Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Division of Nephrology and Hypertension, Department of Medicine, University of Cape Town, Cape Town, South Africa.
Nephrol Dial Transplant. 2024 Oct 30;39(11):1762-1771. doi: 10.1093/ndt/gfae116.
Kidney diseases have become a global epidemic with significant public health impact. Chronic kidney disease (CKD) is set to become the fifth largest cause of death by 2040, with major impacts on low-resource countries. This review is based on a recent report of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) which uncovered gaps in key vehicles of kidney care delivery assessed using World Health Organization building blocks for health systems (financing, services delivery, workforce, access to essential medicines, health information systems and leadership/governance). High-income countries had more centres for kidney replacement therapies (KRT), higher KRT access, higher allocation of public funds to KRT, larger workforces, more health information systems, and higher government recognition of CKD and KRT as health priorities than low-income nations. Evidence identified from the current ISN-GKHA initiative should serve as template for generating and advancing policies and partnerships to address the global burden of kidney disease. The results provide opportunities for kidney health policymakers, nephrology leaders and organizations to initiate consultations to identify strategies for improving care delivery and access in equitable, resource-sensitive manners. Policies to increase use of public funding for kidney care, lower the cost of KRT and increase workforces should be a high priority in low-resource nations, while strategies that expand access to kidney care and maintain current status of care should be prioritized in high-income countries. In all countries, the perspectives of people with CKD should be exhaustively explored to identify core kidney care priorities.
肾脏疾病已成为全球范围内具有重大公共卫生影响的流行疾病。到 2040 年，慢性肾脏病（CKD）将成为第五大死亡原因，对资源匮乏国家的影响尤为严重。本综述基于国际肾脏病学会全球肾脏健康地图集（ISN-GKHA）的一份最新报告，该报告揭示了使用世界卫生组织卫生系统构建模块（融资、服务提供、劳动力、基本药物获取、卫生信息系统和领导力/治理）评估的肾脏保健服务提供的关键载体方面存在差距。高收入国家拥有更多的肾脏替代治疗（KRT）中心，KRT 机会更多，公共资金对 KRT 的分配更多，劳动力更大，卫生信息系统更多，政府对 CKD 和 KRT 的重视程度更高作为健康优先事项比低收入国家。从当前的 ISN-GKHA 倡议中获得的证据应该作为制定和推进政策和伙伴关系的模板，以解决全球肾脏疾病负担。结果为肾脏健康政策制定者、肾脏病学领导者和组织提供了机会，以启动磋商，确定以公平、资源敏感的方式改善护理提供和获取的策略。增加公共资金用于肾脏保健、降低 KRT 成本和增加劳动力的政策应成为资源匮乏国家的重中之重，而扩大肾脏保健机会和维持现有保健水平的战略应成为高收入国家的优先事项。在所有国家，都应详尽探讨慢性肾脏病患者的观点，以确定核心肾脏保健优先事项。
