Introduction:
The successes achieved in the field of kidney transplantation (KT) have defined it as the "golden method" of treating patients with end-stage chronic renal disease (ESRD). But we should not forget that programmed hemodialysis (HD) remains the main method of renal replacement therapy, which helps to overcome an acute decline in kidney function and gain time before kidney transplantation. It is also an alternative way to prolong life for those who are not candidates for transplantation (patients with diabetes, cancer, etc.). According to the data of the chief nephrologist of the Republic of Uzbekistan, 4,213 patients were on program hemodialysis in 2021. By 2024 year about 1500 kidney transplants were performed at the State Institution RSSPMC of surgery named after academician V. Vakhidov. This figure is significantly lower than the annual increase in the number of patients on replacement therapy. Despite the fact that dialysis brings the patient out of a serious condition, it cannot prevent the progression of chronic renal failure and its complications. In addition, with long-term treatment with hemodialysis, it also brings its own characteristic complications. As a result, the patient gradually develops disorders in all organs and systems, and, first of all, in the cardiovascular system. Objective: Studying the effectiveness of using hemodialysis as replacement therapy in end-stage chronic renal failure and to evaluate the results of pre-dialysis kidney transplantation.
Methods:
The medical records of 1200 patients with chronic renal failure who were treated from 2010 till 2024 year at the V. Vakhidov Republican Scientific and Practical Medical Center of Surgery were studied. We were formed 2 groups. The first group consisted of patients who had been on program hemodialysis for a long time (from 1 year to 9 years), and the second group included patients who had undergone pre-dialysis kidney transplantation.
Results:
In the process of studying the issue of the timing of kidney transplantation (before dialysis or while on program HD), an analysis of the initial state of patients with CRF in both groups was performed. Biochemical and physiological parameters of patients after KT were also compared. The data showed that serum creatinine in patients on HD was 600 ± 90 mmol/l, in pre-dialysis patients - 800 ± 150 mmol/l, which indicates obvious renal failure. The glomerular filtration (GF) rate in the first group was 7-8 ml/min, in the second - 10-12 ml/min. During the evaluation of the effectiveness of dialysis therapy, it was found that the urea in the blood serum of patients on HD was 23.0 ± 5 mmol / l, in pre-dialysis patients - 28.1 ± 7.0 mmol / l. The urea level after hemodialysis in patients decreased to 17 ± 3 mmol / l. In all patients, the level of total calcium, phosphorus and parathyroid hormone in the blood serum was routinely examined. The calcium level in the blood of patients on HD was - 1.94 ± 0.15 mmol / l and in pre-dialysis patients - 2.32 ± 0.16 mmol / l. The phosphorus level in the first group was - 1.71 ± 0.13 mmol / l and in the second group - 1.86 ± 0.15 mmol / l. It should be noted that the level of parathyroid hormone was elevated. And secondary hyperparathyroidism was diagnosed in 18% of patients. Also, to determine the risk of developing cardiovascular complications, all patients underwent echocardiography. Comparative analysis showed that in patients on programmed HD, the end-diastolic volume (EDV) and end-systolic volume (ESV) were much higher than in pre-dialysis patients. The EDV indicator in the first group varied within 170-220 ml, ESV 80-90 ml. Whereas in pre-dialysis patients, the EDV did not exceed 150±10 ml, ESV-60±8 ml. Also, pulmonary hypertension (PH) stage 2-3 was detected in 30% of patients on programmed HD. This was explained by the fact that in the postoperative period, all pre-dialysis patients had optimal and normal BP, while in the group of hemodialysis patients, in most cases, the BP level remained within the upper limit of the norm.
Conclusions:
Comparative analysis of pre- and postoperative parameters of patients at the pre-dialysis stage and patients undergoing program HD showed that laboratory and clinical data, as well as the general condition of pre-dialysis patients, were better. The postoperative period was uneventful with fewer surgical complications and acute rejection crises. In addition, earlier normalization of all renal parameters was revealed. This contributed to the rapid recovery of patients and a reduction in the duration of the rehabilitation period. Based on clinical experience, pre-dialysis kidney transplantation provides a better somatic and psychoemotional status of the patient after LT, compared with patients who underwent KT with preliminary hemodialysis therapy. The results showed that pre-dialysis KT has many advantages over KT after hemodialysis treatment, and the determining factor was the initial status of the recipient.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.