Dialysis Transplantation Research Articles

Effects of Intensive Blood Pressure Control in the Management of Patients With Type 2 Diabetes Mellitus in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Trial

To appreciate the importance of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial,1 one needs to remember that the systolic blood pressure (BP) target currently recommended by major guidelines for diabetic patients, that is, 130 mm Hg, except in the Appropriate Blood Pressure Control in Diabetes Study (ABCD) normotensive trial,7 which consisted of only a few hundred patients and had changes in creatinine clearance as the primary end point. Thus, ACCORD represents the only large-scale randomized trial that provides information on what happens to the cardiovascular risk of diabetic patients when SBP is reduced to 130 mm Hg as a result of randomization to the usual (rather than the tight) BP control treatment strategy. Thus, the message from ACCORD to guidelines and clinical practice is that in diabetic patients it is not necessary to adopt …

Weight Management Tips for Patients on Hemodialysis

The prevalence of overweight and obesity in therenal populationis increasingatan exponential rate proportionate to the prevalence seen in the general U.S. population. Dialysis units and transplant centers alike are faced with an estimated majorityof patients (60%)awaiting transplantation who considered overweight or obese. 1 Obesity asreflectedbyabodymassindex(BMI)of30 kg/m 2 orover isassociatedwithincreasedmorbidityfrom hypertension, dyslipidemia, type 2 diabetes, congestiveheartdisease,stroke,gallbladderdisease,osteoarthritis, sleep apnea and respiratory problems, and certain types of cancer. Obesity is attributable to premature death and an increase in all-cause mortality. 2 Patients with chronic kidney disease may find that their BMI alone can prevent them from being a suitable candidate for kidney transplantation. Several studies indicate that obesity at time of kidney transplantation has an adverse affect on graft function and patient survival. 3 Evidence suggests that patients with elevated BMI may have a higher incidence of perioperative complications includingdelayedgraftfunction,delayedwoundhealing, ventral hernias, deep vein thrombosis, and increased risk of various infections. 4 Beyond the

Antineutrophil cytoplasmic antibody-associated vasculitis with renal involvement

Antineutrophil cytoplasmic antibody-associated vasculitis is an autoimmune disease involving small to medium blood vessels. It is an uncommon illness, but can have devastating consequences, particularly on kidney function and other vital organs. Exciting progress has been made in the treatment of the disease largely because of international collaboration in randomised clinical trials. Patient survival has improved dramatically with advancements in disease diagnosis and medical treatment. The long-term morbidity from the disease, although improving, remains substantial with up to 10% of survivors requiring dialysis or kidney transplantation. Clinical trials are underway using more specifically targeted immunosuppressants in the hope to improve the long-term patient outcomes. Advancements are also being made in understanding the pathogenesis of the disease and this will further assist disease treatment and outcomes in the future.

