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Is dialysis better than kidney transplant?

The answer to this question is not a straightforward one, as both dialysis and kidney transplant have their own advantages and disadvantages. Let’s look at each method in detail to determine which is better, taking into account various factors.

Dialysis is a medical procedure that helps remove waste and excess fluid from the body when the kidneys are not able to perform this vital function effectively. There are two types of dialysis: hemodialysis and peritoneal dialysis. Hemodialysis involves removing blood from the body, passing it through an artificial kidney machine called a dialyzer, and then returning the cleaned blood to the body.

Peritoneal dialysis involves inserting a catheter into the abdomen and using the peritoneal membrane as a natural filter for removing waste and fluids.

One of the significant benefits of dialysis is that it is widely available and can be done in the outpatient setting. Dialysis is also effective in managing symptoms of kidney failure such as fluid overload, high blood pressure, and electrolyte imbalances. Additionally, dialysis can prolong the life of a patient with end-stage renal disease (ESRD) by removing waste products and preventing complications such as heart failure, stroke, and kidney damage.

However, there are some drawbacks to dialysis. Dialysis does not replace all the functions of a healthy kidney, so patients often experience fatigue, muscle cramps, and decreased appetite. Additionally, dialysis requires patients to follow a strict diet and fluid restrictions, which can be challenging to manage for some.

Dialysis also involves undergoing treatment several times a week, which can impact a patient’s quality of life and limit their ability to work, travel, or participate in regular activities.

On the other hand, kidney transplantation involves replacing a diseased kidney with a healthy kidney from a living or deceased donor. Kidney transplant is generally considered the best option for patients with ESRD because it restores kidney function to a more normal level than dialysis. Patients who receive a kidney transplant experience improved quality of life, better long-term outcomes, and reduced hospitalizations and treatments associated with dialysis.

Kidney transplantation is also usually a one-time procedure, requiring only occasional checkups and medication to prevent rejection. Transplantation provides the opportunity for patients to live a near “normal” life as a healthy kidney can regulate electrolyte balance and remove toxins naturally.

However, kidney transplant also has some limitations. Kidney transplantation is not always available to all ESRD patients due to the scarcity of donated organs. Matching donors can also be difficult, and patients may have to wait for years for a suitable donor match. Additionally, transplanted kidneys are not always a guaranteed success and can be rejected by the recipient’s immune system, which may require a second or subsequent transplant.

After transplant even with anti-rejection medication, there is always a risk that the new kidney could fail or lose functionality after an extended period.

Both dialysis and kidney transplantation have their own benefits and drawbacks. While dialysis is widely available and effective in managing symptoms of kidney failure, it does not replace all kidney functions and can significantly impact a patient’s quality of life. Kidney transplantation is the best option for ESRD patients, providing better long-term outcomes and improving quality of life.

However, kidney transplantation is not widely available, which makes dialysis the preferred option in some cases. the decision to choose either dialysis or kidney transplantation must always be a personal one and should be discussed with a healthcare provider and with information on the individual’s health status, lifestyle preferences, resources, and wishes.

Do you live longer on a kidney transplant or dialysis?

Living with kidney disease is challenging and requires significant lifestyle changes. Both kidney transplant and dialysis are treatment options for end-stage renal disease (ESRD) patients, which aim to improve the quality of life and extend the lifespan of patients. However, when it comes to the longevity of life, kidney transplant generally offers a better outcome than dialysis.

Kidney transplant is a surgical procedure where a healthy kidney from a living or deceased donor is transplanted into the recipient’s body. The transplanted kidney takes over the function of the failed kidney, and the patient can discontinue dialysis. Kidney transplant patients have shown to have a higher life expectancy than those on dialysis.

According to the US Renal Data System, the 5-year survival rate for kidney transplant recipients is around 77%, compared to 36% for dialysis patients. The survival rate only gets better with time, with the 10-year-lifetime expectancy of a kidney transplant patient being about 55%, while dialysis patients have only around 20%.

Dialysis treatment, on the other hand, is initiated when kidneys are no longer functioning, and there aren’t any suitable donors for transplantation. Dialysis is a process that imitates some of the kidney’s functions, such as removing excess waste, salt, and water from the blood in patients with ESRD.

