撒哈拉以南非洲地区需要透析的终末期肾病成人和儿童的结局：系统评价。

Outcomes in adults and children with end-stage kidney disease requiring dialysis in sub-Saharan Africa: a systematic review.

机构信息

Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon.

Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana.

出版信息

Lancet Glob Health. 2017 Apr;5(4):e408-e417. doi: 10.1016/S2214-109X(17)30057-8. Epub 2017 Feb 20.

DOI:10.1016/S2214-109X(17)30057-8

PMID:28229924

Abstract

BACKGROUND

The burden of end-stage kidney disease (ESKD) in sub-Saharan Africa is unknown but is probably high. Access to dialysis for ESKD is limited by insufficient infrastructure and catastrophic out-of-pocket costs. Most patients remain undiagnosed, untreated, and die. We did a systematic literature review to assess outcomes of patients who reach dialysis and the quality of dialysis received.

METHODS

We searched PubMed, African Journals Online, WHO Global Health Library, and Web of Science for articles in English or French from sub-Saharan Africa reporting dialysis outcomes in patients with ESKD published between Jan 1, 1990, and Dec 22, 2015. No studies were excluded to best represent the current situation in sub-Saharan Africa. Outcomes of interest included access to dialysis, mortality, duration of dialysis, and markers of dialysis quality in patients with ESKD. Data were analysed descriptively and reported using narrative synthesis.

FINDINGS

Studies were all of medium to low quality. We identified 4339 studies, 68 of which met inclusion criteria, comprising 24 456 adults and 809 children. In the pooled analysis, 390 (96%) of 406 adults and 133 (95%) of 140 children who could not access dialysis died or were presumed to have died. Among those dialysed, 2747 (88%) of 3122 adults in incident ESKD cohorts, 496 (16%) of 3197 adults in prevalent ESKD cohorts, and 107 (36%) of 294 children with ESKD died or were presumed to have died. 2508 (84%) of 2990 adults in incident ESKD cohorts discontinued dialysis compared with 64 (5%) of 1364 adults in prevalent ESKD cohorts. 41 (1%) of 4483 adults in incident ESKD cohorts, 2280 (19%) of 12 125 adults in prevalent ESKD cohorts, and 71 (19%) of 381 children with ESKD received transplants. 16 studies reported on management of anaemia, 17 on dialysis frequency, eight on dialysis accuracy, and 22 on vascular access for dialysis INTERPRETATION: Most patients with ESKD starting dialysis in sub-Saharan Africa discontinue treatment and die. Further work is needed to develop equitable and sustainable strategies to manage individuals with ESKD in sub-Saharan Africa.

FUNDING

None.

摘要

背景

撒哈拉以南非洲地区终末期肾病（ESKD）的负担尚不清楚，但可能很高。由于基础设施不足和灾难性的自费支出，ESKD 患者获得透析的机会有限。大多数患者未被诊断，未得到治疗，最终死亡。我们进行了系统的文献综述，以评估进入透析的患者的结局以及接受的透析质量。

方法

我们在 PubMed、African Journals Online、世界卫生组织全球卫生图书馆和 Web of Science 中搜索了以英语或法语发表的、1990 年 1 月 1 日至 2015 年 12 月 22 日期间在撒哈拉以南非洲地区报告 ESKD 患者透析结局的文章。为了最好地代表撒哈拉以南非洲地区的现状，没有排除任何研究。感兴趣的结局包括进入透析、死亡率、透析持续时间和 ESKD 患者透析质量的标志物。数据采用描述性分析并使用叙述性综合报告。

结果

研究均为中低质量。我们共检索到 4339 项研究，其中 68 项符合纳入标准，包括 24456 名成年人和 809 名儿童。在汇总分析中，406 名成年人中有 390 名（96%）和 140 名儿童中有 133 名（95%）无法接受透析的患者死亡或据推测已经死亡。在接受透析的患者中，2747 名（88%）新发 ESKD 队列中的成年人、3197 名成年人中（16%）的 496 名、294 名儿童中（36%）的 107 名死亡或据推测已经死亡。 2990 名新发 ESKD 队列中有 2508 名（84%）成年人停止透析，而 1364 名成年人中只有 64 名（5%）处于普遍 ESKD 队列中。 4483 名新发 ESKD 队列中有 41 名（1%）成年人、12125 名成年人中（19%）的 2280 名和 381 名儿童中有 71 名（19%）接受了移植。 16 项研究报告了贫血的管理，17 项研究报告了透析频率，8 项研究报告了透析准确性，22 项研究报告了透析血管通路。