Preparing for the Family Meeting #222

Journal of Palliative MedicineVol. 13, No. 2 Fast Facts and ConceptsPreparing for the Family Meeting #222David E. Weissman, Timothy E. Quill, and Robert M. ArnoldDavid E. WeissmanSearch for more papers by this author, Timothy E. QuillSearch for more papers by this author, and Robert M. ArnoldSearch for more papers by this authorPublished Online:28 Jan 2010https://doi.org/10.1089/jpm.2010.9879AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Preparing for the Family Meeting #222." , 13(2), pp. 203–204FiguresReferencesRelatedDetailsCited byTop Ten Tips Palliative Care Clinicians Should Know About Trauma and Emergency Surgery Lindsay K. Haines, Allyson C. Cook, Justin S. Hatchimonji, Vanessa P. Ho, Elle L. Kalbfell, Kathleen M. O'Connell, Jacinta C. Robenstine, Mathias Schlögl, Christine C. Toevs, Christopher A. Jones, Robert S. Krouse, and Niels D. Martin4 June 2021 | Journal of Palliative Medicine, Vol. 24, No. 7Communication23 April 2021A Surgeon’s Review for Difficult Conversations3 March 2020 | Current Surgery Reports, Vol. 8, No. 2What is the evidence for conducting palliative care family meetings? A systematic review19 August 2016 | Palliative Medicine, Vol. 31, No. 3Advance Directives8 December 2016A Systematic Review of Family Meeting Tools in Palliative and Intensive Care Settings10 July 2016 | American Journal of Hospice and Palliative Medicine®, Vol. 33, No. 8Validation of the Family Meeting Behavioral Skills Checklist. An Instrument to Assess Fellows’ Communication SkillsAnnals of the American Thoracic Society, Vol. 13, No. 8Death Disclosure and Delivery of Difficult News in Trauma #305 Sangeeta Lamba, Sarah Bryczkowski, Leslie Tyrie, David E. Weissman, and Anne C. Mosenthal3 May 2016 | Journal of Palliative Medicine, Vol. 19, No. 5Examining family meetings at end of life: The model of practice in a hospice inpatient unit31 October 2014 | Palliative and Supportive Care, Vol. 13, No. 5Development and pilot testing the Family Conference Rating Scale: A tool aimed to assess interprofessional patient-centred communication and collaboration competencies14 July 2015 | Journal of Interprofessional Care, Vol. 29, No. 5The elderly patient on dialysis: geriatric considerations19 June 2013 | Nephrology Dialysis Transplantation, Vol. 29, No. 5Advanced Directives5 February 2013Preventive Ethics in the Intensive Care UnitAACN Advanced Critical Care, Vol. 23, No. 2Cross-Cultural Communication and Use of the Family Meeting in Palliative Care28 December 2010 | American Journal of Hospice and Palliative Medicine®, Vol. 28, No. 6 Volume 13Issue 2Feb 2010 InformationCopyright 2010, Mary Ann Liebert, Inc.To cite this article:David E. Weissman, Timothy E. Quill, and Robert M. Arnold.Preparing for the Family Meeting #222.Journal of Palliative Medicine.Feb 2010.203-204.http://doi.org/10.1089/jpm.2010.9879Published in Volume: 13 Issue 2: January 28, 2010PDF download

Assessment of Improved Prediction Beyond Traditional Risk Factors

The moderate predictive performance of cardiovascular disease risk models necessitates more studies that investigate the incremental value of novel biomarkers. In recent years, many new biomarkers have been evaluated for their ability to improve prediction of cardiovascular disease beyond traditional risk factors, including C-reactive protein, coronary artery calcium, and single-nucleotide polymorphisms in the 9p21 region.1 The interest in novel biomarkers is propelled, in part, by emerging discoveries from genomewide association studies of genetic variants associated with risk for many common diseases.2 Nonetheless, family history, an “old” tool in clinical practice—crucial for the diagnosis and management of genetic disorders—has not been adequately explored for its value in risk assessment and prevention of common diseases.3 Positive family history is a strong risk factor for cardiovascular diseases,4,5 reflecting the consequences of genetic and nongenetic risk factors that are shared among relatives. From a practical perspective, family history is a strong determinant of disease that is relatively easy to assess. For this reason, family history is advocated as a useful tool for identifying individuals at increased risk of disease and for tailoring preventive interventions.4,6,7 However, the challenge is to show that this knowledge has clinical utility for improving health.8 Article see p 97 In this issue of Circulation: Cardiovascular Genetics , Scheuner et al9 report the incremental value of adding family history information to the General Cardiovascular Risk Profile to improve identification of individuals with advanced coronary artery calcification. The incremental value of family history in disease prediction is assessed in several questions10: 1. Does family history improve prediction beyond traditional risk factors? 2. Does improved prediction change treatment decisions or health recommendations? 3. Do these changes improve health outcomes or have other benefits? 4. Do the incremental benefits outweigh the extra costs? This evaluation is a stepwise …

Monitoring hepatitis C infection in a major Swedish nephrology unit and molecular resolution of a new case of nosocomial transmission