There are two types of dialysis- hemodialysis and peritoneal dialysis, and patients on either undergo multiple sessions of treatment that can take several hours a day. Dialysis treatment for ESRD patients is a life-long commitment that requires significant adjustments to the patient’s lifestyle. The average lifespan of a dialysis patient is about five years, with only 40% of patients surviving beyond five years.

There are many factors contributing to the higher mortality rate of patients on dialysis. Patients on dialysis have a high risk of developing cardiovascular diseases, infections, and other complications related to ESRD that could shorten their lifespan. Moreover, the risk of infections with dialysis is higher as devices such as catheters are used repeatedly over time.

Despite the risks of immunosuppression, kidney transplant remains the preferred option for patients with ESRD when compared to life-long dialysis. A kidney transplant improves the quality of life and longevity of patients providing them with the freedom to lead a normal life. It is important to note that every patient is unique, and the benefits of a kidney transplant may differ among individuals.

Therefore, it is essential to consult with a physician to choose a suitable treatment option for ESRD patients to improve their lifespan and quality of life.

Why kidney transplant is better than dialysis?

When it comes to the treatment of end-stage renal disease (ESRD), people have two options- dialysis or kidney transplant. While both are effective in their own right, kidney transplant is generally considered a better option than dialysis for a number of reasons.

First and foremost, a kidney transplant offers a better quality of life. Dialysis is a time-consuming and inconvenient process that requires patients to spend several hours hooked up to a machine several times a week. Additionally, patients on dialysis have to adhere to a strict diet and are often limited in their daily activities.

On the other hand, a kidney transplant can provide patients with greater freedom and flexibility, allowing them to resume normal activities and travel without restrictions.

Secondly, a kidney transplant is more cost-effective than dialysis in the long run. While the initial cost of a kidney transplant may be high, the ongoing costs associated with dialysis including the cost of treatments, medication, and follow-up care can add up significantly over time. In fact, studies have shown that a kidney transplant can save patients and their families up to $1 million over the course of their lifetime.

Moreover, a kidney transplant typically offers better health outcomes than dialysis. Patients who receive a transplant are more likely to live longer than those on dialysis. They also have a lower risk of developing complications such as infections, cardiovascular disease and other chronic health conditions.

Studies have also shown that patients who receive a transplant report a higher level of satisfaction with their overall health and well-being.

Lastly, a kidney transplant provides the opportunity for an improved quality of life for patients and their loved ones. Living donor transplants, where a living person donates one of their kidneys, offer the best outcomes and can also provide a sense of satisfaction and fulfillment for the donor. Additionally, a successful kidney transplant can help patients to return to work or school and improve their overall sense of independence.

While both dialysis and kidney transplant are effective treatments for end-stage renal disease, a kidney transplant is generally considered a better option for patients in terms of quality of life, cost-effectiveness, and overall health outcomes. With advances in medicine and technology, kidney transplantation has become a safe and increasingly common procedure, with high success rates and positive outcomes for patients and their families.

Is your life shortened after a kidney transplant?

In general, there is no evidence to suggest that a person’s life will be shortened after a successful kidney transplant. On the contrary, a kidney transplant can greatly improve a person’s quality of life and life expectancy, as it can effectively treat end-stage renal disease (ESRD) and its associated complications.

People with ESRD have a significantly increased risk of premature death compared to the general population due to the high prevalence of comorbidities such as cardiovascular disease, infections, and malignancies. Kidney transplant recipients, however, have a lower risk of death from these conditions than those who remain on dialysis.

According to a study published in the New England Journal of Medicine, individuals who receive a kidney transplant from a living donor have a significantly lower all-cause mortality rate and a higher life expectancy compared to those who remain on dialysis or receive a kidney from a deceased donor.

However, it is important to acknowledge that kidney transplantation, like all major surgeries, carries some risks. These risks include complications during surgery, immune system reactions, and the possibility of developing infection or cancer due to the use of immunosuppressive medications. Some individuals may experience organ rejection, which can lead to the need for additional medical interventions.

These risks can have a negative impact on a person’s overall health and well-being.

Additionally, it is important to note that the success of a kidney transplant depends largely on the health of the recipient both before and after the transplant. It is critical for transplant recipients to follow a strict regimen of immunosuppressive medications, attend all follow-up appointments, and engage in healthy behaviors such as regular exercise and a nutritious diet.

