Reflections on renal replacement therapy (particularly on dialysis).
Organ replacement therapy is one of the three new forms of life (molecular biology, computer science, organ replacement) that modern techno-medicine affords. Of all the organs, the kidney is pre-eminent in quality and quantity of results. The kidney experience, indeed, acts as a teacher to the other organs in terms of organization and clinical practice. Among the various programs used in the treatment of chronic renal failure, transplantation stands first. It is the only non-illusory form of therapy (in clinical, social and economic terms), but it is only possible in 30% of cases, due to the shortage of valid donors. Artificial replacement (hemodialysis or its alternatives), predominates today and will predominate tomorrow, provided the political and economic structures of various countries are able to afford it. Without dialysis, transplantation itself would not be possible in over 95% of cases, and the graft would have failed in 50% after surgery. Thus, without the backup af artificial replacement therapy, transplantation may be an individual solution for individual cases, but not the solution to the problem as a whole in social terms. Although progressive improvements in technology have resulted in improved survival both in dialysis and in transplantation, all the other expectations of high-tech replacement have tended to be disappointing. As a multidisciplinary reality, renal replacement therapy still requires the integration of various sciences. Results so far achieved have shown the discrepancy between expectations and results, and indicated the way to follow to make the treatment biologically closer to man and physiologically closer to the organ.
Bonomini
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D000818:Animals; D030801:Animals, Genetically Modified; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D016030:Kidney Transplantation / Q000401:mortality; D006435:Renal Dialysis / Q000401:mortality / Q000639:trends; D017582:Renal Replacement Therapy / Q000401:mortality / Q000639:trends; D014183:Transplantation, Heterologous