Hepatitis C virus (HCV) infection is a frequent problem in hemodialysis units. The prevalence and incidence of HCV infection over a decade were studied in a nephrology unit affected by previous nosocomial HCV transmission. The HCV non-structural 5B protein gene was sequenced to achieve phylogenetic analysis of a new (incident) case of infection. Proportions of patients who were and were not infected with HCV remained similar over the period, as did the inflow and outflow of patients infected previously. In 1997, 12/157 (8%) of patients at the unit (treatment: hemodialysis, peritoneal dialysis, and renal transplant recipients) were positive in HCV RNA, whereas in 2007 the overall number was 9/239 (4%). One patient acquired an HCV infection, and the NS5B sequence in that case clustered with genotype 2b sequences found in patients from an earlier outbreak. Comparing the HCV from the incident patient with several stored longitudinal samples and cloned PCR products from the most likely source patient revealed close phylogenetic relationship with an HCV quasispecies member from the possible source. The source patient and the incident newly infected patient were not scheduled on the same dialysis shift, although the records showed that simultaneous treatment occurred on two occasions during the months preceding transmission. In conclusion, over the 10-year period, the proportion of HCV-infected patients at the unit was unchanged. Only one new infection occurred, which originated from a fellow patient's quasispecies. This establishes phylogenetic analysis as a valuable tool for tracing patient sources of HCV transmission.

Cross-transmission of vancomycin-resistant Enterococcus in patients undergoing dialysis and kidney transplant

The objective of this study was to investigate the occurrence of vancomycin-resistant Enterococcus (VRE) cross-transmission between two patient groups (long-term dialysis and kidney transplant patients). Molecular typing, by automated ribotyping with the RiboPrinter Microbial Characterization System (Qualicon, USA), was used to analyze VRE isolates from 31 fecal samples of 320 dialysis patients and 38 fecal samples of 280 kidney transplant patients. Clonal spread of E. faecalis and E. casseliflavus was observed intragroup, but not between the two groups of patients. In turn, transmission of E. gallinarum and E. faecium between the groups was suggested by the finding of vancomycin-resistant isolates belonging to the same ribogroup in both dialysis and transplant patients. The fact that these patients were colonized by VRE from the same ribogroup in the same health care facility provides evidence for cross-transmission and supports the adoption of stringent infection control measures to prevent dissemination of these bacteria.

Theory and practical application of blood-based renal replacement therapy

The term renal replacement therapy incorporates three modalities that control or correct biochemical and fluid disturbances of renal failure. Peritoneal dialysis and renal transplantation are two forms of renal replacement therapy that are outside the remit of this article. This review focuses upon the third group which are blood-based and involve direct treatment of a patient's blood in a closed, extracorporeal circuit. They provide renal replacement for end-stage renal failure and during periods of severe acute kidney injury, and also for non-renal indications such as the management of drug overdoses. Blood-based renal replacement therapies are often loosely referred to as 'haemodialysis', although this is only one of a range of treatments. This article outlines the theory and practical applications of these treatments.

What dishwashers and humans have in common

One answer to the title question could be that both ‘species’, dishwashers and humans, can be protected from unwanted calcification by the anticalcifying properties of small double-phosphate molecules, diphosphonates or pyrophosphates, respectively. More than 40 years ago, we started to realize that there are compounds present in many biological fluids capable of inhibiting precipitation of calcium phosphates [1]. These compounds have been identified as inorganic pyrophosphates (P–O–P) and have been demonstrated to slow the transformation of amorphous calcium phosphate into its crystalline form while inhibiting crystal aggregation. This observation led to the development of diphosphonates, in which the P–O–P bond is replaced by a P–C–P bond and, subsequently, to the development of bone scanning agents and bisphosphonates. While excellent evidence has since accrued that diphosphonate detergents protect dishwashers from premature calcification and ‘sudden death’—and, thus, contribute to longevity—this evidence is still weak and just starting to accumulate in mammals and human beings. The paper by O'Neill, Sigrist and McIntyre in this issue of Nephrology Dialysis Transplantation is one step forward in exploring the potential clinical role of endogenous pyrophosphates in human disease scenarios and, consequently, addresses the patient population at highest risk for unwanted calcification, i.e. individuals suffering from advanced chronic kidney disease (CKD) [2]. The authors measured plasma pyrophosphate concentrations in 115 individuals in CKD stages 4–5D and correlated these levels with the degree and change in large artery calcification which was quantitatively detected at the superficial femoral artery by computed tomography (CT). CT imaging was obtained at baseline and after 1 year. An inverse association was found between baseline calcification score and pyrophosphate levels; also, an inverse, though non-significant trend regarding calcification progression and pyrophosphate levels was reported. In the past and over many years, this group of investigators has led the path towards this current and sig

Aberrant protein expression in plasma and kidney tissue during experimental obstructive nephropathy