Failure to do so can increase the risk of complications and reduce the lifespan of the transplanted kidney.

While there are risks associated with kidney transplantation, a successful transplant can significantly improve a person’s life expectancy and quality of life. It is important for transplant recipients to take an active role in their health care and follow all recommended guidelines to maximize the benefits of the transplant.

What is the age for kidney transplant?

The eligibility for kidney transplant is determined based on several factors, such as the patient’s age, overall health condition, and medical history. Generally, there is no fixed age limit for kidney transplant, as each case is unique and requires personalized attention. However, the age-related health issues can affect the suitability for undergoing the surgery.

In general, younger individuals tend to have better outcomes with a kidney transplant. For example, patients below the age of 50 have a higher survival rate after the surgery compared to those above the age of 70. However, the overall health status of the individual, such as the presence of other medical conditions like diabetes, hypertension, or heart diseases, plays a significant role in the decision.

In addition to age, the medical team evaluates the patient’s physical condition and psychological readiness for undergoing the surgery. The transplant evaluation process includes a series of tests to determine the patient’s suitability for the procedure. The tests may include blood tests, imaging studies, and other diagnostic evaluations to assess the function of different organs and systems.

Apart from the age factor, the availability of a suitable donor is also a crucial aspect to consider. Most patients receive kidneys from deceased donors, while others may have the option of living donor transplant. In any case, a comprehensive evaluation process is necessary to match the donor and recipient’s compatibility before the surgery.

There is no fixed age limit for kidney transplant, and the decision is based on a case-by-case evaluation. The eligibility for transplantation depends on several factors, such as age, overall health status, psychological readiness, and availability of a compatible donor. A multidisciplinary approach involving the medical team, patient, and their family is necessary to make an informed decision about kidney transplantation.

Why do kidney transplants only last 10 years?

Kidney transplants are a form of medical treatment that involves the surgical transplantation of a healthy kidney from a donor into a recipient who has end-stage renal disease (ESRD). Kidney transplants are an effective and life-saving treatment option for patients with ESRD that has the potential to improve their overall quality of life.

However, despite the benefits of kidney transplantation, it is commonly known that the lifespan of a transplanted kidney is limited, with most transplants typically lasting around 10 years before requiring a secondary transplant.

The primary reason why kidney transplants only last for around 10 years is due to the nature of the human immune system. The immune system is an intricate network of cells, tissues, and organs that work together to protect the body from harmful substances such as viruses, bacteria, and toxins. When a foreign object is introduced into the body, such as a transplanted kidney, the immune system recognizes the foreign tissue as a threat and attempts to attack it, leading to rejection of the transplanted organ.

To prevent the immune system from rejecting a transplanted kidney, patients must take immunosuppressive medications for the rest of their lives, which reduces the body’s immune response. These medications work by suppressing the production and activity of immune cells that would otherwise recognize and attack the transplanted kidney.

However, even with the use of immunosuppressive drugs, the immune system can still cause damage to the transplanted kidney over time, leading to chronic rejection and eventual loss of function.

Other factors that can contribute to the limited lifespan of a transplanted kidney include underlying medical conditions, such as diabetes or high blood pressure, which can cause damage to the kidney over time. Moreover, the age and health of the donor can also play a role, as the quality of the donated kidney can impact its overall lifespan.

The limited lifespan of kidney transplants is primarily due to the immune system’s response to foreign tissue and the potential for chronic rejection, even with the use of immunosuppressive drugs. While kidney transplantation is an effective and life-saving treatment option for patients with ESRD, it is essential to continue to research and develop new treatments and therapies to improve the lifespan of transplanted organs and ultimately increase the quality of life for patients.

How long does the average person live after a kidney transplant?

The average life expectancy after a kidney transplant varies depending on several factors, including the age and health of the patient, the type of kidney transplant (living donor or deceased donor), and the severity of any underlying medical conditions. That being said, in general, kidney transplant recipients can expect to live for many years following the procedure.

According to the United Network for Organ Sharing (UNOS), the one-year survival rate for kidney transplant recipients is around 96%, while the three-year survival rate is approximately 89%. After five years, the survival rate falls slightly to around 83%, with a ten-year survival rate of 55-60%. However, with advances in medical technology and improved post-transplant care, these figures are constantly improving.

