Centre for Kidney Disease Research, University of Queensland, Brisbane, Australia; Translational Research Institute, Brisbane, Australia; Metro South and Ipswich Nephrology and Transplant Services (MINTS), Princess Alexandra Hospital, Brisbane, Australia.
Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Am J Kidney Dis. 2021 Mar;77(3):315-325. doi: 10.1053/j.ajkd.2020.05.032. Epub 2020 Aug 12.
RATIONALE & OBJECTIVE: Approximately 11% of people with kidney failure worldwide are treated with peritoneal dialysis (PD). This study examined PD use and practice patterns across the globe.
A cross-sectional survey.
SETTING & PARTICIPANTS: Stakeholders including clinicians, policy makers, and patient representatives in 182 countries convened by the International Society of Nephrology between July and September 2018.
PD use, availability, accessibility, affordability, delivery, and reporting of quality outcome measures.
Descriptive statistics.
Responses were received from 88% (n=160) of countries and there were 313 participants (257 nephrologists [82%], 22 non-nephrologist physicians [7%], 6 other health professionals [2%], 17 administrators/policy makers/civil servants [5%], and 11 others [4%]). 85% (n=156) of countries responded to questions about PD. Median PD use was 38.1 per million population. PD was not available in 30 of the 156 (19%) countries responding to PD-related questions, particularly in countries in Africa (20/41) and low-income countries (15/22). In 69% of countries, PD was the initial dialysis modality for≤10% of patients with newly diagnosed kidney failure. Patients receiving PD were expected to pay 1% to 25% of treatment costs, and higher (>75%) copayments (out-of-pocket expenses incurred by patients) were more common in South Asia and low-income countries. Average exchange volumes were adequate (defined as 3-4 exchanges per day or the equivalent for automated PD) in 72% of countries. PD quality outcome monitoring and reporting were variable. Most countries did not measure patient-reported PD outcomes.
Low responses from policy makers; limited ability to provide more in-depth explanations underpinning outcomes from each country due to lack of granular data; lack of objective data.
Large inter- and intraregional disparities exist in PD availability, accessibility, affordability, delivery, and reporting of quality outcome measures around the world, with the greatest gaps observed in Africa and South Asia.
全世界约有 11%的肾衰竭患者接受腹膜透析（peritoneal dialysis，PD）治疗。本研究旨在调查全球 PD 的使用情况和实践模式。
横断面调查。
国际肾脏病学会于 2018 年 7 月至 9 月召集了来自 182 个国家的利益相关者，包括临床医生、政策制定者和患者代表。
PD 的使用、供应、可及性、可负担性、实施以及质量结果衡量指标的报告。
描述性统计分析。
88%（n=160）的国家做出了回应，共有 313 名参与者（257 名肾病医生[82%]、22 名非肾病医生[7%]、6 名其他卫生专业人员[2%]、17 名行政人员/政策制定者/公务员[5%]和 11 名其他人员[4%]）。156 个国家中有 85%（n=156）回答了与 PD 相关的问题。每百万人口 PD 使用中位数为 38.1。在 156 个对 PD 相关问题做出回应的国家中，有 30 个（19%）国家没有 PD，特别是在非洲（20/41）和低收入国家（15/22）。在 69%的国家中，PD 是新诊断肾衰竭患者初始透析方式的比例≤10%。接受 PD 治疗的患者预计需支付治疗费用的 1%至 25%，南亚和低收入国家的患者自付费用（患者产生的现金支出）较高（>75%）。72%的国家的平均交换量充足（定义为每天 3-4 次交换或自动化 PD 的等效交换量）。PD 质量结果监测和报告存在差异。大多数国家未测量患者报告的 PD 结果。
政策制定者的回应率较低；由于缺乏详细数据，无法提供每个国家结果的更深入解释；缺乏客观数据。
全世界 PD 的供应、可及性、可负担性、实施以及质量结果衡量指标的报告存在较大的区域内和区域间差异，在非洲和南亚观察到的差距最大。
