Van Biesen Wim, Jha Vivekanand, Abu-Alfa Ali K, Andreoli Sharon P, Ashuntantang Gloria, Bernieh Bassam, Brown Edwina, Chen Yuqing, Coppo Rosanna, Couchoud Cecile, Cullis Brett, Douthat Walter, Eke Felicia U, Hemmelgarn Brenda, Hou Fan Fan, Levin Nathan W, Luyckx Valerie A, Morton Rachael L, Moosa Mohammed Rafique, Murtagh Fliss E M, Richards Marie, Rondeau Eric, Schneditz Daniel, Shah Kamal D, Tesar Vladimir, Yeates Karen, Garcia Garcia Guillermo
Nephrology Department, Ghent University Hospital, Ghent, Belgium.
George Institute for Global Health India, New Delhi, India.
Kidney Int Suppl (2011). 2020 Mar;10(1):e63-e71. doi: 10.1016/j.kisu.2019.11.004. Epub 2020 Feb 19.
Achievement of equity in health requires development of a health system in which everyone has a fair opportunity to attain their full health potential. The current, large country-level variation in the reported incidence and prevalence of treated end-stage kidney disease indicates the existence of system-level inequities. Equitable implementation of kidney replacement therapy (KRT) programs must address issues of availability, affordability, and acceptability. The major structural factors that impact equity in KRT in different countries are the organization of health systems, overall health care spending, funding and delivery models, and nature of KRT prioritization (transplantation, hemodialysis or peritoneal dialysis, and conservative care). Implementation of KRT programs has the potential to exacerbate inequity unless equity is deliberately addressed. In this review, we summarize discussions on equitable provision of KRT in low- and middle-income countries and suggest areas for future research.
实现健康公平需要发展一种卫生系统，在该系统中每个人都有公平的机会充分发挥其健康潜力。目前，各国在报告的终末期肾病治疗发病率和患病率方面存在很大差异，这表明存在系统层面的不公平现象。公平实施肾脏替代治疗（KRT）计划必须解决可及性、可负担性和可接受性问题。影响不同国家KRT公平性的主要结构因素包括卫生系统的组织形式、总体医疗保健支出、资金和提供模式以及KRT优先排序的性质（移植、血液透析或腹膜透析以及保守治疗）。除非刻意解决公平问题，否则实施KRT计划有可能加剧不公平。在本综述中，我们总结了关于低收入和中等收入国家公平提供KRT的讨论，并提出了未来研究的领域。