It’s important to note that these survival rates are just averages, and many people live much longer than these predictions. Patients who maintain a healthy lifestyle, follow their recommended medication regimen, and attend regular follow-up appointments with their transplant team are more likely to enjoy a longer and healthier life.

Of course, there are also risks associated with kidney transplant surgery and post-transplant care, including infections, organ rejection, and complications from immunosuppressive drugs. However, advances in transplantation techniques and ongoing medical research are constantly improving outcomes and reducing risks for transplant recipients.

The average person can expect to live for many years after a kidney transplant, with a good chance of reaching at least the five-year point and potentially even longer. The best way to maximize the chances of a successful transplant and a long life thereafter is to follow the advice of your medical team and take an active role in managing your own health.

What is the most common cause of death in kidney transplant patients?

The most common cause of death in kidney transplant patients varies depending on various factors such as the patient’s age, overall health, severity and duration of kidney disease, immunosuppressive regimen, comorbidities, and post-transplant complications. However, several studies have indicated that cardiovascular disease (CVD) is the leading cause of death among kidney transplant recipients.

CVD includes various conditions such as coronary artery disease, myocardial infarction, stroke, and heart failure, among others.

CVD is a significant concern for transplant patients as they have an increased risk of developing cardiovascular complications due to factors such as chronic kidney disease, hypertension, diabetes, and dyslipidemia. Moreover, kidney transplant patients are also exposed to risk factors such as immunosuppressive medications, chronic inflammation, and oxidative stress, which promote the development of CVD.

Several studies have demonstrated a high prevalence of traditional cardiovascular risk factors among kidney transplant patients, including advanced age, male gender, smoking, obesity, hypertension, dyslipidemia, and diabetes. Additionally, transplant recipients also experience unique risk factors such as transplant-related factors, including delayed graft function, acute rejection, and chronic allograft dysfunction, which may result in increased cardiovascular risk and mortality.

To reduce the risk of CVD and improve outcomes, kidney transplant patients receive regular monitoring and management of cardiovascular risk factors, including blood pressure, blood glucose, blood lipids, and weight. Furthermore, immunosuppressive medications and other medications that may affect cardiovascular health are prescribed with caution, and alternative therapies are considered if side effects occur.

While kidney transplant provides a new lease of life for renal failure patients, it comes with its own set of challenges, and cardiovascular disease remains a leading cause of mortality in this population. Thus, efforts must be made to identify and manage cardiovascular risk factors in kidney transplant patients to reduce the risk of CVD and improve long-term outcomes.

How long can you live on dialysis without a kidney transplant?

Dialysis is a medical treatment that removes waste and excess fluids from the body of a patient whose kidneys are not functioning properly. Dialysis can be performed in two ways – hemodialysis and peritoneal dialysis. Hemodialysis involves the use of a machine that filters blood outside the body and returns it to the patient’s body, while peritoneal dialysis involves using the lining of the abdomen as a filter.

The survival rates for dialysis patients vary depending on various factors such as age, overall health, duration of kidney disease, underlying medical conditions, adherence to treatment, and nutritional status. According to the National Kidney Foundation, the average life expectancy for patients on dialysis is 5 to 10 years.

However, this does not mean that all dialysis patients will die within a decade. Some patients may survive longer, while others may not live as long. In fact, some patients have managed to live up to 30 years on dialysis without a kidney transplant.

Several factors can affect the lifespan of a dialysis patient. One of the primary factors is adherence to dialysis treatment. Patients who attend all their appointments and follow their treatment regimens are more likely to live longer. On the other hand, patients who frequently miss appointments or do not follow their treatments may experience complications that can shorten their lifespan.

Another factor that affects life expectancy is the underlying medical conditions. Patients with multiple health issues, such as heart disease, diabetes, or a history of strokes, may not live as long as those with fewer comorbidities.

The ideal solution for kidney disease patients on dialysis is to receive a kidney transplant. A successful transplant can significantly improve the patient’s quality of life and increase their life expectancy. However, due to the shortage of available kidneys for transplantation, some patients may need to remain on dialysis for an extended period.

In such cases, it is essential to adhere to treatment and undergo regular medical checkups to help manage any complications that may arise.

How long do you have to live if your kidneys are failing with dialysis?

The answer to this question can vary depending on various factors such as the individual’s age, overall health, underlying conditions, and the effectiveness of the dialysis treatment. Dialysis can help replace the function of the kidneys to a certain extent, but it is not a permanent solution.

