When Kidneys Fail, Transplant May be the Answer

By Mary Ann C. Lim, MD

Did you know that according to the National Institutes of Health (NIH), chronic kidney disease affects more than 37 million people in the United States? 

What’s more, over 800,000 U.S. residents are living with advanced kidney disease, a life-threating condition that requires treatment through dialysis or kidney transplant. 

For patients with advanced kidney disease who want to know if transplant is the right choice for them, Penn Transplant Institute provides transplant evaluations at Penn Medicine Princeton Health.

What do your kidneys do?

Most people have two kidneys, though some may be born with one.  Your kidneys perform several crucial functions to maintain your overall health:  

• Clean and filter your blood and rid your body of internal waste products and toxins, including urea, creatinine, and uric acid, which are byproducts of metabolism.

• Keep your sodium and other electrolytes in balance and regulate your body’s water balance.

• Maintain the pH balance in your blood so that processes that are essential to life, including oxygen delivery to tissues, continue to function properly.

• Release a hormone that helps with blood pressure control.

• Produce a hormone that is critical to making red blood cells.

• Produce vitamins that control growth and regulate calcium and phosphorus, which contribute to bone health.

The two main causes of kidney disease are diabetes and high blood pressure. According to the NIH, nearly one in three people with diabetes and one in five people with high blood pressure have kidney disease.

How do I know if I have kidney disease?

The answer is “you don’t,” at least, not until the very late stages. In advanced kidney disease, a range of problems can occur, including:

• High blood pressure.
• Anemia.
• Fluid buildup that can cause swelling and shortness of breath.
• Electrolyte imbalance that can cause irregular heart rhythm.
• A buildup of poisonous waste products, making you feel ill.

However, early kidney disease has no symptoms. Because of this, many people are unaware of their disease until it is quite advanced. Early diagnosis is important to help slow kidney disease progression.  Any patient with risk factors (diabetes, hypertension, obesity or has a family history of kidney disease) should ask their doctors about tests to check for kidney disease.

How is kidney disease diagnosed?

Chronic kidney disease is defined by the presence of either kidney damage or decreased kidney function for more than three months. Kidney damage can be seen on imaging and in blood and urine tests.

Glomerular filtration rate (GFR) estimates how well your kidneys filter blood and can be done with a simple blood test. GFR below 60 ml (milliliter)/min (minute)/1.73m² (body surface) for more than three months is considered chronic kidney disease. Persistent blood or protein in your urine may also signal damaged kidneys.

Advanced kidney disease is diagnosed when your GFR is 15 ml/min/1.73m² or lower. This is also referred to as kidney failure.

How is kidney diseased managed?

When detected early, most kidney disease can be managed through a combination of lifestyle changes and medications and by controlling blood pressure and blood sugar.

In advanced kidney disease, management options include dialysis or kidney transplantation.

Dialysis is a treatment where a dialysis machine replaces some of the function of the kidneys, essentially removing waste products from your blood and excess fluid from your body. 

A kidney transplant is a surgical procedure that involves placing someone else’s healthy kidney into your body, allowing the new kidney to function as it normally would, except in your body.  

Because transplant patients have an organ that is not their own, they are required to be on immunosuppressant medications for the remainder of their lives (for as long as the kidney is working) to prevent the body from rejecting the donated kidney.

Why transplant?

For patients who are healthy enough to undergo a kidney transplant and take lifelong immunosuppressants, transplant is the recommended treatment.

Patients who receive a successful kidney transplant will no longer need dialysis, allowing those who have not yet started dialysis to avoid it altogether.  Compared to being on dialysis, blood pressure is often easier to manage, fluid and dietary restrictions are usually no longer necessary. Patients may return to work and enjoy an improved quality of life.  Most importantly, transplant can prolong your life compared to staying on dialysis.

A kidney can come from a living or a deceased donor.  Given the choice, you should always choose a living donor. 

Why a living donor?

The benefits of a living donor include:

• Much shorter wait time. Once you and your donor are ready, transplant can happen.

• Kidney lasts longer. Living donors must be healthy to be allowed to donate, therefore kidneys are also healthy.

Anyone who is older than 21 years old can be a potential donor. Donors can be relatives, friends, co-workers, strangers. The only requirements from donors are that donation be made voluntarily, and that they are healthy enough to give away one of their kidneys. All potential living donors undergo a thorough health evaluation prior to donation to ensure that their post-donation risk for kidney disease is minimal. Patients at risk for developing kidney disease, such as those with diabetes, are not allowed to donate.

A donor can donate directly to a loved one if they are a good match.  However, when a potential donor’s and a recipient’s blood or tissue type do not match, the donor-recipient pair can go through a paired kidney exchange, where the donor donates to someone who matches, and the recipient then receives a kidney from another suitable donor. 

Hospital expenses incurred by a living donor are paid for by the recipient’s insurance.  After a short recovery time following the surgery, living donors can continue with their normal lives. 

What if I don’t have a living donor?

Patients without a living donor may turn to deceased donors, individuals who have designated themselves to be organ donors before their death or whose family made the decision to donate on their behalf.  

Unfortunately, the wait time for a deceased donor kidney is long — about six to eight years in this region. 

For this reason, early listing on the deceased donor list is important.  You are eligible for deceased donor listing when your GFR is 20 ml/min/1.73m² or less or if you are on dialysis.   

Penn Transplant Institute — Kidney Transplant Program

The Penn Medicine Transplant Institute performs the most kidney transplants in the area with outcomes that consistently meet or exceed national averages. In addition, Penn Medicine’s living donor program is the most experienced in the greater Philadelphia region. 

While the main surgery happens at the main campus in Philadelphia, Penn clinicians who specialize in transplant care and are familiar with the unique needs of transplant patients provide evaluations for new patients through the Kidney Transplant Program at Penn Medicine Princeton Health.

For more information or to make an appointment with the Kidney Transplant Program, call (215) 662-6200 or visit PennMedicine.org/Kidney-Transplant.

Mary Ann C. Lim, MD, is a board-certified kidney transplant nephrologist, an associate professor of clinical medicine at Perelman School of Medicine and a member of the medical staff at Penn Medicine Princeton Health.