Global Epidemiology of End-Stage Kidney Disease and Disparities in Kidney Replacement Therapy.
Global Epidemiology of End-Stage Kidney Disease and Disparities in Kidney Replacement Therapy.
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DOI：
10.1159/000514550
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发表时间：
2021
影响因子：
4.2
通讯作者：
Nee R
中科院分区：
文献类型：
--
作者：
Thurlow JS;Joshi M;Yan G;Norris KC;Agodoa LY;Yuan CM;Nee R
终末期肾病（ESKD）的全球流行病学反映了每个国家独特的遗传、环境、生活方式和社会人口特征。对 ESKD 的反应，特别是肾脏替代治疗 (KRT)，取决于当地的疾病负担、文化和社会经济。在这里，我们探讨了 ESKD 发病率和患病率的地理差异和全球趋势，并研究了 KRT 模式、实践模式和死亡率的变化。最后，我们讨论了获得 KRT 的差异，以及减少 ESKD 全球负担和改善低收入和中等收入国家 (LMIC) 获得治疗的战略。 2003年至2016年间，许多高收入国家接受治疗的ESKD发病率相对稳定，但主要在东亚和东南亚大幅上升。全球范围内接受治疗的 ESKD 患病率有所增加，这可能是由于 ESKD 生存率提高、人口结构变化、ESKD 风险因素患病率较高以及经济增长国家中 KRT 普及率的增加。在美国，接受 KRT 的 ESKD 患者未经调整的 5 年生存率为 41%，在欧洲为 48%，在日本为 60%。在大多数国家，透析是主要的 KRT，其中血液透析是最常见的方式。透析实践模式的差异导致了全球生存结果的一些差异。在世界范围内，KRT 在收入水平较高的人群中更为普遍，并且由于缺乏 KRT 途径而过早死亡的人数估计比接受治疗的人数高出三倍。世界各地许多需要 KRT 作为维持生命治疗的人却没有得到治疗，其中大多数是在医疗保健资源严重有限的中低收入国家。这一巨大的治疗差距要求重点关注基于人群的预防策略以及开发负担得起且具有成本效益的 KRT。要实现 KRT 获取的全球公平性，需要政府、私营部门、非政府组织和专业组织共同努力倡导有效的公共政策、医疗保健服务、劳动力能力、教育、研究和支持。
The global epidemiology of end-stage kidney disease (ESKD) reflects each nation’s unique genetic, environmental, lifestyle and sociodemographic characteristics. The response to ESKD, particularly regarding kidney replacement therapy (KRT), depends on local disease burden, culture, and socioeconomics. Here, we explore geographic variation and global trends in ESKD incidence and prevalence and examine variations in KRT modality, practice patterns and mortality. We conclude with a discussion on disparities in access to KRT, and strategies to reduce ESKD global burden and to improve access to treatment in low- and middle-income countries (LMIC). From 2003–2016, incidence rates of treated ESKD were relatively stable in many higher income countries but rose substantially predominantly in East and Southeast Asia. The prevalence of treated ESKD has increased worldwide, likely due to improving ESKD survival, population demographic shifts, higher prevalence of ESKD risk factors and increasing KRT access in countries with growing economies. Unadjusted 5-year survival of ESKD patients on KRT was 41% in the United States, 48% in Europe, and 60% in Japan. Dialysis is the predominant KRT in most countries, with hemodialysis being the most common modality. Variations in dialysis practice patterns account for some of the differences in survival outcomes globally. Worldwide, there is a greater prevalence of KRT at higher income levels, and the number of people who die prematurely because of lack of KRT access is estimated at up to three times higher than the number who receive treatment. Many people worldwide in need of KRT as a life-sustaining treatment do not receive it, mostly in LMICs where health care resources are severely limited. This large treatment gap demands a focus on population-based prevention strategies and development of affordable and cost-effective KRT. Achieving global equity in KRT access will require concerted efforts in advocating effective public policy, health care delivery, workforce capacity, education, research, and support from the government, private sector, nongovernmental and professional organizations.
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DOI：
10.34067/kid.0005152020
发表时间：
2020-12-31
期刊：
KIDNEY360
影响因子：
--
作者：
Jardine, Thabiet;Davids, Mogamat Razeen
通讯作者：
Davids, Mogamat Razeen
影响因子：
13.2
作者：
Daugirdas, John T.;Depner, Thomas A.;Weiner, Daniel E.
通讯作者：
Weiner, Daniel E.
影响因子：
13.6
作者：
Dember, Laura M.;Lacson, Eduardo, Jr.;Landis, J. Richard
通讯作者：
Landis, J. Richard
影响因子：
0.8
作者：
Chauhan, R;Mendonca, S
通讯作者：
Mendonca, S
影响因子：
39
作者：
Cervantes, Lilia;Fischer, Stacy;Ortega, Debora
通讯作者：
Ortega, Debora