Abstract

End-stage renal disease (ESRD) is a growing global public health issue. While dialysis sustains life in these patients, it limits quality of life and is associated with high morbidity and mortality rates. Kidney transplantation, as the treatment option closest to natural kidney function, significantly improves both survival and quality of life. This study aims to explore the clinical, quality of life, and economic advantages of kidney transplantation compared to dialysis. A total of 1,500 patients who underwent kidney transplantation or started dialysis treatment between April 1, 2021, and April 30, 2024 were included. Using optimal balanced matching (OBM), survival and cardiovascular outcomes (MACE) were compared between kidney transplant recipients and dialysis patients. Transplant recipients showed significantly lower mortality rates (3.0% vs. 18.5%) compared to the dialysis group. Additionally, the incidence of MACE was lower in the transplant group (HR: 0.52; 95% CI: 0.35–0.78). Subgroup analyses indicated that kidney transplantation provided survival benefits across all groups, regardless of age, sex, dialysis modality, and comorbidities. Kidney transplantation offers a clear survival and cardiovascular protection advantage over dialysis in the treatment of ESRD. These findings underscore the importance of prioritizing kidney transplantation as the primary treatment option for ESRD and highlight the need to improve access to this life-saving therapy.

Key words: End-stage renal disease, kidney transplantation, dialysis, renal replacement therapy, access to transplantation