Morbidity and mortality during renal replacement therapy: dialysis versus transplantation

Aim: Many patients with endstage renal disease are eligible for renal trans plantation. To enable a patient to choose between transplantation or to rem ain on dialysis comparable data on morbidity and mortality should be availa ble. Methods: Data were collected retrospectively from the medical records of all patients on the waiting list for renal transplantation and of transp lanted patients during the period January 1, 1990, to January 1, 1997. All patients were dialyzed in the Kennemer Gasthuis and renal transplantation w as performed in the Leiden University Medical Center (LUMC). Morbidity and mortality in both groups were compared. Morbidity was assessed by studying number, length and cause of hospital admissions. Results: During the study period 102 patients had been on the waiting list and 54 patients had been t ransplanted in the LUMC. Mean length of stay on the waiting list before tra nsplantation was 37 months. During the follow-up period 11 patients (10.8%) died on the waiting list and 6 patients (11.1 %) died after renal transpla ntation. The mean length of stay on the waiting list of these two groups wa s much longer, being 55 months and 62 months, respectively. Length of hospi talization was significantly different between both patient groups during t he first 6 months of treatment (13.24 days for those on the waiting list ve rsus 40.75 days transplanted patients) and after 6 months (32.4 days for th ose on the waiting list versus 13.1 days transplanted patients). The number of hospital admissions did not differ significantly. Dialysis-related admi ssions constituted 47% of the total of admissions in the waiting list group and transplantation-related admissions were 43% in the transplanted group. Conclusion: In the present study we revealed no difference in overall mort ality. However, mortality was influenced by length of stay on the waiting l ist. Morbidity was increased during the first 6 months after transplantatio n. Therapy modality greatly influenced the specific cause of morbidity.