Htay Htay, Alrukhaimi Mona, Ashuntantang Gloria E, Bello Aminu K, Bellorin-Font Ezequiel, Benghanem Gharbi Mohammed, Braam Branko, Feehally John, Harris David C, Jha Vivekanand, Jindal Kailash, Kalantar-Zadeh Kamyar, Kazancioglu Rumeyza, Kerr Peter G, Levin Adeera, Lunney Meaghan, Okpechi Ikechi G, Olah Michelle E, Olanrewaju Timothy Olusegun, Osman Mohamed A, Parpia Yasin, Perl Jeffrey, Qarni Bilal, Rashid Harun Ur, Rateb Ahmed, Rondeau Eric, Salako Babatunde Lawal, Sola Laura, Tchokhonelidze Irma, Tonelli Marcello, Wiebe Natasha, Wirzba Isaac, Yang Chih-Wei, Ye Feng, Zemchenkov Alexander, Zhao Ming-Hui, Johnson David W
Department of Nephrology, Metro South and Ipswich Nephrology and Transplant Services (MINTS), Princess Alexandra Hospital, Brisbane, Australia.
Department of Renal Medicine, Singapore General Hospital, Singapore.
Kidney Int Suppl (2011). 2018 Feb;8(2):64-73. doi: 10.1016/j.kisu.2017.10.010. Epub 2018 Jan 19.
Access to essential medications and health products is critical to effective management of kidney disease. Using data from the ISN Global Kidney Health Atlas multinational cross-sectional survey, global access of patients with kidney disease to essential medications and health products was examined. Overall, 125 countries participated, with 118 countries, composing 91.5% of the world's population, providing data on this domain. Most countries were unable to access eGFR and albuminuria in their primary care settings. Only one-third of low-income countries (LICs) were able to measure serum creatinine and none were able to access eGFR or quantify proteinuria. The ability to monitor diabetes mellitus through serum glucose and glycated hemoglobin measurements was suboptimal. Pathology services were rarely available in tertiary care in LICs (12%) and lower middle-income countries (45%). While acute and chronic hemodialysis services were available in almost all countries, acute and chronic peritoneal dialysis services were rarely available in LICs (18% and 29%, respectively). Kidney transplantation was available in 79% of countries overall and in 12% of LICs. While over one-half of all countries publicly funded RRT and kidney medications with or without copayment, this was less common in LICs and lower middle-income countries. In conclusion, this study demonstrated significant gaps in services for kidney care and funding that were most apparent in LICs and lower middle-income countries.
获得基本药物和保健产品对于有效管理肾脏疾病至关重要。利用国际肾脏病学会全球肾脏健康地图集跨国横断面调查的数据，对全球肾病患者获得基本药物和保健产品的情况进行了研究。总体而言，有125个国家参与，其中118个国家（占世界人口的91.5%）提供了该领域的数据。大多数国家在其初级保健机构中无法获得估算肾小球滤过率（eGFR）和蛋白尿数据。只有三分之一的低收入国家能够检测血清肌酐，没有一个国家能够获得eGFR或定量蛋白尿。通过检测血糖和糖化血红蛋白来监测糖尿病的能力欠佳。在低收入国家（12%）和中低收入国家（45%）的三级医疗中，病理服务很少提供。虽然几乎所有国家都提供急性和慢性血液透析服务，但低收入国家的急性和慢性腹膜透析服务很少（分别为18%和29%）。总体上79%的国家可提供肾脏移植服务，在低收入国家这一比例为12%。虽然超过一半的国家为肾脏替代治疗（RRT）和肾脏药物提供公共资金，无论是否有共付费用，但在低收入国家和中低收入国家这种情况较少见。总之，这项研究表明，肾脏护理服务和资金方面存在显著差距，在低收入国家和中低收入国家最为明显。
