Kelly Dearbhla M, Anders Hans-Joachim, Bello Aminu K, Choukroun Gabriel, Coppo Rosanna, Dreyer Gavin, Eckardt Kai-Uwe, Johnson David W, Jha Vivekanand, Harris David C H, Levin Adeera, Lunney Meaghan, Luyckx Valerie, Marti Hans-Peter, Messa Piergiorgio, Mueller Thomas F, Saad Syed, Stengel Benedicte, Vanholder Raymond C, Weinstein Talia, Khan Maryam, Zaidi Deenaz, Osman Mohamed A, Ye Feng, Tonelli Marcello, Okpechi Ikechi G, Rondeau Eric
Wolfson Centre for the Prevention of Stroke and Dementia, University of Oxford, John Radcliffe Hospital, Oxford, UK.
Department of Nephrology, Beaumont Hospital, Dublin, Ireland.
Kidney Int Suppl (2011). 2021 May;11(2):e106-e118. doi: 10.1016/j.kisu.2021.01.007. Epub 2021 Apr 12.
Populations in the high-income countries of Western Europe are aging due to increased life expectancy. As the prevalence of diabetes and obesity has increased, so has the burden of kidney failure. To determine the global capacity for kidney replacement therapy and conservative kidney management, the International Society of Nephrology conducted multinational, cross-sectional surveys and published the findings in the International Society of Nephrology Global Kidney Health Atlas. In the second iteration of the International Society of Nephrology Global Kidney Health Atlas, we aimed to describe the availability, accessibility, quality, and affordability of kidney failure care in Western Europe. Among the 29 countries in Western Europe, 21 (72.4%) responded, representing 99% of the region's population. The burden of kidney failure prevalence varied widely, ranging from 760 per million population (pmp) in Iceland to 1612 pmp in Portugal. Coverage of kidney replacement therapy from public funding was nearly universal, with the exceptions of Germany and Liechtenstein where part of the costs was covered by mandatory insurance. Fourteen (67%) of 21 countries charged no fees at the point of care delivery, but in 5 countries (24%), patients do pay some out-of-pocket costs. Long-term dialysis services (both hemodialysis and peritoneal dialysis) were available in all countries in the region, and kidney transplantation services were available in 19 (90%) countries. The incidence of kidney transplantation varied widely between countries from 12 pmp in Luxembourg to 70.45 pmp in Spain. Conservative kidney care was available in 18 (90%) of 21 countries. The median number of nephrologists was 22.9 pmp (range: 9.47-55.75 pmp). These data highlight the uniform capacity of Western Europe to provide kidney failure care, but also the scope for improvement in disease prevention and management, as exemplified by the variability in disease burden and transplantation rates.
由于预期寿命延长，西欧高收入国家的人口正在老龄化。随着糖尿病和肥胖症患病率的上升，肾衰竭负担也在增加。为了确定全球肾脏替代治疗和保守肾脏管理的能力，国际肾脏病学会开展了多国横断面调查，并在《国际肾脏病学会全球肾脏健康地图集》上发表了研究结果。在《国际肾脏病学会全球肾脏健康地图集》的第二次迭代中，我们旨在描述西欧肾衰竭护理的可及性、可获得性、质量和可负担性。在西欧的29个国家中，21个国家（72.4%）作出了回应，占该地区人口的99%。肾衰竭患病率负担差异很大，从冰岛的每百万人口760例到葡萄牙的每百万人口1612例不等。公共资金用于肾脏替代治疗的覆盖率几乎是普遍的，德国和列支敦士登除外，在这两个国家，部分费用由强制保险支付。21个国家中有14个（67%）在护理提供点不收费，但在5个国家（24%），患者确实需要支付一些自付费用。该地区所有国家都提供长期透析服务（血液透析和腹膜透析），19个国家（90%）提供肾脏移植服务。各国之间肾脏移植的发生率差异很大，从卢森堡的每百万人口12例到西班牙的每百万人口70.45例不等。21个国家中有18个（90%）提供保守肾脏护理。肾病科医生的中位数为每百万人口22.9名（范围：每百万人口9.47 - 55.75名）。这些数据凸显了西欧提供肾衰竭护理的统一能力，但也表明在疾病预防和管理方面仍有改进空间，疾病负担和移植率的差异就是例证。