Patients with end-stage renal disease (ESRD) are often put on long-term dialysis to manage their condition. According to research, the average life expectancy of a patient on dialysis is approximately five to ten years, but this can vary based on individual circumstances.

However, it’s important to note that dialysis treatment is not a cure for kidney failure, and it may cause complications and side effects such as infection, low blood pressure, anemia, and more. Additionally, many factors can affect the duration of life expectancy such as the severity of the disease, the frequency and duration of dialysis sessions, the individual’s adherence to treatment, and any other underlying medical conditions.

In some cases, patients may undergo a kidney transplant as an alternative to dialysis, and this may provide a much longer lifespan. Overall, the prognosis for those with kidney failure and undergoing dialysis treatment can vary greatly depending on individual factors, so it’s important to speak with a healthcare provider to determine the best course of treatment and management plan.

Can kidneys start working again after dialysis?

Dialysis is a medical treatment that is used for patients with kidney failure. This treatment involves the use of a machine to filter out toxins and fluids from the blood that the kidneys are no longer able to remove efficiently. Dialysis is necessary to keep the body functioning when the kidneys lose most or all of their ability to filter and remove waste products from the bloodstream.

The question whether kidneys can start working again after dialysis is a complex one, and the answer depends on various factors.

In general, it is unlikely that a person with chronic kidney disease or end-stage renal disease will regain full kidney function after dialysis. This is because the damage to the kidneys is progressive and, in most cases, irreversible. Dialysis is a way to support the body and prolong life, but it cannot cure kidney disease.

However, there are cases where the kidneys can recover some function, especially if the dialysis treatment is started early enough. Acute kidney injury or temporary kidney failure can occur in response to factors like dehydration, blood loss, infection, or medication toxicity. In these cases, dialysis can help to remove the harmful substances from the blood and give the kidneys a chance to recover.

If the underlying cause of the kidney injury is identified and treated promptly, the kidneys may be able to regain their full function.

Furthermore, kidney transplant is considered to be the definitive treatment for kidney failure. This procedure is often preferred because it provides a new, healthy kidney that can replace the removed kidney. After a successful transplant, dialysis is no longer needed, and the patient can resume a normal life with the new kidney.

In some cases, a person who has been on dialysis for a long time may be able to receive a successful kidney transplant, allowing their own kidneys to start working again.

While it is unlikely that kidneys can fully recover after dialysis, the chance of recovery depends on many factors. In cases of acute kidney injury or temporary kidney failure, the kidneys can recover some function. Additionally, kidney transplant provides a viable option for patients with kidney failure to regain kidney function.

Therefore, it is essential to consult with a healthcare professional for personalized advice on the right course of treatment based on one’s unique medical history and condition.

Can you eventually get off dialysis?

Dialysis is a life-saving treatment for patients with kidney failure, which helps to remove waste, excess fluids, and other impurities from the blood that would normally be removed by healthy kidneys. However, it is not a cure for kidney disease and patients usually need to undergo dialysis treatment for the rest of their lives, unless they can receive a kidney transplant.

There are various reasons why someone may require dialysis, such as a congenital disease or acquired through long-term, uncontrolled diabetes or hypertension. In some cases, the cause and severity of kidney disease can be treated to the point where dialysis is no longer necessary, but this isn’t always possible.

There are certain factors that can influence a patient’s ability to get off dialysis, such as age, the underlying cause of their kidney disease, and overall health. If someone is young, otherwise healthy, and their kidney function has only recently declined, they may have a better chance of regaining some kidney function through medications, dietary changes or if they are lucky, spontaneous kidney recovery, which could result in dialysis being temporarily or permanently stopped.

However, for many patients, the damage to the kidneys is irreversible, meaning that dialysis remains a lifelong requirement. In such cases, the focus typically shifts to managing the complications associated with long-term dialysis, such as anemia, fluid overload, and bone disease.

For patients on dialysis who wish to explore alternative treatments, transplant remains the best option. A successful kidney transplant from a compatible donor could replace the need for dialysis altogether. However, this process is not straightforward, and patients usually need to meet several eligibility criteria, including being healthy enough to withstand a major operation, undergoing rigorous screening and testing to make sure they have no medical problems, and will be required to take immunosuppressive medications for the rest of their lives.

