysis? If you are not a candidate for a kidney transplant, how long can you remain on dialysis?

Answer: In projecting how long an individual is likely to survive after the onset of what is called end-stage renal disease (ESRD), the key factors are: 1. Patient age and gender, 2. Cause of kidney failure, and 3. Method of treatment.

Not surprisingly, the younger one is when stricken by ESRD, the longer the possible life extension. As examples, a 20 year old may live another 40 years while an 80 year old may expect less than five years of additional life from ESRD treatment. What caused the kidney failure can often limit future life. It follows that cancer of the kidneys or bladder may have a much worse outlook than kidney failure due to high blood pressure. Following their extra years of life in the general population, in those with ESRD, women live about 10 percent longer than men of the same age with the same cause of kidney failure.

Comparing outcomes of ESRD therapy supports the strong conclusion that overall, survival is much longer with a kidney transplant than by treatment with either peritoneal dialysis (PD) or hemodialysis. To illustrate, a healthy 65-year-old man in the general population can expect about 17 years of life in the absence of kidney failure but will live for only 3.6 years on dialysis. A kidney transplant would permit that same man 12 years of life. Further complicating predictions of life with ESRD is the reality that those fortunate in obtaining their kidney transplant from a live donor almost always live longer than an age matched recipient of a kidney from a deceased donor. Adding the impact of the marvelous return to normal “Quality of Life” that many kidney transplant recipients experience, it is rational to strive for the transplant option over dialysis whenever possible. Whether or not a kidney transplant is the correct treatment for any specific patient is a changing question in terms of upper age or cause of kidney disease. When dialysis treatment was first introduced, being older than 45 meant absolute exclusion from therapy. Today, the average age of new dialysis patients in the United States is 64 years. Similarly, kidney transplants are now being performed in very old patients as well as in many instances when the cause of ESRD was considered reason to refuse a transplant.

In thinking through why the issue of which option is best for any specific ESRD patient, the nephrologist attempts to balance availability and willingness of potential family kidney donors with the relative urgency of the patient’s sickness. The wait for a deceased kidney donor in New York, for example, is now nearly 10 years, meaning some dialysis patients on the wait list will not live long enough to get the desired transplant. Without question, the best choice, just about always, is to receive a well matched live donor kidney. In my experience, I care for kidney recipients who are cheerful and fully functional more than 30 years after their transplant. It is unusual for those on dialysis to sustain a near normal life after 20 years. On the clearly positive side, the outlook for both dialysis and transplant patients is continuously improving.

Answer provided by Eli A. Friedman, MD. Dr. Friedman is Distinguished Teaching Professor at SUNY Health Science Center Brooklyn, NY. Dr. Friedman also serves as the Chairman of the AAKP Medical Advisory Board and is an AAKP Life Member.

The Dear Doctor column provides readers with an opportunity to submit kidney-related health questions to healthcare professionals. The answers are not to be construed as a diagnosis and, therefore, alterations in current healthcare should not occur until the patient’s physician is consulted. 

This article originally appeared in the January 2010 issue of aakpRENALIFE.