Wearne Nicola, Kilonzo Kajiru, Effa Emmanuel, Davidson Bianca, Nourse Peter, Ekrikpo Udeme, Okpechi Ikechi G
Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa.
Department of Medicine, Kilimanjaro Christian Medical College, Moshi, Tanzania.
Int J Nephrol Renovasc Dis. 2017 Jan 4;10:1-9. doi: 10.2147/IJNRD.S104208. eCollection 2017.
Chronic kidney disease is a major public health problem that continues to show an unrelenting global increase in prevalence. The prevalence of chronic kidney disease has been predicted to grow the fastest in low- to middle-income countries (LMICs). There is evidence that people living in LMICs have the highest need for renal replacement therapy (RRT) despite the lowest access to various modalities of treatment. As continuous ambulatory peritoneal dialysis (CAPD) does not require advanced technologies, much infrastructure, or need for dialysis staff support, it should be an ideal form of RRT in LMICs, particularly for those living in remote areas. However, CAPD is scarcely available in many LMICs, and even where available, there are several hurdles to be confronted regarding patient selection for this modality. High cost of CAPD due to unavailability of fluids, low patient education and motivation, low remuneration for nephrologists, lack of expertise/experience for catheter insertion and management of complications, presence of associated comorbid diseases, and various socio-demographic factors contribute significantly toward reduced patient selection for CAPD. Cost of CAPD fluids seems to be a major constraint given that many countries do not have the capacity to manufacture fluids but instead rely heavily on fluids imported from developed countries. There is need to invest in fluid manufacturing (either nationally or regionally) in LMICs to improve uptake of patients treated with CAPD. Workforce training and retraining will be necessary to ensure that there is coordination of CAPD programs and increase the use of protocols designed to improve CAPD outcomes such as insertion of catheters, treatment of peritonitis, and treatment of complications associated with CAPD. Training of nephrology workforce in CAPD will increase workforce experience and make CAPD a more acceptable RRT modality with improved outcomes.
慢性肾脏病是一个重大的公共卫生问题，其患病率在全球范围内持续呈无情的上升趋势。预计慢性肾脏病患病率在低收入和中等收入国家（LMICs）增长最快。有证据表明，尽管获得各种治疗方式的机会最少，但生活在LMICs的人群对肾脏替代治疗（RRT）的需求却最高。由于持续非卧床腹膜透析（CAPD）不需要先进技术、大量基础设施，也不需要透析工作人员的支持，它应该是LMICs中RRT的理想形式，特别是对于那些生活在偏远地区的人。然而，许多LMICs几乎没有CAPD，即使有，在选择这种治疗方式的患者时也面临几个障碍。由于液体供应不足导致CAPD成本高昂、患者教育和积极性低、肾病专家报酬低、缺乏导管插入和并发症管理的专业知识/经验、存在相关合并症以及各种社会人口因素，都显著导致选择CAPD的患者减少。鉴于许多国家没有生产液体的能力，而是严重依赖从发达国家进口的液体，CAPD液体成本似乎是一个主要制约因素。有必要在LMICs投资于液体生产（无论是在国家层面还是区域层面），以提高接受CAPD治疗的患者数量。有必要进行劳动力培训和再培训，以确保CAPD项目的协调，并增加使用旨在改善CAPD结果的方案，如导管插入、腹膜炎治疗以及与CAPD相关的并发症治疗。对肾病劳动力进行CAPD培训将增加劳动力经验，并使CAPD成为一种更可接受的RRT方式，同时改善治疗结果。
