Division of Vascular Surgery and Endovascular Therapy, University of Colorado, Anschutz School of Medicine, Aurora, CO.
Division of Vascular Surgery, University of California Los Angeles, David Geffen School of Medicine, 200 UCLA Medical Plaza, Suite 526, Los Angeles, CA 90095.
Semin Vasc Surg. 2021 Mar;34(1):71-78. doi: 10.1053/j.semvascsurg.2021.02.010. Epub 2021 Feb 4.
End-stage kidney disease (ESKD) is a common and morbid disease that affects patients' quality and length of life, representing a large portion of health care expenditure in the United States. These patients commonly have associated diabetes and cardiovascular disease, with high rates of cardiovascular-related death. Management of ESKD requires renal replacement therapy via dialysis or transplantation. While transplantation provides the greatest improvement in survival and quality of life, the vast majority of patients are treated initially with hemodialysis. However, outcomes differ significantly among patient populations. Barriers in access to care have particularly affected at-risk populations, such as Black and Hispanic patients. These patients receive less pre-ESKD nephrology care, are less likely to initiate dialysis with a fistula, and wait longer for transplants-even in pediatric populations. Priorities for ESKD care moving into the future include increasing access to nephrology care in underprivileged populations, providing patient-centered care based on each patient's "life plan," and focusing on team-based approaches to ESKD care. This review explores ESKD from the perspective of epidemiology, costs, vascular access, patient-reported outcomes, racial disparities, and the impact of the COVID-19 crisis.
终末期肾病（ESKD）是一种常见且严重的疾病，会影响患者的生活质量和寿命，占美国医疗保健支出的很大一部分。这些患者通常伴有糖尿病和心血管疾病，心血管相关死亡率较高。ESKD 的治疗需要通过透析或移植进行肾脏替代治疗。虽然移植能最大程度地提高生存率和生活质量，但绝大多数患者最初还是接受血液透析治疗。然而，患者群体之间的治疗效果存在显著差异。获得医疗服务的障碍尤其影响了高危人群，如黑人和西班牙裔患者。这些患者接受的预 ESKD 肾病护理较少，更不可能一开始就用瘘管进行透析，而且即使是在儿科人群中，等待移植的时间也更长。未来 ESKD 护理的重点包括增加贫困人群获得肾病护理的机会，根据每个患者的“生活计划”提供以患者为中心的护理，并关注以团队为基础的 ESKD 护理方法。本综述从流行病学、成本、血管通路、患者报告的结果、种族差异以及 COVID-19 危机的角度探讨了 ESKD。