Kidney failure is a major health problem worldwide. Patients with end-stage renal disease require intensive medical support by dialysis or kidney transplantation. Current methods for diagnosis of kidney disease are either invasive or insensitive, and renal function may decline by as much as 50% before it can be detected using current techniques. The goal of this study was, therefore, to identify biomarkers of kidney disease (associated with renal fibrosis) that can be used for the development of a non-invasive clinical test for early disease detection. We utilized two protein-profiling technologies (SELDI-TOF MS and 2-D) to screen the plasma and kidney proteome for aberrantly expressed proteins in an experimental mouse model of unilateral uretric obstruction, which mimics the pathology of human renal disease. Several differentially regulated proteins were detected at the plasma level of day-3-obstructed animals, which included serum amyloid A1, fibrinogen α, haptoglobin precursor protein, haptoglobin and major urinary proteins 11 and 8. Differentially expressed proteins detected at the tissue level included ras-like activator protein 2, haptoglobin precursor protein, malate dehydrogenase, α enolase and murine urinary protein (all p<0.05 versus controls). Immunohistochemistry was used to confirm the up-regulation of fibrinogen. Interestingly, these proteins are largely separated into four major classes: (i) acute-phase reactants (ii) cell-signaling molecules (iii) molecules involved in cell growth and metabolism and (iv) urinary proteins. These results provide new insights into the pathology of obstructive nephropathy and may facilitate the development of specific assay(s) to detect and monitor renal fibrosis.

Low protein diets for chronic kidney disease in non diabetic adults

For more than fifty years, low protein diets have been proposed to patients with kidney failure. However, the effects of these diets in preventing severe kidney failure and the need for maintenance dialysis have not been resolved. To determine the efficacy of low protein diets in delaying the need to start maintenance dialysis. Cochrane Renal Group studies register, the Cochrane Central Register of Controlled studies, MEDLINE, and EMBASE. Congress abstracts (American Society of Nephrology since 1990, European Dialysis Transplant Association since 1985, International Society of Nephrology since 1987). Direct contacts with investigators. Randomised studies comparing two different levels of protein intake in adult patients suffering from moderate to severe kidney failure, followed for at least one year. Two authors independently selected studies and extracted data. Statistical analyses were performed using the random effects model and the results expressed as risk ratio (RR) for dichotomous outcomes with 95% confidence intervals (CI). Collection of the number of "renal deaths" defined as the need for starting dialysis, the death of a patient or a kidney transplant during the study. Ten studies were identified from over 40 studies. A total of 2000 patients were analysed, 1002 had received reduced protein intake and 998 a higher protein intake. There were 281 renal deaths recorded, 113 in the low protein diet and 168 in the higher protein diet group (RR 0.68, 95% CI 0.55 to 0.84, P = 0.0002). To avoid one renal death, 2 to 56 patients need to be treated with a low protein diet during one year. Reducing protein intake in patients with chronic kidney disease reduces the occurrence of renal death by 32% as compared with higher or unrestricted protein intake. The optimal level of protein intake cannot be confirmed from these studies.

The growing importance of mTORC1-S6K1 signaling in kidney

renal hypertrophy, which aptly describes the condition of increased kidney mass attributable to enlargement more so than proliferation of tubular and glomerular cells, can occur under many circumstances, but the underlying mechanism(s) remain poorly understood. Diabetes mellitus is a common disease

Chronic kidney disease--assessing the impact

Chronic kidney disease (CKD) is important. In a study of over a million people, CKD was associated with both increased mortality and age-standardized risk of cardiovascular disease, even when known risk factors were controlled for.1 Impaired kidney function has implications for prescribing and for the use of over the counter preparations, especially non-steroidal anti-inflammatory drugs. In addition, a proportion of people with moderately reduced kidney function will experience a progressive loss of kidney function. This will affect their health and may require renal replacement therapy with dialysis or kidney transplantation. Unfortunately, we do not have a perfect method for the routine quantification of kidney function. Serum creatinine levels rise significantly only with severe renal dysfunction, and creatinine production is influenced by age, sex, muscle mass and ethnicity. Formulae which take into account some or all of these factors can be used to produce an estimated glomerular filtration rate (eGFR) from serum creatinine. Many countries, including the UK, have adopted the MDRD (Modification of Diet in Renal Disease) formula for routine reporting of eGFRs.2 However, the interpretation of these eGFRs is not always straightforward. They are inaccurate when there is good renal function and most laboratories only report eGFRs <60 ml/min/1.73 m2. The confidence intervals are wide, …

Relaxin: An Endogenous Renoprotective Factor?

