近日，加拿大阿尔伯塔大学教授Aminu K Bello及其课题组对世界各国和地区终末期肾病的护理状况进行了调查。2019年10月31日，《英国医学期刊》在线发表了这项成果。

2018年7月至9月，国际肾脏病学会（ISN）对182个国家进行了一项国际横断面调查。共有160个国家回应，占世界总人口的97.8%。结果发现各国肾脏替代治疗（透析和移植）和保守性肾脏管理的能力和结构存在着很大的差异，即融资机制、卫生人力、服务交付和可用技术。

全球218个国家中有91个（42％）提供了已治疗的终末期肾脏疾病患病率的信息，患病率从每百万人口4例至3392例，估计值相差800多倍。卢旺达是唯一一个报告治疗疾病患病率的低收入国家，53个非洲国家中仅有5个国家报告了这些数据，不到10%。在159个国家中，102个国家（64%）为肾脏替代治疗提供了公共资金，68个（43%）国家在提供治疗时不收取费用，34个（21%）国家收取了一些费用。

156个国家均提供血液透析（100%），其中119个国家提供腹膜透析（76%），155个国家中有114个国家提供肾移植（74%）。在154个国家中，108个（70%）国家仅50%的患者能得到肾透析治疗，45个（29%）国家仅50%的患者能够得到肾移植治疗，124个国家采用保守性肾脏管理。全球范围内，肾科医生的中位数为每百万人口9.96人，这与经济水平有关。

总之，这些综合数据反映了各个国家能够为终末期肾病患者提供最佳治疗的能力。各国间肾病的负担、肾脏替代治疗和保守性肾脏管理的能力存在着巨大的差异，这会影响相关政策的制定。

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