Jha Vivekanand
Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Ethn Dis. 2009 Spring;19(1 Suppl 1):S1-27-32.
Of the 1.5 million people of South Asia, a large number live in extreme poverty in rural urban areas and have limited access to health care. End-stage renal disease (ESRD) is a devastating medical, social, and economic problem. Lack of registries prevent an accurate assessment of the incidence or prevalence of ESRD, but a recent population-based study assessed the age-adjusted incidence at 232 cases per million population per year. ESRD treatment facilities are available only in major cities, requiring many patients to travel long distances to seek care. Many patients never come to medical attention. Until recently, infection-related glomerulonephritides were considered the most common cause of ESRD, but recent years have shown rapid emergence of diabetic nephropathy as the most frequent cause among new ESRD patients who are younger compared to their Western counterparts. A large number presents with a short history of ESRD of undetermined etiology and often require emergency dialysis. Non-availability of health insurance limits the ability of patients to afford costly ESRD care. The quality of chronic dialysis is dictated mostly by non-medical, financial factors. Maintenance hemodialysis (HD) facilities are scarce. Chronic peritoneal dialysis is not cheaper than HD; high cost and nephrologist bias have limited the growth of peritoneal dialysis in South Asia. Transplants using organs from a related donor is the only viable form of renal replacement therapy for the majority. Cost issues and lack of an effective deceased donor program have limited its availability. Improvement in ESRD care would require strong support from the government, awareness on the part of the medical community of the need of timely referral of these patients to the nephrologist, appropriate pre-dialysis education and development of a network of integrated ESRD treatment facilities for optimal utilization of all forms of renal replacement therapy so that the outcomes of these patients can be improved.
在南亚的150万人中，有大量人口生活在城乡地区的极端贫困之中，获得医疗保健的机会有限。终末期肾病（ESRD）是一个极具破坏性的医学、社会和经济问题。由于缺乏登记系统，无法准确评估ESRD的发病率或患病率，但最近一项基于人群的研究评估出年龄调整后的发病率为每年每百万人口232例。ESRD治疗设施仅在大城市才有，这使得许多患者需要长途跋涉去寻求治疗。许多患者根本得不到医疗关注。直到最近，感染相关性肾小球肾炎一直被认为是ESRD最常见的病因，但近年来，糖尿病肾病迅速成为新的ESRD患者中最常见的病因，这些患者比西方同龄人更年轻。大量患者表现为病因不明的ESRD病史较短，常常需要紧急透析。医疗保险的缺乏限制了患者负担昂贵的ESRD治疗费用的能力。慢性透析的质量主要由非医疗、财务因素决定。维持性血液透析（HD）设施稀缺。慢性腹膜透析并不比HD便宜；高成本和肾病专家的偏见限制了南亚腹膜透析的发展。对于大多数人来说，使用亲属供体器官进行移植是唯一可行的肾脏替代治疗形式。成本问题和缺乏有效的已故供体项目限制了其可用性。改善ESRD护理需要政府的大力支持，需要医学界认识到及时将这些患者转诊给肾病专家的必要性，进行适当的透析前教育，并建立一个综合的ESRD治疗设施网络，以优化所有形式的肾脏替代治疗的利用，从而改善这些患者的治疗效果。
