Bello Aminu K, McIsaac Mark, Okpechi Ikechi G, Johnson David W, Jha Vivekanand, Harris David C H, Saad Syed, Zaidi Deenaz, Osman Mohamed A, Ye Feng, Lunney Meaghan, Jindal Kailash, Klarenbach Scott, Kalantar-Zadeh Kamyar, Kovesdy Csaba P, Parekh Rulan S, Prasad Bhanu, Khan Maryam, Riaz Parnian, Tonelli Marcello, Wolf Myles, Levin Adeera
Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada.
Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Kidney Int Suppl (2011). 2021 May;11(2):e66-e76. doi: 10.1016/j.kisu.2021.01.001. Epub 2021 Apr 12.
The International Society of Nephrology established the Global Kidney Health Atlas project to define the global capacity for kidney replacement therapy and conservative kidney care, and this second iteration was to describe the availability, accessibility, quality, and affordability of kidney failure (KF) care worldwide. This report presents results for the International Society of Nephrology North America and the Caribbean region. Relative to other regions, the North America and Caribbean region had better infrastructure and funding for health care and more health care workers relative to the population. Various essential medicines were also more available and accessible. There was substantial variation in the prevalence of treated KF in the region, ranging from 137.4 per million population (pmp) in Jamaica to 2196 pmp in the United States. A mix of public and private funding systems cover costs for nondialysis chronic kidney disease care in 60% of countries and for dialysis in 70% of countries. Although the median number of nephrologists is 18.1 (interquartile range, 15.3-29.5) pmp, which is approximately twice the global median of 9.9 (interquartile range, 1.2-22.7) pmp, some countries reported shortages of other health care workers. Dialysis was available in all countries, but peritoneal dialysis was underutilized and unavailable in Barbados, Cayman Islands, and Turks and Caicos. Kidney transplantation was primarily available in Canada and the United States. Economic factors were the major barriers to optimal KF care in the Caribbean countries, and few countries in the region have chronic kidney disease-specific national health care policies. To address regional gaps in KF care delivery, efforts should be directed toward augmenting the workforce, improving the monitoring and reporting of kidney replacement therapy indicators, and implementing noncommunicable disease and chronic kidney disease-specific policies in all countries.
国际肾脏病学会设立了全球肾脏健康地图项目，以确定全球肾脏替代治疗和保守肾脏护理的能力，此次的第二次迭代旨在描述全球范围内肾衰竭（KF）护理的可及性、可获得性、质量和可负担性。本报告展示了国际肾脏病学会北美和加勒比地区的结果。相对于其他地区，北美和加勒比地区拥有更好的医疗保健基础设施和资金，相对于人口而言，医疗保健工作者也更多。各种基本药物的可获得性和可及性也更高。该地区接受治疗的KF患病率存在很大差异，从牙买加的每百万人口137.4例到美国的每百万人口2196例不等。60%的国家的公共和私人资金系统混合覆盖非透析慢性肾脏病护理费用，70%的国家覆盖透析费用。尽管肾病学家的中位数为每百万人口18.1名（四分位间距为15.3 - 29.5），约为全球中位数9.9名（四分位间距为1.2 - 22.7）的两倍，但一些国家报告称其他医疗保健工作者短缺。所有国家都有透析服务，但巴巴多斯、开曼群岛和特克斯和凯科斯群岛的腹膜透析未得到充分利用且无法提供。肾脏移植主要在加拿大和美国提供。经济因素是加勒比国家获得最佳KF护理的主要障碍，该地区很少有国家制定针对慢性肾脏病的国家医疗保健政策。为解决KF护理提供方面的区域差距，应努力增加劳动力，改善肾脏替代治疗指标的监测和报告，并在所有国家实施针对非传染性疾病和慢性肾脏病的政策。
