Erickson Robin L, Kamath Nivedita, Iyengar Arpana, Ademola Adebowale, Esezobor Christopher, Lalji Rowena, Hedin Erin, 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
Paediatric Kidney Service, Starship Children's Hospital, University of Auckland, Auckland, New Zealand.
Department of Pediatric Nephrology, St. John's Medical College Hospital, Bangalore, India.
PLOS Glob Public Health. 2024 Dec 20;4(12):e0004086. doi: 10.1371/journal.pgph.0004086. eCollection 2024.
Vulnerable populations, such as the elderly, children, displaced people, and refugees, often encounter challenges in accessing healthcare. In this study, we used data from the third iteration of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) to describe kidney care access and delivery to vulnerable populations across countries and regions. Using data from an international survey of clinicians, policymakers, and patient advocates, we assessed the funding and coverage of vulnerable populations on all aspects of kidney replacement therapies (KRT). Overall, 167 countries or jurisdictions participated in the survey, representing 97.4% of the world's population. Children had less access than adults to KRT: hemodialysis (HD) in 74% of countries, peritoneal dialysis (PD) in 53% of countries, and kidney transplantation (KT) in 80% of countries. Available nephrologist workforce for pediatric kidney care was much lower than for adults (0.69 per million population [pmp] vs 10.08 pmp). Refugees or displaced people with kidney failure did not have access to HD, PD, or KT in 21%, 33%, and 37% of the participating countries, respectively. Low-income countries (LICs) were less likely to provide KRT access to refugees compared to high-income countries (HICs): HD: 13% vs 22%; PD: 19% vs 61%; KT: 30% vs 44%. Testing for kidney disease was routinely offered to elderly people in only 61% of countries: LICs (45%), lower-middle-income countries (56%), upper-middle-income countries (54%), and HICs (75%). Equitable access to kidney care for vulnerable people, particularly for children and displaced people, remains an area of unmet need. Strategies are needed to address this issue.
弱势群体，如老年人、儿童、流离失所者和难民，在获得医疗保健方面往往面临挑战。在本研究中，我们使用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，来描述各国和各地区弱势群体的肾脏护理获取和提供情况。通过对临床医生、政策制定者和患者倡导者进行的一项国际调查所获得的数据，我们评估了弱势群体在肾脏替代疗法（KRT）各个方面的资金和覆盖情况。总体而言，167个国家或司法管辖区参与了调查，占世界人口的97.4%。儿童获得KRT的机会比成人少：在74%的国家中儿童接受血液透析（HD）的机会较少，在53%的国家中接受腹膜透析（PD）的机会较少，在80%的国家中接受肾脏移植（KT）的机会较少。可用于儿科肾脏护理的肾病医生人力远远低于成人（每百万人口0.69人对比每百万人口10.08人）。在21%、33%和37%的参与国家中，患有肾衰竭的难民或流离失所者分别无法获得HD、PD或KT。与高收入国家（HIC）相比，低收入国家（LIC）为难民提供KRT的可能性较小：HD：13%对比22%；PD：19%对比