While there are cases where a patient can stop dialysis treatment, it is usually only temporary or short term, and most patients with chronic kidney disease will need dialysis treatment for the rest of their lives unless they can go through a kidney transplant.

How can I get off dialysis naturally?

Dialysis is a medical treatment that is needed when the kidneys are not functioning properly. It serves as an artificial means of filtering waste products and excess fluids from the body. While dialysis can be a life-saving treatment for those with kidney failure, it is not a permanent solution. It is important to understand that there is no one-size-fits-all solution for getting off dialysis naturally.

However, there are several things that you can do to improve your kidney health and potentially decrease reliance on dialysis.

1. Dietary Changes: One of the most important things that you can do to improve your kidney health is to adjust your diet. A diet rich in fruits, vegetables, whole grains, and lean proteins is essential. You should limit your salt intake, reduce the amount of potassium in your diet, and monitor your fluid intake.

Speak to a doctor, dietician or nutritionist for professional advice on a dietary plan that fits with your specific medical condition.

2. Manage Blood Pressure and Diabetes: High blood pressure and diabetes are two key factors that can lead to kidney damage. Managing these conditions can help to slow down the progression of kidney damage and improve kidney function. So, it is essential to get your blood pressure checked regularly by a medical professional and take medications as prescribed.

Similarly, controlling your blood sugar levels can also help to protect your kidneys.

3. Exercise: Regular physical activity is essential to maintain a healthy body and improve your overall kidney health. Exercise helps to reduce blood pressure, maintain a healthy weight, control blood sugar levels, and improve overall circulation.

4. Natural Remedies: There are many natural remedies that can potentially help to improve kidney function. Some of the most effective ones include nettle leaf tea, dandelion root tea, turmeric, and ginger. However, it is important to talk to a doctor before integrating any natural remedies into your treatment plan.

5. Follow Medical Advice: Following your doctor’s advice is crucial. Make sure to attend your scheduled appointments, take your medications as prescribed, and communicate any changes in your condition to your healthcare provider.

It is important to keep in mind that there is no one magical solution for getting off dialysis naturally. However, making healthy lifestyle choices and incorporating the above recommendations into your daily routine can improve your overall kidney function, leading to less reliance on dialysis. It is vital to discuss all medical decisions with your healthcare provider and ensure that any decisions made are the best for your overall health and well-being.

How great is the survival advantage of transplantation over dialysis in elderly patients?

Transplantation has been found to be a better option for elderly patients when compared to dialysis. This is because transplantation provides a significant survival advantage over dialysis. Studies have shown that elderly patients who receive a kidney transplant have a higher survival rate compared to those on dialysis.

The survival advantage of transplantation over dialysis in elderly patients can be attributed to several factors. Firstly, transplantation provides a better quality of life compared to dialysis. Patients who have received a transplant have reported feeling better and have been able to return to their normal activities.

This improvement in quality of life can have a positive effect on overall health and may contribute to a longer life expectancy.

Secondly, transplantation reduces the risk of comorbidities associated with dialysis. Patients on dialysis have a higher risk of developing diseases such as cardiovascular disease, anemia, and bone disease. These comorbidities can significantly impact the survival rate of patients on dialysis. Transplantation, on the other hand, provides a more sustainable option for patients and can help to reduce the risk of these comorbidities.

Thirdly, transplantation provides a better control of fluid and electrolyte balance compared to dialysis, which reduces the risk of complications. Patients receiving a transplant can regulate their body’s fluid and electrolyte balance more naturally, making fluid and electrolyte imbalances less likely.

This improved control can help to reduce the risk of complications and improve overall health.

Finally, transplantation reduces the amount of time spent on treatment compared to dialysis. Patients on dialysis may have to spend several hours every day on treatment routines. Transplant patients, however, only require a few hours of care per week, allowing them to resume their regular day-to-day activities.

This reduced time spent on treatment can have a significant impact on the quality of life and overall health of patients.

Overall, the survival advantage of transplantation over dialysis in elderly patients is significant. Transplantation provides a more sustainable option for patients and can help to improve quality of life, reduce comorbidities, provide better control of fluid and electrolyte balance and reduce the amount of time spent on treatment.

All of these factors contribute to higher survival rates in elderly transplant patients compared to those on dialysis.


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