McFarlane Philip A
Division of Nephrology, St. Michael's Hospital, Toronto, Ontario, Canada.
Semin Dial. 2010 Sep-Oct;23(5):516-9. doi: 10.1111/j.1525-139X.2010.00740.x.
Most dialysis patients would choose to receive a kidney transplant if possible. However, some patients who are receiving intensive hemodialysis (HD) have opted against transplantation and have chosen to remain on dialysis. In this paper, we examine studies that help to inform the decision between receiving a kidney transplant and remaining on intensive HD. There are no randomized trials directly comparing transplant to intensive HD. Database and prospective nonrandomized studies support a number of conclusions. First, compared to conventional HD, survival appears to be better with either transplantation or intensive HD. Survival appears to be similar between intensive HD and deceased donor kidney transplantation, but the best survival is reported with live donor transplantation. Secondly, people with a kidney transplant or receiving intensive HD report a higher quality of life than people on conventional HD. There is insufficient evidence to determine whether there are significant quality of life differences between these treatments. Finally, the costs of intensive HD compare favorably to those of conventional HD. Renal transplantation is more costly in the first year, but after about 2 years should be less costly than any form of HD. Based on these studies eligible intensive HD patients should be encouraged to pursue transplantation, especially live kidney donor transplantation. Individual concerns about the relative risks and benefits of renal transplantation may drive some patients to choose to stay on dialysis. Clinicians should explore the reasons behind such a decision to ensure that the patient is properly informed; however, appropriately reasoned decisions should be respected.
大多数透析患者若有可能会选择接受肾移植。然而，一些正在接受强化血液透析（HD）的患者却选择不进行移植，而是继续接受透析治疗。在本文中，我们研究了一些有助于为肾移植和继续接受强化血液透析之间的决策提供参考的研究。目前尚无直接比较移植与强化血液透析的随机试验。数据库和前瞻性非随机研究支持了一些结论。首先，与传统血液透析相比，移植或强化血液透析的患者生存率似乎更高。强化血液透析和 deceased 供体肾移植的生存率似乎相似，但据报道活体供体移植的生存率最佳。其次，接受肾移植或强化血液透析的患者报告的生活质量高于接受传统血液透析的患者。尚无足够证据确定这些治疗方法在生活质量方面是否存在显著差异。最后，强化血液透析的成本与传统血液透析相比具有优势。肾移植在第一年成本更高，但大约两年后应该比任何形式的血液透析成本更低。基于这些研究，应鼓励符合条件的强化血液透析患者寻求移植，尤其是活体肾供体移植。患者对肾移植相对风险和益处的个人担忧可能会促使一些患者选择继续接受透析。临床医生应探究此类决策背后的原因，以确保患者得到充分告知；然而，合理的决策应得到尊重。
