Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore.
Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
Nephrol Dial Transplant. 2024 Sep 5;39(Supplement_2):ii11-ii17. doi: 10.1093/ndt/gfae131.
Hemodialysis (HD) is the most commonly utilized modality for kidney replacement therapy worldwide. This study assesses the organizational structures, availability, accessibility, affordability and quality of HD care worldwide.
This cross-sectional study relied on desk research data as well as survey data from stakeholders (clinicians, policymakers and patient advocates) from countries affiliated with the International Society of Nephrology from July to September 2022.
Overall, 167 countries or jurisdictions participated in the survey. In-center HD was available in 98% of countries with a median global prevalence of 322.7 [interquartile range (IQR) 76.3-648.8] per million population (pmp), ranging from 12.2 (IQR 3.9-103.0) pmp in Africa to 1575 (IQR 282.2-2106.8) pmp in North and East Asia. Overall, home HD was available in 30% of countries, mostly in countries of Western Europe (82%). In 74% of countries, more than half of people with kidney failure were able to access HD. HD centers increased with increasing country income levels from 0.31 pmp in low-income countries to 9.31 pmp in high-income countries. Overall, the annual cost of in-center HD was US$19 380.3 (IQR 11 817.6-38 005.4), and was highest in North America and the Caribbean (US$39 825.9) and lowest in South Asia (US$4310.2). In 19% of countries, HD services could not be accessed by children.
This study shows significant variations that have remained consistent over the years in availability, access and affordability of HD across countries with severe limitations in lower-resourced countries.
血液透析（HD）是全球范围内最常用的肾脏替代治疗方式。本研究评估了全球范围内 HD 治疗的组织架构、可及性、可及性、可负担性和质量。
本横断面研究依赖于桌面研究数据以及 2022 年 7 月至 9 月期间来自国际肾脏病学会附属国家的利益攸关方（临床医生、政策制定者和患者倡导者）的调查数据。
总体而言，167 个国家或司法管辖区参与了调查。中心 HD 在 98%的国家都有提供，全球中位数患病率为每百万人口 322.7[四分位距（IQR）76.3-648.8]，从非洲的 12.2（IQR 3.9-103.0）pmp 到东亚和北亚的 1575（IQR 282.2-2106.8）pmp。总体而言，30%的国家提供家庭 HD，主要在西欧国家（82%）。在 74%的国家中，超过一半的肾衰竭患者能够接受 HD。HD 中心的数量随着国家收入水平的提高而增加，从低收入国家的 0.31 pmp 增加到高收入国家的 9.31 pmp。总体而言，中心 HD 的年费用为 19380.3 美元（IQR 11817.6-38005.4），在北美和加勒比地区最高（39825.9 美元），在南亚最低（4310.2 美元）。在 19%的国家，儿童无法获得 HD 服务。
本研究表明，多年来，全球各国在 HD 的可及性、可及性和可负担性方面存在显著差异，资源较少的国家存在严重限制。
