Kidney Research Institute, Seattle, WA, USA.
Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA, USA.
Nat Rev Nephrol. 2020 Oct;16(10):573-585. doi: 10.1038/s41581-020-0315-4. Epub 2020 Jul 30.
The development of dialysis by early pioneers such as Willem Kolff and Belding Scribner set in motion several dramatic changes in the epidemiology, economics and ethical frameworks for the treatment of kidney failure. However, despite a rapid expansion in the provision of dialysis - particularly haemodialysis and most notably in high-income countries (HICs) - the rate of true patient-centred innovation has slowed. Current trends are particularly concerning from a global perspective: current costs are not sustainable, even for HICs, and globally, most people who develop kidney failure forego treatment, resulting in millions of deaths every year. Thus, there is an urgent need to develop new approaches and dialysis modalities that are cost-effective, accessible and offer improved patient outcomes. Nephrology researchers are increasingly engaging with patients to determine their priorities for meaningful outcomes that should be used to measure progress. The overarching message from this engagement is that while patients value longevity, reducing symptom burden and achieving maximal functional and social rehabilitation are prioritized more highly. In response, patients, payors, regulators and health-care systems are increasingly demanding improved value, which can only come about through true patient-centred innovation that supports high-quality, high-value care. Substantial efforts are now underway to support requisite transformative changes. These efforts need to be catalysed, promoted and fostered through international collaboration and harmonization.
早期先驱者如 Willem Kolff 和 Belding Scribner 开创的透析技术发展，引发了肾脏衰竭治疗的流行病学、经济学和伦理框架的几个重大变化。然而，尽管透析的提供（尤其是血液透析）迅速扩大，尤其是在高收入国家（HICs），真正以患者为中心的创新速度却放缓了。从全球角度来看，当前的趋势尤其令人担忧：即使对于 HICs，当前的成本也不可持续，而且全球范围内，大多数患有肾衰竭的人都放弃了治疗，导致每年有数百万人死亡。因此，迫切需要开发具有成本效益、可及性的新方法和透析模式，并提供改善的患者结果。肾脏病学研究人员越来越多地与患者合作，以确定他们对有意义的结果的优先事项，这些结果应该用于衡量进展。这种合作的首要信息是，尽管患者重视寿命延长，但减轻症状负担和实现最大的功能和社会康复更为重要。作为回应，患者、支付方、监管机构和医疗保健系统越来越要求提高价值，而这只能通过真正以患者为中心的创新来实现，这种创新支持高质量、高价值的护理。目前正在进行大量努力来支持必要的变革。这些努力需要通过国际合作和协调来促进、推广和培育。
