Why is kidney failure (ESRF) a problem? (5 reasons)
This may seem an unnecessary question on a website on CKD.
More than 2 million people worldwide receive treatment for end-stage renal failure (ESRF), a devastating diagnosis with increasing incidence due to escalating rates of diabetes mellitus and hypertension.
So. Why is this a problem?
1. Number of patients with ERSF
There are approximately 70,000 patients with ESRD in the UK (and 8000 new patients per year).
Of those, about 40,000 (55%) are transplanted. But 30,000 (45%) are not, and dependent on (1) thrice weekly 4 hour (usually) sessions of hemodialysis, or (2) peritoneal dialysis (PD). Both types of dialysis are life-limiting treatments with a 50% mortality at 5 years (an outlook worse than most types of cancer).
2. Limitations of dialysis
Dialysis only replaces about 5% native renal function, and hence most dialysis patients still experience symptoms and complications of ESRF, including endocrine, cognitive and sexual dysfunction. Dialysis is also invasive and unpleasant.
3. Immunosuppression for transplants
Whilst kidney transplantation offers good (ish) outcomes – with a 5-year kidney survival of about 85% for deceased donor transplants – lifelong immunosuppression carries serious health complications, and graft rejection is of perpetual concern.
And only 20% of those with ESRF are fit enough to receive a kidney transplant.
4. Demand for transplants (and variable wait around the UK)
Furthermore, the demand for donor organs far exceeds supply; with nearly 3000 kidney transplants are performed annually in the UK – and over 5250 patients waiting. Hence some are never transplanted.
The average wait for a transplant is about about 16 months. In the latest (2023) analysis the median average was 497 days; but this varies significantly throughout the UK (the lowest is 235 days in Oxford, and highest is 707 days at Royal Free).
5. Medication
The medications that dialysis (and transplant) patients are numerous and unpleasant.
Summary
We have described why is kidney failure (ESRF) a problem, and given 5 reasons. It may seem obvious. But we think it is worth stating. We hope this has been helpful.
Other resources
Can an implantable kidney free patients from dialysis?
The latest UK renal registry report (2023) and NHS Blood and Transplant kidney report (2023) are excellent sources of information.
Last Reviewed on 13 June 2024