Nkunu Victoria, Tungsanga Somkanya, Diongole Hassane M, Sarki Abdulshahid, Arruebo Silvia, Caskey Fergus J, Damster Sandrine, Donner Jo-Ann, Jha Vivekanand, Levin Adeera, Nangaku Masaomi, Saad Syed, Ye Feng, Okpechi Ikechi G, Bello Aminu K, Johnson David W, Tonelli Marcello
Division of General Internal Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
PLOS Glob Public Health. 2024 Dec 2;4(12):e0003979. doi: 10.1371/journal.pgph.0003979. eCollection 2024.
In low- and lower-middle-income countries (LLMICs), delivering equitable kidney care presents substantial challenges, resulting in significant disparities in disease management and treatment outcomes for people with kidney failure. This comprehensive report leveraged data from the International Society of Nephrology-Global Kidney Health Atlas (ISN-GKHA), to provide a detailed update on the landscape of kidney replacement therapy (KRT) in LLMICs. Among the 65 participating LLMICs, reimbursement for KRT (publicly funded by the government and free at the point of delivery) was available in 28%, 15%, and 8% for hemodialysis (HD), peritoneal dialysis (PD), and kidney transplantation (KT), respectively. Additionally, while 56% and 28% of LLMICs reported the capacity to provide quality HD and PD, only 41% reported accessibility to chronic dialysis, defined as >50% of the national population being able to access KRT, and a mere 5% LLMICs reported accessibility to KT. Workforce shortages in nephrology further compound these challenges. Kidney registries and comprehensive policies for non-communicable diseases and chronic kidney disease care were limited in LLMICs. A comprehensive and cost-effective approach is crucial to address these challenges. Collaboration at global, regional, country, and individual levels is essential to enhance the quality of kidney care across LLMICs.
在低收入和中低收入国家（LLMICs），提供公平的肾脏护理面临重大挑战，导致肾衰竭患者在疾病管理和治疗结果方面存在显著差异。本综合报告利用了国际肾脏病学会全球肾脏健康地图集（ISN-GKHA）的数据，详细介绍了LLMICs中肾脏替代治疗（KRT）的情况。在65个参与的LLMICs中，KRT（由政府公共资助且在提供时免费）的报销比例分别为血液透析（HD）28%、腹膜透析（PD）15%和肾移植（KT）8%。此外，虽然56%和28%的LLMICs报告有提供高质量HD和PD的能力，但只有41%报告有慢性透析的可及性，即全国超过50%的人口能够获得KRT，而只有5%的LLMICs报告有KT的可及性。肾脏病学方面的劳动力短缺进一步加剧了这些挑战。LLMICs中肾脏登记系统以及非传染性疾病和慢性肾脏病护理的综合政策都很有限。采取全面且具有成本效益的方法对于应对这些挑战至关重要。全球、区域、国家和个人层面的合作对于提高LLMICs的肾脏护理质量至关重要。
