Which tx modality is superior considering all the risks and side effects? How does age of patient play into it?
I have no particular expertise about this, but what I can tell you is that my home dialysis nephrologist still recommends staying on the transplant waiting list, even though daily nocturnal gets you pretty close in terms of functionality. I’m not like some who think a transplant is a panacea. I’ve seen too many tranplant recipients who have had big problems with it after the novelty wore off. Transplants have their own set of risks (not the least of which is various forms of cancer and serious infections due to immunosuppression), and one of them is the same as dialysis: cardiovascular disease.
However, dialysis is still a relatively troublesome procedure with a number of inherent risks. We don’t choose dialysis, we do it because we have to. Some of us do choose daily nocturnal hemo if it’s available simply because it appears to be the best option for dialysis. I’ve heard some nephrologists say that daily nocturnal may just be the single best treatment option they can offer, and, I’m not sure if they include transplants in that statement.
I haven’t had a transplant yet, but, I’m still hoping I won’t have to wait much longer than the 3 years I’ve already waited. It’s got to beat being connected to a machine in order to live. But on the other hand, I think the fear of then losing it might be eased a bit knowing that I could go back on home hemo.
But let me tell you, daily nocturnal hemo at home is so good that it does make you wonder if you should just stay on it rather than take the risks of a transplant. Some people actually make that choice to stay on it. But for anyone of us, it’s still dialysis and there’s no guarantee of being to remain on that particular modality. Lots of things could happen to force a move back in centre or to short daily.
In terms of your specific question regarding a comparison of risks and side effects, I don’t think there are any studies which clearly address this. We don’t even really have clinical trial evidence to prove daily hemo of any kind improves mortality rates compared to conventional hemo.
Another aspect to consider is access sites. Dialysis patients can run out of them eventually. Any period of time with a transplant gives you that much more time.