Abraham Georgi, Jayaseelan T, Matthew Milly, Padma P, Saravanan A K, Lesley Nancy, Reddy Yuvaram N V, Saravanan S, Reddy Yogesh N V
Department of Nephrology, Chennai, Tamil Nadu, India.
Hemodial Int. 2010 Apr;14(2):211-7. doi: 10.1111/j.1542-4758.2010.00441.x.
Chronic kidney disease is reaching epidemic proportions and the number of patients on renal replacement therapy (RRT) is increasing worldwide and also in developing countries. To meet the challenge of providing RRT, a few charity organizations provide hemodialysis units for underprivileged patients, as the private hospitals are unaffordable for the majority. There is a paucity of information on the outcome of dialysis in these patients. Here, we describe the outcome of hemodialysis patients comparing the middle- and upper-class income group with the lower class income group. A retrospective analysis was carried out in 558 CKD patients initiated on maintenance hemodialysis in two different dialysis facilities. Group A (n=247) included those who belonged to the lowermost socioeconomic status and were undergoing dialysis in two nonprofit, charity (TANKER)-run dialysis units, and Group B (n=311) was undergoing dialysis in a nonprofit hospital setting where no subsidy was given. Those patients of a low socioeconomic status, especially those who are diabetics, have a higher death rate (Group A-38.1%, Group B-4.2%) and loss to follow-up (Group A-25.9%, Group B-0.3%) compared with those who are in the middle- and high-income group. Higher EPO use and hence higher hemoglobin levels (Group A-6.4+/-1.2, Group B-8.9+/-1.5 P<0.001) were observed in those who were in the middle and the higher income group. Lower serum phosphorus level was observed in the low-socioeconomic group (Group A-4.7+/-1.5, Group B-5.5+/-1.9, P<0.001). Patients belonging to the middle and higher socioeconomic group undergo more transplantations compared with the lower socioeconomic group (Group A-2.4%, Group B-65.6%).
慢性肾脏病正呈流行趋势，全球及发展中国家接受肾脏替代治疗（RRT）的患者数量都在增加。为应对提供RRT的挑战，一些慈善组织为贫困患者提供血液透析单位，因为大多数人负担不起私立医院的费用。关于这些患者透析结果的信息匮乏。在此，我们描述了血液透析患者中、高收入群体与低收入群体的透析结果。对在两个不同透析机构开始接受维持性血液透析的558例慢性肾脏病患者进行了回顾性分析。A组（n = 247）包括那些社会经济地位最低且在两个由非营利慈善机构（TANKER）运营的透析单位接受透析的患者，B组（n = 311）在一家无补贴的非营利医院环境中接受透析。与中高收入群体相比，社会经济地位低的患者，尤其是糖尿病患者，死亡率更高（A组 - 38.1%，B组 - 4.2%）且失访率更高（A组 - 25.9%，B组 - 0.3%）。中高收入群体使用促红细胞生成素更多，因此血红蛋白水平更高（A组 - 6.4±1.2，B组 - 8.9±1.5，P<0.001）。社会经济地位低的群体血清磷水平较低（A组 - 4.7±1.5，B组 - 5.5±1.9，P<0.001）。与社会经济地位低的群体相比，社会经济地位中高的群体接受移植的比例更高（A组 - 2.4%，B组 - 65.6%）。
