University of Guadalajara Health Sciences Center, Guadalajara, Mexico.
Am J Kidney Dis. 2012 Mar;59(3):319-24. doi: 10.1053/j.ajkd.2012.01.004.
There remain major challenges to providing optimal treatment for ESRD worldwide and a need, particularly in low-income economies, to mandate more focus on community screening and implementation of simple measures to minimize progression of chronic kidney disease. The recent designation of renal disease as an important noncommunicable disease at the United Nations High Level Meeting on Noncommunicable Diseases is one step in this direction.(32) But early detection and prevention programs will never prevent ESRD in everyone with chronic kidney disease, and kidney transplantation is an essential, viable, cost-effective, and life-saving therapy which should be equally available to all people in need. It may be the only tenable long-term treatment option for ESRD in low-income countries since it is both cheaper and provides a better outcome for patients than other treatment for ESRD. However, the success of transplantation has not been delivered evenly across the world and substantial disparities still exist in access to transplantation.We remain troubled by commercialization of living donor transplantation and exploitation of vulnerable populations for profit. There are solutions available. These include demonstrably successful models of kidney transplant programs in many developing countries; growing availability of less-expensive generic immunosuppressive agents; improved clinical training opportunities; governmental and professional guidelines legislating prohibition of commercialization and defining professional standards of ethical practice; and a framework for each nation to develop self-sufficiency in organ transplantation through focus on both living donation and especially nationally managed deceased organ donation programs. The Transplantation Society and the ISN have pledged to work together in coordinated joint global outreach programs to help establish and grow appropriate kidney transplant programs in low- and middle-income countries utilizing their considerable joint expertise. World Kidney Day 2012 provides a focus to help spread this message to governments, all health authorities and communities across the world.
在全球范围内为终末期肾病患者提供最佳治疗仍然面临重大挑战，特别是在低收入经济体中，需要更加注重社区筛查，并采取简单措施来减缓慢性肾脏病的进展。最近在联合国非传染性疾病问题高级别会议上将肾脏疾病确定为一种重要的非传染性疾病，这是朝这个方向迈出的一步。（32）但是，早期发现和预防计划永远无法预防所有慢性肾脏病患者发生终末期肾病，而肾移植是一种重要的、可行的、具有成本效益的、能救命的治疗方法，所有有需要的人都应能平等地获得这种治疗。在低收入国家，它可能是终末期肾病唯一可行的长期治疗选择，因为它比其他治疗方法更便宜，对患者的预后更好。然而，肾移植在全球的普及情况并不均衡，在获得肾移植的机会方面仍存在巨大差距。我们仍然对活体供者移植的商业化和利用弱势群体牟利感到困扰。有解决方案可用。这些包括许多发展中国家的肾脏移植计划中明显成功的模式；更便宜的通用免疫抑制剂的供应增加；改善临床培训机会；政府和专业准则规定禁止商业化和定义道德实践的专业标准；以及为每个国家制定通过关注活体捐赠和特别是国家管理的已故器官捐赠计划实现器官移植自给自足的框架。移植学会和国际肾脏病学会承诺共同开展协调一致的全球外联方案，以便利用各自的专长，在中低收入国家建立和扩大适当的肾脏移植计划。2012 年世界肾脏日为传播这一信息提供了一个重点，以帮助全世界各国政府、所有卫生当局和社区了解这一信息。
