Garcia-Garcia Guillermo, Monteon-Ramos J Francisco, Garcia-Bejarano Hector, Gomez-Navarro Benjamin, Reyes Imelda Hernandez, Lomeli Ana Maria, Palomeque Miguel, Cortes-Sanabria Laura, Breien-Alcaraz Hugo, Ruiz-Morales Norma M
Jalisco Dialysis and Transplant Registry (REDTJAL), Hospital Civil de Guadalajara, Apdo. Postal 2-70, 44281 Guadalajara, Jalisco, Mexico.
Kidney Int Suppl. 2005 Aug(97):S58-61. doi: 10.1111/j.1523-1755.2005.09710.x.
End-stage renal disease represents a serious public health problem in Jalisco, Mexico. It is reported among the 10 leading causes of death, with an annual mortality rate of 12 deaths per 100,000 population. The state population is 6.3 million, and more than half do not have medical insurance. In this study, we report the population's access to renal replacement therapy (RRT).
Patients > or =15 years of age, who started RRT between January 1998 and December 2000 at social security or health secretariat medical facilities, were included. Nine facilities participated in the study. At the start of treatment, the patient's facility, age, gender, cause of renal failure, and initial treatment modality were registered.
Within the study period, 2456 started RRT, 1767 (72%) at social security facilities and 687 (28%) at health secretariat facilities, for an annual incidence rate of 195 per million population (pmp). The main cause of renal failure was diabetes mellitus (51% of patients). There were significant differences between the 2 populations. Patients with social security were older (53.1 +/- 17 vs. 45.1 +/- 20 years, P= 0.001) and had more diabetes (54% vs. 42%, P= 0.001) than those without social security. They had higher acceptance (327 pmp vs. 99 pmp, P= 0.001) and prevalence rates (939 pmp vs. 166 pmp, P= 0.001) than patients without medical insurance. Dialysis use was similar in both populations. Eighty-five percent of patients were on continuous ambulatory peritoneal dialysis and 15% on hemodialysis. Kidney transplant rate was higher among insured patients (72 pmp vs. 7.5 pmp, P= 0.001). The number of dialysis programs and nephrologists that offered renal care also differed. There were 10 dialysis programs in social security and 3 in health secretariat facilities. Fourteen nephrologists looked after the insured population, whereas 5 cared for the uninsured (7.7 pmp vs. 2.1 pmp, P= 0.001). The latter had access to 8 hemodialysis stations compared with 34 for the insured population (3.4 pmp vs. 18.8 pmp, P= 0.001).
Access to RRT is unequal in our state. Although it is universal for the insured population, it is severely restricted for the poor. Social and economical factors, as well as the limited number of understaffed, centralized dialysis facilities, could explain these differences.
终末期肾病是墨西哥哈利斯科州一个严重的公共卫生问题。它位列十大主要死因之中，年死亡率为每10万人口中有12人死亡。该州人口为630万，超过半数没有医疗保险。在本研究中，我们报告了该州人口接受肾脏替代治疗（RRT）的情况。
纳入1998年1月至2000年12月期间在社会保障或卫生秘书处医疗设施开始接受RRT的15岁及以上患者。九家医疗机构参与了该研究。在治疗开始时，记录患者的医疗机构、年龄、性别、肾衰竭病因和初始治疗方式。
在研究期间，2456人开始接受RRT，1767人（72%）在社会保障医疗机构，687人（28%）在卫生秘书处医疗机构，年发病率为每百万人口195例（pmp）。肾衰竭的主要原因是糖尿病（占患者的51%）。这两类人群之间存在显著差异。有社会保障的患者年龄更大（53.1±17岁对45.1±20岁，P = 0.001），糖尿病患者更多（54%对42%，P = 0.001）。他们的接受率（327 pmp对99 pmp，P = 0.001）和患病率（939 pmp对166 pmp，P = 0.001）均高于没有医疗保险的患者。两类人群的透析使用率相似。85%的患者接受持续非卧床腹膜透析，15%接受血液透析。参保患者的肾移植率更高（72 pmp对7.5 pmp，P = 0.001）。提供肾脏护理的透析项目数量和肾病专家数量也有所不同。社会保障机构有10个透析项目，卫生秘书处医疗机构有3个。14名肾病专家负责参保人群，而5名负责未参保人群（7.7 pmp对2.1 pmp，P = 0.001）。后者可使用8个血液透析站，而参保人群为34个（3.4 pmp对18.8 pmp，P = 0.001）。
在我们州，接受RRT的机会不平等。虽然参保人群普遍能够接受，但穷人受到严重限制。社会和经济因素，以及人员配备不足、集中化的透析设施数量有限，可能解释了这些差异。
