南非东开普省肾脏替代治疗状况：行动呼吁。

Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa; Department of Internal Medicine, Faculty of Health Sciences, Walter Sisulu University and Nelson Mandela Academic Hospital, Mthatha, South Africa.

Department of Surgery, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.

S Afr Med J. 2023 Mar 8;113(4):e313. doi: 10.7196/SAMJ.2023.v113i4.313.

BACKGROUND

South Africa (SA) is one of the most financially unequal countries in the world. This situation is highlighted by disparate access to healthcare, particularly provision of kidney replacement therapy (KRT). Unlike the private sector, public sector access to KRT is highly rationed, and patient selection is based on suitability for transplantation and capacity.

OBJECTIVES

To investigate the state of the KRT service in Eastern Cape Province, SA, by analysing access to and provision of KRT in the province for individuals with end-stage kidney disease, as well as disparities between the private and public healthcare systems.

METHODS

This was a retrospective descriptive study to examine KRT provision and temporal trends in the Eastern Cape. Data were obtained from the South African Renal Registry and the National Transplant Waiting List. KRT provision was compared between the three main referral centres, in Gqeberha (formerly Port Elizabeth), East London and Mthatha, and between the private and public healthcare systems.

RESULTS

There were 978 patients receiving KRT in the Eastern Cape, with an overall treatment rate of 146 per million population (pmp). The treatment rate for the private sector was 1 435 pmp, compared with 49 pmp in the public sector. Patients treated in the private sector were older at initiation of KRT (52 v. 34 years), and more likely to be male, to be HIV positive, and to receive haemodialysis as their KRT modality. Peritoneal dialysis was more commonly used in Gqeberha and East London as the first and subsequent KRT modality, compared with Mthatha. There were no patients from Mthatha on the transplant waiting list. There were no waitlisted HIV-positive patients in the public sector in East London, compared with 16% of the public sector patients in Gqeberha. The kidney transplant prevalence rate was 58 pmp in the private sector and 19 pmp in the public sector, with a combined prevalence of 22 pmp, constituting 14.9% of all patients on KRT. We estimated the shortfall of KRT provision in the public sector to be ~8 606 patients.

CONCLUSION

Patients in the private sector were 29 times more likely to access KRT than their public sector counterparts, who were on average 18 years younger at initiation of KRT, probably reflecting selection bias in an overburdened public health system. Transplantation rates were low in both sectors, and lowest in Mthatha. A large public sector KRT provision gap exists in the Eastern Cape and needs to be addressed urgently.

背景

南非是世界上贫富差距最大的国家之一。这种情况在医疗保健方面表现得尤为明显，尤其是在肾脏替代疗法（KRT）的提供方面。与私营部门不同，公共部门的 KRT 服务受到高度限制，患者的选择基于是否适合移植和是否有能力接受治疗。

目的

通过分析东开普省（南非）终末期肾病患者接受 KRT 的机会和 KRT 的提供情况，以及私营和公共医疗保健系统之间的差异，研究该省的 KRT 服务状况。

方法

这是一项回顾性描述性研究，旨在检查东开普省的 KRT 服务提供情况和时间趋势。数据来自南非肾脏登记处和国家移植等候名单。比较了格贝哈（原名伊丽莎白港）、东伦敦和姆塔塔三个主要转诊中心之间以及私营和公共医疗保健系统之间的 KRT 服务提供情况。

结果

东开普省有 978 名患者接受 KRT 治疗，总治疗率为每百万人 146 人（pmp）。私营部门的治疗率为 1435 pmp，而公共部门为 49 pmp。接受 KRT 治疗的私营部门患者在开始 KRT 时年龄更大（52 岁比 34 岁），且更可能为男性、HIV 阳性，以及接受血液透析作为其 KRT 治疗方式。与姆塔塔相比，格贝哈和东伦敦更常将腹膜透析作为最初和后续的 KRT 治疗方式。姆塔塔没有患者在移植等候名单上。东伦敦公共部门没有等候接受移植的 HIV 阳性患者，而格贝哈的公共部门患者中有 16%是 HIV 阳性。私营部门的肾脏移植患病率为 58 pmp，公共部门为 19 pmp，两者合计患病率为 22 pmp，占所有接受 KRT 治疗患者的 14.9%。我们估计公共部门的 KRT 服务缺口约为 8606 人。