Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa.
BMJ. 2024 Oct 14;387:e079937. doi: 10.1136/bmj-2024-079937.
To assess changes in key measures of kidney care using data reported in 2019 and 2023.
Cross sectional survey in 148 countries.
Surveys from International Society of Nephrology Global Kidney Health Atlas between 2019 and 2023 that included participants from countries in Africa (n=36), Eastern and Central Europe (n=16), Latin America (n=18), the Middle East (n=11), Newly Independent States and Russia (n=10), North America and the Caribbean (n=8), North and East Asia (n=6), Oceania and South East Asia (n=15), South Asia (n=7), and Western Europe (n=21).
Countries that participated in both surveys (2019 and 2023).
Comparison of 2019 and 2023 data for availability of kidney replacement treatment services, access, health financing, workforce, registries, and policies for kidney care. Data for countries that participated in both surveys (2019 and 2023) were included in our analysis. Country data were aggregated by International Society of Nephrology regions and World Bank income levels. Proportionate changes in the status of these measures across both periods were reported.
Data for 148 countries that participated in both surveys were available for analysis. The proportions of countries that provided public funding (free at point of delivery) increased from 27% in 2019 to 28% in 2023 for haemodialysis, 23% to 28% for peritoneal dialysis, and 31% to 36% for kidney transplantation services. Centres for these treatments increased from 4.4 per million population (pmp) to 4.8 pmp (P<0.001) for haemodialysis, 1.4 pmp to 1.6 pmp for peritoneal dialysis, and 0.43 pmp to 0.46 pmp for kidney transplantation services. Overall, access to haemodialysis and peritoneal dialysis improved, however, access to kidney transplantation decreased from 30 pmp to 29 pmp. The global median prevalence of nephrologists increased from 9.5 pmp to 12.4 pmp (P<0.001). Changes in the availability of kidney registries and in national policies and strategies for kidney care were variable across regions and country income levels. The reporting of specific barriers to optimal kidney care by countries increased from 55% to 59% for geographical factors, 58% to 68% (P=0.043) for availability of nephrologists, and 46% to 52% for political factors.
Important changes in key areas of kidney care delivery were noted across both periods globally. These changes effected the availability of, and access to, kidney transplantation services. Countries and regions need to enact enabling strategies for preserving access to kidney care services, particularly kidney transplantation.
利用 2019 年和 2023 年报告的数据评估肾脏护理关键措施的变化。
在 148 个国家进行的横断面调查。
2019 年至 2023 年期间，国际肾脏病学会全球肾脏健康图谱的调查包括来自非洲（n=36）、东欧和中欧（n=16）、拉丁美洲（n=18）、中东（n=11）、独联体和俄罗斯（n=10）、北美和加勒比地区（n=8）、北亚和东亚（n=6）、大洋洲和东南亚（n=15）、南亚（n=7）和西欧（n=21）的国家的参与者。
参加了两次调查（2019 年和 2023 年）的国家。
比较 2019 年和 2023 年肾脏替代治疗服务、可及性、卫生筹资、劳动力、登记册和肾脏护理政策的可用性。我们的分析纳入了参加了两次调查（2019 年和 2023 年）的国家的数据。按国际肾脏病学会区域和世界银行收入水平对国家数据进行了汇总。报告了这两个时期这些措施状况的比例变化。
对参加了两次调查的 148 个国家的数据进行了分析。提供公共资金（免费提供）的国家比例从 2019 年的 27%上升到 2023 年的血液透析 28%，腹膜透析 23%上升到 28%，肾脏移植服务 31%上升到 36%。这些治疗方法的中心从每百万人 4.4 个增加到血液透析 4.8 个（P<0.001），腹膜透析从 1.4 个增加到 1.6 个，肾脏移植从 0.43 个增加到 0.46 个。总的来说，血液透析和腹膜透析的可及性有所改善，但肾脏移植的可及性从 30 个增加到 29 个。全球中位数的肾病学家人数从每百万人 9.5 人增加到 12.4 人（P<0.001）。在肾脏登记册的可用性以及国家肾脏护理政策和战略方面，各国的变化在区域和国家收入水平上存在差异。各国报告的优化肾脏护理的具体障碍从地理因素的 55%增加到 59%，从 58%增加到 68%（P=0.043）的肾病学家可用性，以及从 46%增加到 52%的政治因素。
在全球范围内，肾脏护理提供的关键领域都发生了重要变化。这些变化影响了肾脏移植服务的可及性和可及性。各国和地区需要制定扶持战略，以维持肾脏护理服务的可及性，特别是肾脏移植。
