Department of Nephrology-Dialysis, Renaissance University Hospital Center, University of N'Djamena, Chad, Africa.
Department of Nephrology-Dialysis, Dalal Diam University Hospital Center, Cheikh Anta Diop University of Dakar, Senegal, Africa.
Semin Nephrol. 2023 Jul;43(4):151440. doi: 10.1016/j.semnephrol.2023.151440. Epub 2023 Nov 27.
In lower-income settings there is often a dearth of resources and nephrologists, especially pediatric nephrologists, and individual physicians often find themselves caring for patients with chronic kidney diseases and end-stage kidney failure across the age spectrum. The management of such patients in high-income settings is relatively protocolized and permits high-volume services to run efficiently. The basic principles of managing chronic kidney disease and providing dialysis are similar for adults and children, however, given the differences in body size, causes of kidney failure, nutrition, and growth between children and adults with kidney diseases, nephrologists must understand the relevance of these differences, and have an approach to providing quality and safe dialysis to each group. Prevention, early diagnosis, and early intervention with simple therapeutic and lifestyle interventions are achievable goals to manage symptoms, complications, and reduce progression, or avoid kidney failure in children and adults. These strategies currently are easier to implement in higher-resource settings with robust health systems. In many low-resource settings, kidney diseases are only first diagnosed at end stage, and resources to pay out of pocket for appropriate care are lacking. Many barriers therefore exist in these settings, where specialist nephrology personnel may be least accessible. To improve management of patients at all ages, we highlight differences and similarities, and provide practical guidance on the management of children and adults with chronic kidney disease and kidney failure. It is important that children are managed with a view to optimizing growth and well-being and maximizing future options (eg, maintaining vein health and optimizing cardiovascular risk), and that adults are managed with attention paid to quality of life and optimization of physical health.
在低收入环境中，资源和肾脏病专家（尤其是儿科肾脏病专家）往往匮乏，而且个别医生常常发现自己需要治疗各个年龄段的慢性肾脏病和终末期肾衰竭患者。在高收入环境中，这类患者的管理相对规范化，因此能够高效地开展大量服务。成人和儿童的慢性肾脏病管理和透析提供原则基本相同，然而，鉴于儿童和患有肾脏疾病的成人在体型、肾衰竭原因、营养和生长方面存在差异，肾脏病专家必须了解这些差异，并为每组患者提供高质量和安全的透析。预防、早期诊断和早期干预，采用简单的治疗和生活方式干预，是实现管理症状、并发症和减缓进展或避免儿童和成人肾衰竭的可实现目标。这些策略在资源充足且医疗体系强大的高收入环境中更容易实施。在许多资源匮乏的环境中，肾脏病只有到终末期才首次诊断，而且缺乏支付适当治疗费用的资源。因此，在这些资源匮乏的环境中存在许多障碍，而专科肾脏病人员可能最难以企及。为了改善所有年龄段患者的管理，我们重点介绍了差异和相似之处，并就慢性肾脏病和肾衰竭儿童和成人的管理提供了实用指导。重要的是，儿童的管理应着眼于优化生长和福祉，并最大限度地增加未来选择（例如，保持静脉健康和优化心血管风险），而成年人的管理应注重生活质量和身体健康的优化。
