Kidney Transplant Clinical Decision-Making and Brain Health Early Warning in an Aging Society: Survival Rate Comparison and Current Status Survey of Alzheimer's Disease

VI. Kidney Transplantation Kidney transplantation, commonly known as "kidney replacement," does not involve replacing the original kidney with a new one. Instead, a new kidney is implanted into the patient's body, usually in the iliac fossa, to replace the function of the original kidney. Kidney transplantation is widely recognized as the best treatment for chronic renal failure-uremia. Kidney transplantation has been used clinically for over forty years, and among all organ transplants, kidney transplantation has the best efficacy and safety. Kidney transplantation surgery is a high-risk procedure compared to other surgeries. Because patients with renal failure may have damage and dysfunction in various systems of the body, not all patients with renal failure are suitable candidates for kidney transplantation; this is what doctors generally refer to as the clinical indications for kidney transplantation. Although there is practically no age limit for kidney transplantation-currently, kidney transplants can be performed on people ranging from infants a few months old to people over 80 years old-the recipient's age does affect the outcome of the transplant. The general age requirement is 13-60 years old, which can be appropriately relaxed if the recipient is in good health. However, recipients older than 55 years old have a higher risk of complications and complications. For recipients under 13 years old, especially under 4 years old, the difficulty of kidney transplantation surgery increases significantly, all of which affect the success rate and outcome. Kidney transplantation is suitable for uremia patients in good health after dialysis treatment. However, complications are common after kidney transplantation for certain diseases, so caution is advised. Kidney transplantation is suitable for various primary or secondary kidney diseases, such as glomerulonephritis, interstitial nephritis, hereditary nephritis, polycystic kidney disease, diabetic nephropathy, hypertensive arteriosclerotic nephropathy, drug-induced kidney damage, and lupus nephritis. Patients with abnormal liver function, peptic ulcer disease, lung infection, urinary tract infection, tuberculosis, heart failure, or pericardial effusion must be cured before kidney transplantation. Patients infected with hepatitis B or C viruses should undergo treatment, and kidney transplantation is best performed one month after liver function normalization. Kidney transplantation is not recommended shortly after interferon treatment.

VII. Differences in Survival Rates Between Kidney Transplantation and Dialysis The success rate of kidney transplantation is generally expressed as one-, three-, five-, and ten-year kidney survival rates or overall survival rates. Kidney survival refers to the retention of kidney function. Because of the use of immunosuppressants after kidney transplantation, complications such as infections and drug side effects are common. Therefore, its safety compared to hemodialysis is a major concern. However, with advancements in medicine, kidney transplantation outcomes have greatly improved, making it relatively safe. Currently, the one-year kidney survival rate abroad is over 90%, and the five-year survival rate is 50%–80%, averaging 60%. In China, the one-year kidney survival rate after transplantation is comparable to that abroad, while the five-year survival rate is approximately 50%–70%, slightly lower than abroad. Compared to dialysis, the overall survival rate of the person after kidney transplantation is higher than the survival rate of the kidney itself. Data from Japan shows that the five-year survival rate after kidney transplantation is over 90%, while the five-year survival rate for dialysis is 58%–87%, averaging 70%. Statistics from 1992 in experienced large hospitals in China show that the one-year survival rate for dialysis is 87.5%, and the five-year survival rate is 52%. It is estimated that current survival rates have improved. After a kidney transplant, if the transplanted kidney fails for various reasons, patients with uremia can undergo dialysis again. Therefore, compared to dialysis, the survival rate of kidney transplant recipients is higher than the survival rate of the transplanted kidney itself. In my country, the low survival rate of both kidney transplantation and dialysis is due not only to differences in technological levels but, more importantly, to the unaffordable medical costs. Kidney transplantation has lower long-term overall costs than dialysis. A successful kidney transplant can alleviate or correct most complications of uremia and dialysis. Therefore, combining kidney transplantation with dialysis can prolong the lifespan of uremia patients and improve their quality of life.

Chapter 8 Sub-health and Alzheimer's Disease in the Elderly Section 1 Overview of Alzheimer's Disease Alzheimer's disease refers to the persistent impairment of acquired intelligence in old age, resulting in cognitive deficits and reduced social adaptability. It is an insidious, gradual, chronic, progressive disease primarily characterized by cognitive impairment. Family members often cannot pinpoint the onset time, only seeking medical attention when dementia symptoms become more pronounced. The main manifestations include: cognitive impairment such as loss of abstract thinking, insufficient reasoning, judgment, and planning, and attention deficit; personality impairment such as loss of interest and initiative, emotional dullness or difficulty controlling emotions, and inappropriate social behavior; memory impairment such as forgetfulness, inability to learn, and poor orientation to time, terrain, and visual and spatial information; and speech and cognitive impairment such as slurred speech and overall cognitive deficits. The elderly are generally defined as those over 60 years of age, while the World Health Organization (WHO) defines them as those over 65 years of age. The prevalence of dementia among the elderly population is 4%–5%, and can reach 17%–20% among those over 80 years of age. It is reported that in Europe and the United States, Alzheimer's disease (AD) accounts for about 50% of dementia in the elderly, vascular dementia (VD) accounts for about 15%, and mixed dementia accounts for 15% to 20%. In the United States, the number of people with AD is 4 million, and this number is expected to rise to 11 million by the middle of the next century, costing $10 billion annually. In China, censuses in 11 urban and rural areas show that among people over 60 years old, the prevalence of VD is 324 per 100,000, while the prevalence of AD is 238 per 100,000. It is estimated that by 2025, the number of people with AD worldwide will reach 22 million. As the main type of dementia in the elderly, AD is the fourth leading cause of death after heart disease, cancer, and stroke. Therefore, the prevention and treatment of AD has attracted widespread attention from the medical community and society as a whole. With the increasing severity of population aging in my country, dementia is becoming an increasingly serious social problem. Statistics show that my country currently has 129 million people over the age of 60, with the elderly accounting for 10.15% of the total population, making my country an aging society ahead of schedule. It is noteworthy that the prevalence of dementia is approximately 10% among the population over 60, with Alzheimer's disease (AD) accounting for about 5%, estimated at around 6.45 million patients in my country. Moreover, the prevalence of AD doubles with every 5-year increase in age, and 20% of patients aged 80-85 suffer from dementia. It is the fourth leading cause of death after heart disease, cancer, and stroke, placing a significant burden and pressure on patients' families and society. However, because the early symptoms of the disease are often atypical and easily overlooked by family members, the optimal treatment window is missed. This article introduces some relevant knowledge about dementia in the hope of raising awareness and concern throughout society. Dementia is increasingly becoming a serious social problem. With the continuous improvement of people's living standards and the increasing number and proportion of the elderly population, the incidence of dementia is rising, and the brain health of the elderly is receiving increasing attention from society. According to incomplete statistics, the rate of severe Alzheimer's disease among people over 65 years old is over 5%, and rises to 15% to 20% by age 80. The average survival time of Alzheimer's patients is 5.5 years, making it one of the leading causes of death among the elderly in modern society.