Fibrosis, so-called scarring, is a key cause of pathology and dysfunction in a variety of organs. The biology of healing and scarring are similar, albeit with very different outcomes. Typical of this process in general, renal fibrosis is the result of a disproportionate accumulation of extracellular matrix that occurs in ongoing kidney disease. Renal scarring is both progressive and multifactorial, ultimately leading to end-stage renal failure and the requirement for dialysis or kidney transplantation. Regardless of the underlying etiology, renal mesenchymal cells such as fibroblasts are the cellular basis of this process. Activity and differentiation of these cells are regulated by a number of profibrotic cytokines, growth factors, vasoactive mediators, and other signals, with transforming growth factor-beta being among the most important. However, we now also recognize that there are a number of endogenous antifibrotic factors that are renoprotective by counteracting these signals to limit matrix synthesis and organization and reduce net accumulation. Relaxin is one such factor. The absence of endogenous relaxin results in spontaneous fibrosis with aging and also accelerates the pathogenesis of progressive fibrosis after injury. Both effects are reversed by replenishment with recombinant H2 relaxin. This review summarizes recent developments in the understanding of the cellular and molecular mechanisms in fibrosis and how these are influenced by relaxin.

Risks Associated with Low Doses and Low Dose Rates of Ionizing Radiation: Why Linearity May Be (Almost) the Best We Can Do

Deterministic and stochastic effects associated with high-dose ionizing radiation (x-ray) exposure have been known for almost as long as ionizing radiation itself (1–3). At lower doses, radiation risks are primarily stochastic effects, in particular, somatic effects (cancer) rather than the deterministic effects characteristic of higher-dose exposure (4–6). In contrast to deterministic effects, for stochastic effects, scientific committees generally assume that at sufficiently low doses there is a positive linear component to the dose response—that is, that there is no threshold (4–6). This does not preclude there being higher-order (eg, quadratic) powers of dose in the dose response that may be of importance at higher doses. It is on this basis that models linear (or linear-quadratic) in dose are often used to extrapolate the experience of the Japanese atomic bomb survivors (who were typically exposed at a high dose rate to moderate doses [average, 0.1 Sv]) to estimate risks from low doses and low dose rates (4–6). Most population-based cancer risk estimates are based primarily on the Japanese atomic bomb survivor Life Span Study (LSS) cohort data (4–6). However, evidence of excess risks comes from a large number of other studies as well. In the parallel editorial (7), evidence is presented for possible real (or at least “practical”) thresholds or “hormetic” (beneficial) effects of low doses of ionizing radiation. As we summarize here, and in contrast to the arguments of Tubiana et al (7), we judge that there is little epidemiologic or biologic evidence for these for cancer. The arguments are of three forms: (a) assessment of the degree of curvature in the cancer dose response within the Japanese atomic bomb survivors and other exposed groups (in particular, departure from linear or linear-quadratic curvature), (b) consistency of risks between the Japanese and other moderate- and low-dose cohorts, and (c) assessment of biologic data on mechanisms. Most of the information on radiation-induced cancer risk comes from (a) the Japanese atomic bomb survivors, (b) medically exposed populations, (c) occupationally exposed groups, and (d) environmentally exposed groups (6). In the higher-dose radiation therapy studies, where doses received are very much higher than in the LSS, sometimes in the range at which cell sterilization occurs, excess cancer risks per unit dose tend to be less than in comparable subsets of the LSS (8,9). However, as we show, risks in moderate- and low-dose medically and occupationally exposed groups are generally consistent with those in the LSS.

