新冠疫情揭示了低收入和中低收入国家血液透析护理方面严重的全球不平等现象——国际肾脏病学会/透析预后与实践模式研究（ISN/DOPPS）调查

The COVID-19 Pandemic Identifies Significant Global Inequities in Hemodialysis Care in Low and Lower-Middle Income Countries-An ISN/DOPPS Survey.

作者信息

Tannor Elliot Koranteng, Bieber Brian, Aylward Ryan, Luyckx Valerie, Shah Dibya Singh, Liew Adrian, Evans Rhys, Phiri Chimota, Guedes Murilo, Pisoni Ronald, Robinson Bruce, Caskey Fergus, Jha Vivekanand, Pecoits-Filho Roberto, Dreyer Gavin

机构信息

Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.

Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA.

出版信息

Kidney Int Rep. 2022 May;7(5):971-982. doi: 10.1016/j.ekir.2022.02.027. Epub 2022 Mar 11.

INTRODUCTION

It is unknown how the COVID-19 pandemic has affected the care of vulnerable chronic hemodialysis (HD) patients across regions, particularly in low and lower-middle income countries (LLMICs). We aimed to identify global inequities in HD care delivery during the COVID-19 pandemic.

METHODS

The ISN and the Dialysis Outcomes and Practice Patterns Study (DOPPS) conducted a global online survey of HD units between March and November, 2020, to ascertain practice patterns and access to resources relevant to HD care during the COVID-19 pandemic. Responses were categorized according to World Bank income classification for comparisons.

RESULTS

Surveys were returned from 412 facilities in 78 countries: 15 (4%) in low-income countries (LICs), 111 (27%) in lower-middle income countries (LMICs), 145 (35%) in upper-middle income countries (UMICs), and 141 (34%) in high-income countries (HICs). Respondents reported that diagnostic tests for SARS-CoV-2 were unavailable or of limited availability in LICs (72%) and LMICs (68%) as compared with UMICs (33%) and HICs (20%). The number of patients who missed HD treatments was reported to have increased during the COVID-19 pandemic in LICs (64%) and LMICs (67%) as compared with UMICs (31%) and HICs (6%). Limited access to HD, intensive care unit (ICU) care, and mechanical ventilation among hospitalized patients on chronic dialysis with COVID-19 were also reportedly higher in LICs and LMICs as compared with UMICs and HICs. Staff in LLMICs reported less routine testing for SARS-CoV-2 when asymptomatic as compared with UMICs and HICs-14% in LICs and 11% in LMICs, compared with 26% and 28% in UMICs and HICs, respectively. Severe shortages of personal protective equipment (PPE) were reported by the respondents from LICs and LMICs compared with UMICs and HICs, especially with respect to the use of the N95 particulate-air respirator masks.

CONCLUSION

Striking global inequities were identified in the care of chronic HD patients during the pandemic. Urgent action is required to address these inequities which disproportionately affect LLMIC settings thereby exacerbating pre-existing vulnerabilities that may contribute to poorer outcomes.

引言

新冠疫情如何影响各地区弱势慢性血液透析（HD）患者的护理情况尚不清楚，尤其是在低收入和中低收入国家（LLMICs）。我们旨在确定新冠疫情期间血液透析护理服务中的全球不平等现象。

方法

国际肾脏病学会（ISN）和透析结果与实践模式研究（DOPPS）在2020年3月至11月期间对血液透析单位进行了一项全球在线调查，以确定新冠疫情期间与血液透析护理相关的实践模式和资源获取情况。根据世界银行的收入分类对回复进行分类以作比较。

结果

来自78个国家的412个机构回复了调查：低收入国家（LICs）有15个（4%），中低收入国家（LMICs）有111个（27%），中高收入国家（UMICs）有145个（35%），高收入国家（HICs）有141个（34%）。受访者报告称，与中高收入国家（33%）和高收入国家（20%）相比，低收入国家（72%）和中低收入国家（68%）无法获得或只能有限获得新冠病毒诊断检测。据报告，在新冠疫情期间，低收入国家（64%）和中低收入国家（67%）错过血液透析治疗的患者数量有所增加，而中高收入国家为（31%），高收入国家为（6%）。据报道，与中高收入国家和高收入国家相比，低收入和中低收入国家中感染新冠病毒的慢性透析住院患者获得血液透析、重症监护病房（ICU）护理和机械通气的机会也有限。与中高收入国家和高收入国家相比，中低收入国家的工作人员报告称，无症状时进行新冠病毒常规检测的比例较低——低收入国家为14%，中低收入国家为11%，而中高收入国家和高收入国家分别为26%和28%。与中高收入国家和高收入国家相比，低收入国家和中低收入国家的受访者报告称个人防护装备（PPE）严重短缺，尤其是在使用N95颗粒物空气呼吸器口罩方面。