Bellorin-Font Ezequiel, Pernalete Nidia, Meza Josefina, Milanes Carmen Luisa, Carlini Raul G
National Center of Dialysis and Transplantation, Ministry of Health and the Division of Nephrology, Hospital Universitario de Caracas, Caracas, Venezuela.
Kidney Int Suppl. 2005 Aug(97):S18-22. doi: 10.1111/j.1523-1755.2005.09703.x.
Access to and coverage of renal replacement therapy in minorities and ethnic groups in Venezuela. Numerous studies have documented the presence of racial and minority disparities regarding the impact of renal disease and access to renal replacement therapy (RRT). This problem is less well documented in Latin America. Venezuela, like most countries in the region, is subject to severe constraints in the allocation of resources for high-cost chronic diseases, which limits the access of patients with chronic kidney disease to RRT. Although access to health care is universal, there is both a deficit in coverage and disparity in the access to RRT, largely as a result of socioeconomic limitations and budget constrains. With current rising trends of the incidence of end-stage renal disease (ESRD) and costs of medical technology, the long-term goal of complete RRT coverage will become increasingly out of reach. Current evidence suggests that prevention of progression of renal disease is possible at relatively low cost and broad coverage. Based on this evidence, the Ministry of Health has redesigned its policy with respect to renal disease based on 4 elements: 1. Prevention by means of early detection and referral to multidisciplinary health teams, as well as promotion of health habits in the community. 2. Prevention of progression of renal disease by pharmacologic and nonpharmacologic means. 3. An increase in the rate of coverage and reduction of disparities in the access to dialysis. 4. An increase in the rates of renal transplantation through better organ procurement programs and reinforcement of transplant centers. However, the projected increase in the number of patients with ESKD receiving RRT will represent a serious burden to the health care system. Therefore, implementation of these policies will require the involvement of international agencies as well as an adequate partnership between nephrologists and health care planners, so that meeting the increasing demands of ESKD programs may be balanced with other priorities of our national health system.
委内瑞拉少数族裔和族群获得肾脏替代治疗的情况及覆盖范围。众多研究记录了在肾病影响及获得肾脏替代治疗（RRT）方面存在的种族和少数族裔差异。在拉丁美洲，这个问题的记录较少。与该地区大多数国家一样，委内瑞拉在为高成本慢性病分配资源方面受到严重限制，这限制了慢性肾病患者获得RRT的机会。尽管医疗保健是普遍可及的，但在RRT的覆盖范围方面存在不足，且在获得治疗方面存在差异，这主要是社会经济限制和预算约束的结果。随着终末期肾病（ESRD）发病率和医疗技术成本目前呈上升趋势，实现完全覆盖RRT的长期目标将越来越难以实现。目前的证据表明，以相对较低的成本和广泛的覆盖范围预防肾病进展是可能的。基于这一证据，卫生部已根据四个要素重新设计了其肾病政策：1. 通过早期检测并转诊至多学科医疗团队进行预防，以及在社区推广健康习惯。2. 通过药物和非药物手段预防肾病进展。3. 提高透析的覆盖率并减少获得透析机会的差异。4. 通过更好的器官获取计划和加强移植中心来提高肾移植率。然而，预计接受RRT的ESKD患者数量的增加将给医疗保健系统带来沉重负担。因此，实施这些政策将需要国际机构的参与以及肾病学家与医疗保健规划者之间建立适当的伙伴关系，以便在满足ESKD项目不断增长的需求与我国国家卫生系统的其他优先事项之间取得平衡。
