Igiraneza Grace, Dusabejambo Vincent, Finklestein Fredric O, Rastegar Asghar
Department of Medicine, University Teaching Hospital of Kigali, Kigali, Rwanda.
Yale University School of Medicine, New Haven, Connecticut, USA.
Kidney Int Rep. 2020 Apr 19;5(7):991-999. doi: 10.1016/j.ekir.2020.04.003. eCollection 2020 Jul.
Acute kidney injury (AKI) is prevalent in low- and middle-income countries (LMIC) and is associated with significant morbidity and mortality, particularly among hospitalized patients. Successful strategies for the prevention and management of AKI in these countries are dependent on the capacity of primary care centers to provide optimal initial management of patients at risk for this disorder.
From December 2018 to February 2019, using mixed methods, we assessed hospital capacity and the knowledge of clinicians relevant to the prevention, diagnosis, and management of AKI in Rwanda. A checklist based on Kidney Disease: Improving Global Outcomes (KDIGO) guidelines and clinical vignette-based assessment tool were used to assess hospital capacity and provider knowledge base, respectively. Data were analyzed using stata 13 with findings reported as simple frequencies or means with standard deviation. Multivariate analysis was used to assess factors associated with a higher knowledge score among clinicians.
Ten hospitals and 193 health care providers from sites throughout Rwanda participated in the survey. Surveyed hospitals were equipped with basic general medical equipment but were deficient in diagnostic tools and medical supplies that would allow the diagnosis and nondialytic management of AKI. Although 20% of the hospitals could offer hemodialysis services, peritoneal dialysis services were nonexistent. With regard to knowledge base, the health care providers demonstrated significant deficiencies in the diagnosis and management of AKI. The mean knowledge score for all health providers was 6.3 (±1.5) of a maximum of 11, with a mean (±SD) score for doctors, nurses, and midwives of 6.3 ± 2.05, 6.4 ± 1.3, and 6.08 ± 1.2, respectively. On multivariate analysis, the length of clinical experience and age of the respondents were significantly associated with participants' knowledge score.
This study documents significant barriers to providing optimal management of AKI in primary health care settings in Rwanda, a resource-limited setting. These include lack of specialized medical personnel, significant knowledge gaps among primary health care providers, suboptimal diagnostic capacity, and limited treatment options for detection and management of AKI.
急性肾损伤（AKI）在低收入和中等收入国家（LMIC）中普遍存在，并且与显著的发病率和死亡率相关，尤其是在住院患者中。在这些国家，预防和管理AKI的成功策略取决于基层医疗中心对有患该疾病风险的患者提供最佳初始管理的能力。
2018年12月至2019年2月，我们采用混合方法评估了卢旺达医院的能力以及临床医生对AKI预防、诊断和管理的知识。分别使用基于《改善全球肾脏病预后（KDIGO）指南》的检查表和基于临床病例的评估工具来评估医院能力和医疗服务提供者的知识基础。使用Stata 13对数据进行分析，结果以简单频率或均值及标准差的形式报告。多变量分析用于评估与临床医生较高知识得分相关的因素。
来自卢旺达各地的10家医院和193名医疗服务提供者参与了调查。接受调查的医院配备了基本的普通医疗设备，但缺乏能够进行AKI诊断和非透析治疗的诊断工具和医疗用品。虽然20%的医院能够提供血液透析服务，但腹膜透析服务不存在。在知识基础方面，医疗服务提供者在AKI的诊断和管理方面存在显著不足。所有医疗服务提供者的平均知识得分为6.3（±1.5）（满分11分），医生、护士和助产士的平均（±标准差）得分分别为6.3±2.05、6.4±1.3和6.08±1.2。多变量分析显示，临床经验时长和受访者年龄与参与者的知识得分显著相关。
本研究记录了在资源有限的卢旺达基层医疗环境中提供AKI最佳管理存在的重大障碍。这些障碍包括缺乏专业医务人员、基层医疗服务提供者之间存在重大知识差距、诊断能力欠佳以及AKI检测和管理的治疗选择有限。
