世界各國和地區終末期腎病的護理現狀
作者：
小柯機器人發布時間：2019/11/3 22:49:40
近日，加拿大阿爾伯塔大學教授Aminu K Bello及其課題組對世界各國和地區終末期腎病的護理狀況進行了調查。2019年10月31日，《英國醫學期刊》在線發表了這項成果。
2018年7月至9月，國際腎臟病學會（ISN）對182個國家進行了一項國際橫斷面調查。共有160個國家回應，佔世界總人口的97.8%。結果發現各國腎臟替代治療（透析和移植）和保守性腎臟管理的能力和結構存在著很大的差異，即融資機制、衛生人力、服務交付和可用技術。
全球218個國家中有91個（42％）提供了已治療的終末期腎臟疾病患病率的信息，患病率從每百萬人口4例至3392例，估計值相差800多倍。盧安達是唯一一個報告治療疾病患病率的低收入國家，53個非洲國家中僅有5個國家報告了這些數據，不到10%。在159個國家中，102個國家（64%）為腎臟替代治療提供了公共資金，68個（43%）國家在提供治療時不收取費用，34個（21%）國家收取了一些費用。
156個國家均提供血液透析（100%），其中119個國家提供腹膜透析（76%），155個國家中有114個國家提供腎移植（74%）。在154個國家中，108個（70%）國家僅50%的患者能得到腎透析治療，45個（29%）國家僅50%的患者能夠得到腎移植治療，124個國家採用保守性腎臟管理。全球範圍內，腎科醫生的中位數為每百萬人口9.96人，這與經濟水平有關。
總之，這些綜合數據反映了各個國家能夠為終末期腎病患者提供最佳治療的能力。各國間腎病的負擔、腎臟替代治療和保守性腎臟管理的能力存在著巨大的差異，這會影響相關政策的制定。
附：英文原文
Title: Status of care for end stage kidney disease in countries and regions worldwide: international cross sectional survey
Author: Aminu K Bello, Adeera Levin, Meaghan Lunney, Mohamed A Osman, Feng Ye, Gloria E Ashuntantang, Ezequiel Bellorin-Font, Mohammed Benghanem Gharbi, Sara N Davison, Mohammad Ghnaimat, Paul Harden, Htay Htay, Vivekanand Jha, Kamyar Kalantar-Zadeh, Peter G Kerr, Scott Klarenbach, Csaba P Kovesdy, Valerie A Luyckx, Brendon L Neuen, Donal O』Donoghue, Shahrzad Ossareh, Jeffrey Perl, Harun Ur Rashid, Eric Rondeau, Emily See, Syed Saad, Laura Sola, Irma Tchokhonelidze, Vladimir Tesar, Kriang Tungsanga, Rumeyza Turan Kazancioglu, Angela Yee-Moon Wang, Natasha Wiebe, Chih-Wei Yang, Alexander Zemchenkov, Ming-hui Zhao, Kitty J Jager, Fergus Caskey, Vlado Perkovic, Kailash K Jindal, Ikechi G Okpechi, Marcello Tonelli, John Feehally, David C Harris, David W Johnson
Issue&Volume: 2019/10/31
Abstract:
Objective To determine the global capacity (availability, accessibility, quality, and affordability) to deliver kidney replacement therapy (dialysis and transplantation) and conservative kidney management.
Design International cross sectional survey.
Setting International Society of Nephrology (ISN) survey of 182 countries from July to September 2018.
Participants Key stakeholders identified by ISN’s national and regional leaders.
Main outcome measures Markers of national capacity to deliver core components of kidney replacement therapy and conservative kidney management.
Results Responses were received from 160 (87.9%) of 182 countries, comprising 97.8% (7338.5 million of 7501.3 million) of the world’s population. A wide variation was found in capacity and structures for kidney replacement therapy and conservative kidney management—namely, funding mechanisms, health workforce, service delivery, and available technologies. Information on the prevalence of treated end stage kidney disease was available in 91 (42%) of 218 countries worldwide. Estimates varied more than 800-fold from 4 to 3392 per million population. Rwanda was the only low income country to report data on the prevalence of treated disease; 5 (<10%) of 53 African countries reported these data. Of 159 countries, 102 (64%) provided public funding for kidney replacement therapy. Sixty eight (43%) of 159 countries charged no fees at the point of care delivery and 34 (21%) made some charge. Haemodialysis was reported as available in 156 (100%) of 156 countries, peritoneal dialysis in 119 (76%) of 156 countries, and kidney transplantation in 114 (74%) of 155 countries. Dialysis and kidney transplantation were available to more than 50% of patients in only 108 (70%) and 45 (29%) of 154 countries that offered these services, respectively. Conservative kidney management was available in 124 (81%) of 154 countries. Worldwide, the median number of nephrologists was 9.96 per million population, which varied with income level.
Conclusions These comprehensive data show the capacity of countries (including low income countries) to provide optimal care for patients with end stage kidney disease. They demonstrate substantial variability in the burden of such disease and capacity for kidney replacement therapy and conservative kidney management, which have implications for policy.
DOI: 10.1136/bmj.l5873
Source: https://www.bmj.com/content/367/bmj.l5873