Aviles-Gomez Raymundo, Luquin-Arellano Victor Hugo, Garcia-Garcia Guillermo, Ibarra-Hernandez Margarita, Briseño-Renteria Gregorio
Hospital Civil de Guadalajara, Division of Nephrology, Guadalajara, Jal, Mexico.
Ethn Dis. 2006 Spring;16(2 Suppl 2):S2-70-2.
Chronic kidney disease is a worldwide public health problem. More than one million individuals in the world are on maintenance dialysis, a number that is estimated to double in the next decade. Access to dialysis is significantly different between developed and developing nations. Close to 80% of the world dialysis population is treated in Europe, North America, and Japan, representing 12% of the world's population. The remaining dialysis patients are treated in the developing world. This disparity is likely due to the high cost and complexity of renal replacement therapy (RRT). Dialysis is so costly that is out of reach for low-income countries, which are struggling to provide preventive and therapeutic measures for communicable diseases and other basic needs. Providing renal care to all developing nations, although a difficult task, is not impossible. A number of strategies are proposed. These include the prevention of kidney disease, as well as dialysis and transplantation. Dialysis programs should be decentralized, and kidney transplantation should be promoted as the treatment of choice. The use of generic immunosuppressive drugs can make this therapy more affordable. Peritoneal dialysis seems a good, affordable, therapy for patients living in areas where hemodialysis is not available. Governments should provide funds not only for RRT but also for the prevention of kidney failure. The provision of tax incentives and reaching a critical number of patients on RRT could be incentives for industry to lower the cost of dialysis. The challenges are enormous, but renal care for all could be achieved through a concerted effort between nephrologists, governments, patients, charitable organizations, and industry.
慢性肾脏病是一个全球性的公共卫生问题。全球有超过100万人在接受维持性透析治疗，预计这一数字在未来十年将翻倍。发达国家和发展中国家在透析治疗的可及性方面存在显著差异。全球近80%的透析患者在欧洲、北美和日本接受治疗，而这些地区的人口仅占世界人口的12%。其余透析患者则在发展中国家接受治疗。这种差异可能是由于肾脏替代治疗（RRT）成本高昂且操作复杂。透析费用如此之高，以至于低收入国家难以承受，这些国家正在努力为传染病和其他基本需求提供预防和治疗措施。尽管向所有发展中国家提供肾脏护理是一项艰巨的任务，但并非不可能。人们提出了一些策略。这些策略包括预防肾脏疾病，以及透析和移植。透析项目应实现去中心化，并且应推广肾脏移植作为首选治疗方法。使用通用免疫抑制药物可以使这种治疗更具可承受性。对于生活在无法进行血液透析地区的患者来说，腹膜透析似乎是一种良好且经济实惠的治疗方法。政府不仅应为肾脏替代治疗提供资金，还应为预防肾衰竭提供资金。提供税收激励措施以及使接受肾脏替代治疗的患者达到一定数量，可能会促使企业降低透析成本。挑战巨大，但通过肾病学家、政府、患者、慈善组织和企业的共同努力，有可能实现为所有人提供肾脏护理。
