Garcia Pablo, Strasma Anna K, Wijewickrama Eranga, Arruebo Silvia, Caskey Fergus J, Damster Sandrine, Donner Jo-Ann, Jha Vivekanand, Levin Adeera, Nangaku Masaomi, Saad Syed, Tonelli Marcello, Ye Feng, Okpechi Ikechi G, Bello Aminu K, Johnson David W, Anand Shuchi
Division of Nephrology, Department of Medicine, The University of New Mexico School of Medicine, Albuquerque, New Mexico, United States of America.
Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America.
PLOS Glob Public Health. 2024 Dec 5;4(12):e0004014. doi: 10.1371/journal.pgph.0004014. eCollection 2024.
Chronic kidney disease (CKD) disproportionately affects certain populations as demonstrated by well-established subnational geographic hotspots of CKD in Central America and South Asia. Using data from the third iteration of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA), we aimed to systematically identify sub-national geographic or population clusters with high prevalence of CKD. The ISN-GKHA survey was conducted from July to September 2022, and included questions regarding whether a regional CKD hotspot existed in the respondents' country and possible contributors. A CKD hotspot was defined as a population cluster with a high risk of kidney failure requiring dialysis or transplant, or people dying from kidney failure. Overall, 46 out of 162 responding countries reported subnational hotspots for CKD within their country. Hotspots were reported across all regions, except for the Middle East. Latin America had the highest percentage (12 of 21, 57%) of countries reporting a regional CKD hotspot followed by the regions of North and East Asia, and Western Europe. Adults aged 18 to 44 years and rural populations were most commonly identified as the primary groups affected. Clinical factors were most commonly identified as contributors to CKD (hypertension in 74% and diabetes in 72%), followed by cultural (e.g., diet and herbal medications in 67%), and environmental (e.g., polluted water in 43%) factors. Latin American countries more commonly reported climate, cultural, and environmental factors as contributors compared to other regions. Across the world, there are a number of subnational regions where in-country experts identify a disproportionately higher burden of CKD, commonly occurring among younger age groups with clinical, cultural, and environmental contributors specific to these geographic regions. In-depth studies, starting with systematic epidemiology efforts, are needed to investigate the aetiopathogenesis of these CKD hotspots around the world so that tailored interventions can be offered.
慢性肾脏病（CKD）对某些人群的影响尤为严重，中美洲和南亚已确定的国家以下层面的CKD地理热点地区就证明了这一点。利用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，我们旨在系统地识别CKD高患病率的国家以下层面的地理或人群集群。ISN-GKHA调查于2022年7月至9月进行，包括关于受访者所在国家是否存在地区性CKD热点地区以及可能的影响因素的问题。CKD热点地区被定义为肾衰竭风险高、需要透析或移植的人群集群，或死于肾衰竭的人群。总体而言，162个回复国家中有46个报告了其国内存在国家以下层面的CKD热点地区。除中东地区外，所有地区均报告了热点地区。拉丁美洲报告有地区性CKD热点地区的国家比例最高（21个国家中的12个，占57%），其次是东亚和北亚地区以及西欧。18至44岁的成年人和农村人口最常被确定为受影响的主要群体。临床因素最常被确定为CKD的影响因素（高血压占74%，糖尿病占72%），其次是文化因素（如饮食和草药占67%）和环境因素（如受污染的水占43%）。与其他地区相比，拉丁美洲国家更常报告气候、文化和环境因素为影响因素。在全球范围内，有许多国家以下层面的地区，国内专家认为这些地区的CKD负担过高，且通常发生在较年轻的年龄组中，这些地区有特定的临床、文化和环境影响因素。需要从系统的流行病学研究开始进行深入研究，以调查世界各地这些CKD热点地区的病因发病机制，从而提供针对性的干预措施。
