Issue of June 10, 2018
     
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The gift of new life in kidney transplantation

(June is National Kidney Month. Kidney transplantation is the treatment of choice for end stage kidney disease. This week’s article is written by Dr Georgia Lomibao, an internist-nephrologist who practices in Baguio and Benguet. She is a graduate of Saint Louis University. She trained in internal medicine at the SLU Hospital of the Sacred Heart and in nephrology at the National Kidney and Transplant Institute.)

It is often said that health is wealth. This is especially true to us, physicians, in the field of nephrology as we witness the effects of chronic kidney disease (CKD) take its toll on our patients and their families as well.

CKD is a global burden.

An estimated 10 percent of the world’s population is suffering from this disease, with millions dying each year due to the complications of the illness according to the U.S. National Kidney Foundation.

Cases of renal diseases in the Philippines has also a staggering growth from approximately 10,000 cases annually in 2013 to 14,000 cases annually in 2016. There were approximately 23,000 Filipinos undergoing dialysis in 2013 compared to only 4,000 Filipinos in 2004.

Frighteningly, these numbers continue to escalate up to the present, with the Department of Health estimating an annual increase of 10 to 15 percent in cases of CKD.

CKD or kidney failure is the gradual loss of the kidney’s ability to remove and filter toxins and body wastes from the blood. This results in the accumulation of toxins, fluids and electrolytes that adversely affect the function of other vital organs in the body, when a threshold is reached.

End stage renal disease (ESRD) is an irreversible process and will ultimately lead to death if not addressed and treated by renal replacement therapy (RRT), which may be in the form of hemodialysis, peritoneal dialysis or kidney transplantation.

Uncontrolled diabetes and hypertension remain to be the top two leading causes of CKD worldwide.

Due to the exorbitant costs of undergoing lifelong dialysis for patients with ESRD, kidney transplantation remain to be a promising option to our patients, especially with the advent of kidney transplantation (Z benefit) offered by PhilHealth that went into full implementation in 2013, with P600,000 benefit assistance for patients who are eligible to avail of the benefit package.

The process of kidney transplantation involves placing a healthy kidney inside your body to do the work your own kidneys can no longer do. The healthy kidneys may come from living (related or non-related) donors or deceased donors.

CKD patients, stages 4 and 5, whether on dialysis or not, can be screened for suitability to undergo kidney transplant, unless contraindicated. Age itself is not a contraindication, as long as the patient is medically fit and qualified to undergo the surgery and receive consequent immunosuppression.

Absolute contraindications to kidney transplant, among others, include (but are not limited to) presence of active infection, presence of active malignancy, severe uncontrolled cardiovascular disease, end stage liver disease, and severe restrictive lung disease.

A full work up for both kidney transplant recipient and donor should be done to assess whether both patients are medically, psychologically and ethically acceptable to undergo the procedure without prejudice to age, gender, religion, financial status or ethnicity.

While dialysis can be life saving and can improve the quality of life, undergoing kidney transplant remains to be the best treatment for our patients with CKD. A gift of new life.

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Medical questions and concerns may be emailed to baguiomidlandcourier@yahoo.com or yourmedicalcorner@yahoo.com. Answers will be emailed directly or will be provided in the column.

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