Management of end-stage renal disease: transplantation or dialysis?

The relative merits of dialysis and transplantation in the management of end-stage renal disease change continually as technological advances evolve, with their associated monetary costs. The most notable recent improvements have been in the routine use of recombinant human erythropoietin and in the identification of malnutrition and underdialysis as major sources of morbidity and mortality in dialysis patients. Although the reduction in morbidity and possibly in mortality may be great, these treatments add significantly to the cost of patient care and, therefore, make transplantation even more cost-effective than it has been previously.