Chugh K S, Jha V
Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Kidney Int Suppl. 1995 Aug;50:S7-13.
RRT has crossed the threshold of clinical applications, and its value as an effective modality for management of ESRD is fully established. However, RRT has emphasized the wide gap between developed and developing countries. Most of the developed nations are able to provide sufficient funds, directly or indirectly, for RRT and have organized cadaver donor networks. However, providing RRT is particulary difficult in the developing countries where national incomes are not sufficient to cover even the basic requirements of their citizens. Although some developing countries are making active efforts to establish cadaver donor transplant programs, these are virtually nonexistent in the majority at this time. The abject poverty in the developing world and the increasing success rate of transplantation following the discovery of cyclosporine have led to the commercialization and sale of kidneys for transplantation, an unethical practice which must be curbed. There is a near unanimity of opinion that renal transplantation is far cheaper than prolonged dialysis, and the benefit to the recipient is enormous in terms of the years of life saved and the quality of life. Until such time as cadaveric donor programs become a reality in the developing countries, short periods of dialysis followed by transplants with living-related donor kidneys appear to be the most cost-effective treatments of ESRD.
肾脏替代治疗（RRT）已跨越临床应用的门槛，其作为终末期肾病（ESRD）有效治疗方式的价值已得到充分确立。然而，RRT凸显了发达国家与发展中国家之间的巨大差距。大多数发达国家能够直接或间接地为RRT提供充足资金，并建立了尸体供体网络。然而，在国民收入甚至不足以满足其公民基本需求的发展中国家，提供RRT尤其困难。尽管一些发展中国家正在积极努力建立尸体供体移植项目，但目前大多数国家实际上并不存在此类项目。发展中国家的赤贫以及环孢素发现后移植成功率的提高，导致了肾脏用于移植的商业化和买卖，这种不道德行为必须加以遏制。几乎一致的观点认为，肾移植远比长期透析便宜，就挽救的生命年数和生活质量而言，对受者的益处巨大。在尸体供体项目在发展中国家成为现实之前，短期透析后进行亲属活体供肾移植似乎是ESRD最具成本效益的治疗方法。