Independent two-photon measurements of albumin GSC give low values

Independent two-photon measurements of albumin GSC give low values

Calyceal Plication with Anderson-Hynes Pyeloplasty in a 7-Year-Old Boy with Giant Hydronephrosis of a Single Right Kidney

A 7-year-old boy presented with distended abdomen without any other complaints. A plain abdominal radiograph demonstrated an extremely large soft tissue shadow that occupied right and part of the left hemiabdomen. Ultrasound revealed large hydronephrotic right kidney that occupied whole abdomial cavity without visualization of the left kidney. Dynamic scintigraphy confirmed extreme renal functional damage of the single right kidney. Operation was not indicated according to significant renal impairment. Percutaneous nephrostomy was made. After 9 months with slight functional renal improvement operation was indicated. At operation ureteropelvic junction obstruction was found and Anderson-Hynes pyeloplasty was made with calyceal plication of dilated calyces. Postoperative scintiscans and serial sonographies showed preservation of renal parenchyma with slight functional improvement. This modification of Anderson-Hynes pyeloplastys obviated the need for nephrectomy and was especially valuable in this patient with giant hydronephrosis of the single kidney when nephrectomy would inevitably lead to dialysis and subsequent renal transplantation.

Efficacy and tolerability of lamivudine in hepatitis B infected renal transplant recipients: A single center study

Hepatitis B virus (HBV) infection in patients on hemodialysis and renal transplantation (RT) usually has an unfavorable course. Lamivudine is a synthetic nucleoside analog with a potent action on HBV replication. There is limited data on lamivudine in renal transplant patients with HBV infection and no published report from India. Present study reports on lamivudine therapy in these patients. Patients with HBV infection taken for RT were included. Hepatitis B surface antigen (HBsAg), hepatitis B envelope antigen (HBeAg), HBV-DNA, and liver biopsy before RT were done in all patients. Lamivudine was given in the dose of 50 mg daily during the dialysis and 100 mg daily following successful transplant. Response was evaluated at one year. Of the 739 adult RTs during study period, 35 (4.7%) had HBV infection. Mean age of patients was 30.7 ± 9.8 (16–55 years) and 88.5% were males. Four (11.4%) patients had HCV coinfection. HCV was not treated in any patient. All patients were HBsAg and HBV-DNA positive, while 27 (77%) were HBeAg positive. Mean ALT was 77.8 ± 90 IU/dl; 11 (31.4%) patients had normal ALT. Mean liver biopsy grade was 5.2 ± 1.5 (3–9) and stage was 0.7 ± 0.6 (0–2). At one year following transplantation, ALT was normal in 27 (77%) cases, HBV-DNA undetectable in 16 (45.7%), HBeAg and HBsAg seroconversion in 8 (22.8%), and 3 (8.6%) cases, respectively. All patients tolerated the drug without any significant side effects. Treatment with lamivudine in dialysis and renal transplant patients is well tolerated and safe with efficacy comparable to patients with normal renal function.

Video-Assisted Minilaparotomy Surgery (VAMS): Challenging Cases of Nephron-Sparing Surgery in a Solitary Kidney

Kyo Chul Koo, Woong Kyu Han, Seung Choul Yang From the Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea Although radical nephrectomy is the mainstay in the surgical management of renal cell carcinoma (RCC), a solitary kidney with RCC is an imperative indication for nephron-sparing surgery (NSS). In this rare setting, radical nephrectomy can potentially render the patient anephric, leading to dialysis or renal transplantation. Although open surgery is still the gold standard for NSS, there has been an upsurge in the number of minimally invasive NSS procedures that have demonstrated excellent long-term oncologic, surgical, and functional outcomes. Complex renal tumors in the setting of a solitary kidney add an additional challenge to minimally invasive NSS. Here we describe 3 complex cases of RCC in a solitary kidney treated successfully by video-assisted minilaparotomy surgery-NSS. (Korean J Urol 2009;50:288-292) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Cost Effective Model of Kidney Transplant in India

In a developing country like India, the management of end-stage renal disease is largely guided by economic considerations. In the absence of state funding or health insurance plans, fewer than 10% of all patients receive renal replacement therapy. Among the three Renal Replacement Therapy options (hemodialysis, peritoneal dialysis and renal transplant) available, renal transplant is the preferred mode, as it is most cost-effective and provides a better quality of life. But due to financial constraints and nonavailability of organs, only about 5% of ESRD patients undergo transplant surgery. Only 2% of all transplants are performed from deceased donors due to social stigmata in our country. Major hope of increasing the number of renal transplants lies in developing cost effective measures like preemptive transplant, reducing the duration of dialysis prior to transplant, use of immunosuppression for only up to 1 year, and availability of more deceased donor organs.