Division of Nephrology and Hypertension, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, Western Cape, South Africa.
Internal Medicine Department, Kilimanjaro Christian Medical University College, Kilimanjaro, Moshi, Tanzania.
PLoS One. 2017 Apr 18;12(4):e0176041. doi: 10.1371/journal.pone.0176041. eCollection 2017.
End Stage Kidney Disease (ESKD) is a public health problem with an enormous economic burden. In resource limited settings management of ESKD is often rationed. Racial and socio-economic inequalities in selecting candidates have been previously documented in South Africa. New guidelines for dialysis developed in the Western Cape have focused on prioritizing treatment. With this in mind we aimed at exploring whether the new guidelines would improve inequalities previously documented. A retrospective study of patients presented to the selection committee was conducted at Groote Schuur Hospital. A total of 564 ESKD patients presented between 1 January 2008 and 31 December 2012 were assessed. Half of the patients came from low socioeconomic areas, and presentation was late with either overt uremia (n = 181, 44·4%) or fluid overload (n = 179, 43·9%). More than half (53·9%) of the patients were not selected for the program. Predictors of non-acceptance onto the program included age above 50 years (OR 0·3, p = 0·001), unemployment (OR 0·3, p<0·001), substance abuse (OR 0·2, p<0·001), diabetes (OR 0·4, p = 0·016) and a poor psychosocial assessment (OR 0·13, p<0·001). Race, gender and marital status were not predictors. The use of new guidelines has not led to an increase in inequalities. In view of the advanced nature of presentation greater efforts need to be made to prevent early kidney disease, to allocate more resources to renal replacement therapy in view of the loss of young and potentially productive life.
终末期肾病（ESKD）是一个具有巨大经济负担的公共卫生问题。在资源有限的情况下，ESKD 的管理通常是配给制的。在南非，以前有记录表明在选择候选人方面存在种族和社会经济不平等。西开普省制定的新透析指南侧重于优先治疗。考虑到这一点，我们旨在探讨新指南是否会改善以前记录的不平等。我们在格罗特舒尔医院对选拔委员会提交的患者进行了回顾性研究。评估了 2008 年 1 月 1 日至 2012 年 12 月 31 日期间向选拔委员会提交的 564 名 ESKD 患者。一半的患者来自低社会经济地区，就诊时间较晚，要么明显尿毒症（n = 181，44·4%），要么液体超负荷（n = 179，43·9%）。超过一半（53·9%）的患者未被选入该项目。不能接受该项目的预测因素包括年龄超过 50 岁（OR 0·3，p = 0·001）、失业（OR 0·3，p<0·001）、药物滥用（OR 0·2，p<0·001）、糖尿病（OR 0·4，p = 0·016）和较差的社会心理评估（OR 0·13，p<0·001）。种族、性别和婚姻状况不是预测因素。新指南的使用并没有导致不平等加剧。鉴于就诊的晚期性质，需要做出更大的努力来预防早期肾脏疾病，并考虑到年轻和潜在生产力的生命损失，为肾脏替代治疗分配更多资源。
