Alexander Suceena, Jasuja Sanjiv, Gallieni Maurizio, Sahay Manisha, Rana Devender S, Jha Vivekanand, Verma Shalini, Ramachandran Raja, Bhargava Vinant, Sagar Gaurav, Bahl Anupam, Mostafi Mamun, Pisharam Jayakrishnan K, Tang Sydney C W, Jacob Chakko, Gunawan Atma, Leong Goh B, Thwin Khin T, Agrawal Rajendra K, Vareesangthip Kriengsak, Tanchanco Roberto, Choong Lina H L, Herath Chula, Lin Chih C, Cuong Nguyen T, Haian Ha P, Akhtar Syed F, Alsahow Ali, Rajapurkar Mohan M, Kher Vijay, Mehta Hemant, Bhalla Anil K, Khanna Umesh B, Ray Deepak S, Puri Sonika, Jain Himanshu, Lydia Aida, Vachharajani Tushar
Department of Nephrology, Christian Medical College, Vellore 632004, India.
Department of Nephrology, Indraprastha Apollo Hospital, Delhi 110020, India.
Int J Nephrol. 2021 May 6;2021:6665901. doi: 10.1155/2021/6665901. eCollection 2021.
The association between economic status and kidney disease is incompletely explored even in countries with higher economy (HE); the situation is complex in lower economies (LE) of South Asia and Southeast Asia (SA and SEA).
Fifteen countries of SA and SEA categorized as HE and LE, represented by the representatives of the national nephrology societies, participated in this questionnaire and interview-based assessment of the impact of economic status on renal care.
Average incidence and prevalence of end-stage kidney disease (ESKD) per million population (pmp) are 1.8 times and 3.3 times higher in HE. Hemodialysis is the main renal replacement therapy (RRT) (HE-68%, LE-63%). Funding of dialysis in HE is mainly by state (65%) or insurance bodies (30%); out of pocket expenses (OOPE) are high in LE (41%). Highest cost for hemodialysis is in Brunei and Singapore, and lowest in Myanmar and Nepal. Median number of dialysis machines/1000 ESKD population is 110 in HE and 53 in LE. Average number of machines/dialysis units in HE is 2.7 times higher than LE. The HE countries have 9 times more dialysis centers pmp (median HE-17, LE-02) and 16 times more nephrologist density (median HE-14.8 ppm, LE-0.94 ppm). Dialysis sessions >2/week is frequently followed in HE (84%) and <2/week in LE (64%). "On-demand" hemodialysis (<2 sessions/week) is prevalent in LE. Hemodialysis dropout rates at one year are lower in HE (12.3%; LE 53.4%), death being the major cause (HE-93.6%; LE-43.8%); renal transplants constitute 4% (Brunei) to 39% (Hong Kong) of the RRT in HE. ESKD burden is expected to increase >10% in all the HE countries except Taiwan, 10%-20% in the majority of LE countries.
Economic disparity in SA and SEA is reflected by poor dialysis infrastructure and penetration, inadequate manpower, higher OOPE, higher dialysis dropout rates, and lesser renal transplantations in LE countries. Utility of RRT can be improved by state funding and better insurance coverage.
即使在经济较发达的国家，经济状况与肾脏疾病之间的关联也未得到充分研究；在南亚和东南亚经济欠发达地区，情况更为复杂。
南亚和东南亚的15个国家分为经济较发达和欠发达两类，由各国肾脏病学会代表参与，通过问卷调查和访谈评估经济状况对肾脏护理的影响。
经济较发达地区每百万人口终末期肾病（ESKD）的平均发病率和患病率分别是经济欠发达地区的1.8倍和3.3倍。血液透析是主要的肾脏替代治疗（RRT）方式（经济较发达地区-68%，经济欠发达地区-63%）。经济较发达地区透析的资金主要来自国家（65%）或保险机构（30%）；经济欠发达地区的自付费用（OOPE）较高（41%）。血液透析成本最高的是文莱和新加坡，最低的是缅甸和尼泊尔。经济较发达地区每1000名ESKD患者的透析机中位数为110台，经济欠发达地区为53台。经济较发达地区每个透析单位的透析机平均数量比经济欠发达地区高2.7倍。经济较发达地区每百万人口的透析中心数量是经济欠发达地区的9倍（中位数：经济较发达地区-17个，经济欠发达地区-2个），肾病医生密度是经济欠发达地区的16倍（中位数：经济较发达地区-14.8名/百万人口，经济欠发达地区-0.94名/百万人口）。经济较发达地区经常进行每周超过2次的透析治疗（84%），经济欠发达地区则低于每周2次（64%）。“按需”血液透析（每周少于2次）在经济欠发达地区很普遍。经济较发达地区一年的血液透析退出率较低（12.3%；经济欠发达地区为53.4%），主要原因是死亡（经济较发达地区-93.6%；经济欠发达地区-43.8%）；肾脏移植在经济较发达地区的肾脏替代治疗中占4%（文莱）至39%（香港）。除台湾外，所有经济较发达地区的ESKD负担预计将增加超过10%，大多数经济欠发达地区将增加10%-20%。
南亚和东南亚的经济差距体现在透析基础设施和普及率差、人力不足、自付费用高、透析退出率高以及经济欠发达地区肾脏移植较少。国家资助和更好的保险覆盖可以提高肾脏替代治疗的效用。
