Department of Internal Medicine, University of Uyo Teaching Hospital, Uyo, Nigeria.
Division of Nephrology and Hypertension, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
Nephrology (Carlton). 2024 Dec;29(12):873-883. doi: 10.1111/nep.14402. Epub 2024 Oct 6.
Optimal care for patients with kidney failure reduces the risks of adverse health outcomes, including cardiovascular events and death. We evaluated data from the third iteration of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) to assess the capacity for quality service delivery for kidney failure care across countries and regions.
We explored the quality of kidney failure care delivery and the monitoring of quality indicators from data provided by an international survey of stakeholders from countries affiliated with the ISN from July to September 2022.
One hundred and sixty seven countries participated in the survey, representing about 97.4% of the world's population. In countries where haemodialysis (HD) was available, 81% (n = 134) provided standard HD sessions (three times weekly for 3-4 h per session) to patients. Among countries with peritoneal dialysis (PD) services, 61% (n = 101) were able to provide standard PD care (3-4 exchanges per day). In high-income countries, 98% (n = 62) reported that >75% of centers regularly monitored dialysis water quality for bacteria compared to 28% (n = 5) of low-income countries (LICs). Capacity to monitor the administration of immunosuppression drugs was generally available in 21% (n = 4) of LICs, compared to 90% (n = 57) of high-income countries. There was significant variability between and within regions and country income groups in reporting the quality of services utilized for kidney replacement therapies.
Quality assurance standards on diagnostic and treatment tools were variable and particularly infrequent in LICs. Standardization of delivered care is essential for improving outcomes for people with kidney failure.
为肾衰竭患者提供最佳护理可降低不良健康结果的风险，包括心血管事件和死亡。我们评估了国际肾脏病学会全球肾脏健康地图集（ISN-GKHA）第三次迭代的数据分析，以评估各国和各地区提供肾衰竭护理服务的质量。
我们从 2022 年 7 月至 9 月对国际肾脏病学会附属国家利益相关者的国际调查数据中探讨了肾衰竭护理服务的质量和质量指标的监测情况。
167 个国家参与了调查，代表了全球人口的约 97.4%。在提供血液透析（HD）的国家中，81%（n=134）为患者提供标准 HD 治疗（每周 3 次，每次 3-4 小时）。在开展腹膜透析（PD）服务的国家中，61%（n=101）能够提供标准 PD 护理（每天 3-4 次交换）。在高收入国家中，98%（n=62）报告称，与低收入国家（LICs）的 28%（n=5）相比，>75%的中心定期监测透析用水的细菌质量。21%（n=4）的 LICs 能够监测免疫抑制药物的管理，而 90%（n=57）的高收入国家可以做到这一点。在报告用于肾脏替代治疗的服务质量时，不同地区、国家收入组之间以及同一地区、国家收入组内存在很大差异。
诊断和治疗工具的质量保证标准存在差异，在 LICs 中尤为少见。提供的护理标准化对于改善肾衰竭患者的预后至关重要。
