Internal Medicine-Nephrology, Cheikh Anta Diop University, Dakar, Sénégal.
Department of Pediatric Nephrology, St. John's National Academy of Health Sciences, Bangalore, India.
Curr Opin Nephrol Hypertens. 2018 Nov;27(6):463-471. doi: 10.1097/MNH.0000000000000455.
To assess the use, access to and outcomes of hemodialysis and peritoneal dialysis in low-resource settings.
Hemodialysis tends to predominate because of costs and logistics, however services tend to be located in larger cities, often paid for out of pocket. Outcomes of dialysis-requiring acute kidney injury and end-stage kidney disease may be similar with hemodialysis and peritoneal dialysis, and therefore choice of therapy is dominated by availability, accessibility and patient or physician choice. Some countries have implemented peritoneal dialysis-first policies to reduce costs and improve access, because peritoneal dialysis requires less infrastructure, can be scaled up more easily and can be cheaper when fluids are manufactured locally.
Access to both hemodialysis and peritoneal dialysis remains highly inequitable in lower-resource settings. Although challenges associated with dialysis in low-resource settings are similar, and there are more adults who require dialysis in low-resource settings, addressing hemodialysis and peritoneal dialysis needs of children in low-resource settings requires attention as the global inequities are greatest in this area. Lower-income countries are increasingly seeking to improve access to dialysis through various strategies, but meeting the costs of the entire dialysis population continues to be a major challenge.
评估在资源匮乏环境下血液透析和腹膜透析的使用、可及性和结局。
由于成本和后勤方面的原因，血液透析往往更为普遍，但服务往往集中在较大的城市，通常需要自费支付。需要透析的急性肾损伤和终末期肾病的透析结局可能与血液透析和腹膜透析相似，因此治疗方案的选择主要取决于可用性、可及性以及患者或医生的选择。一些国家已经实施了腹膜透析优先政策，以降低成本和提高可及性，因为腹膜透析需要的基础设施较少，更容易扩大规模，并且当地生产透析液时成本更低。
在资源匮乏环境下，血液透析和腹膜透析的可及性仍然极不平等。尽管资源匮乏环境下的透析面临的挑战相似，而且资源匮乏环境下需要透析的成年人更多，但由于在这一领域全球不平等现象最为严重，因此也需要关注资源匮乏环境下儿童的血液透析和腹膜透析需求。越来越多的低收入国家正在通过各种策略寻求提高透析的可及性，但要满足整个透析人群的费用仍然是一个主要挑战。
