Seminars in nephrology最新文献_第5页

The Human Burden of Mesoamerican Nephropathy: Diagnosis and Treatment in a Complex Web of Socioeconomics, Context, and Stigma 中美洲肾病的人类负担：在社会经济、环境和污名的复杂网络中的诊断和治疗。

IF 2.8 3区医学 Q2 UROLOGY & NEPHROLOGY

Seminars in nephrology

Pub Date : 2025-01-01 DOI: 10.1016/j.semnephrol.2025.151601

Ramón Antonio García-Trabanino MD, MSc, FASN, FSLANH

Mesoamerican endemic nephropathy is a form of chronic kidney disease of still undetermined cause, highly prevalent in specific areas in and around the Mesoamerican region. Generic tubulointerstitial disease is found in kidney biopsies. Incidence and mortality are high in the hot spots. Most patients continue to be diagnosed only when dialysis treatment is urgently required, even though the disease has a fairly clear, identifiable clinical presentation. MeN is a diagnosis of exclusion, identified mostly in young male individuals from affected regions during screenings, after an acute kidney injury event, or after presenting with symptoms such as cramps, numbness, tingling, weakness, dysuria, or a history of "fever." Laboratory findings include hypokalemia, hyponatremia, hyperuricemia, and altered anion gap metabolic acidosis. Several risk factors have been hypothesized, though the cause (or causes) remains elusive. Many patients remain undiagnosed because of barriers to early diagnosis and treatment, mainly the lack of awareness of the disease among the population and health care personnel, the reliance on adapted kidney function thresholds, and the limited accessibility to standard diagnostic tests at the community level. On the other hand, coverage and treatment for those diagnosed early also need improvement because some of the treatment options empirically used are not routinely available at the primary health care level and have not been adequately validated. Another relevant barrier is the stigma surrounding the disease, with communities having been suffering from high death tolls for decades without relief or an end in sight. The dissemination of knowledge—about how the disease is suspected, diagnosed, and treated—and strengthening the local primary health care services adequately will bring hope to the affected communities, enhance opportunities for early diagnosis, and open the door to secondary prevention, ultimately reducing the incidence of dialysis and mortality.

中美洲地方性肾病是一种病因不明的慢性肾脏疾病，在中美洲地区及其周围的特定地区高度流行。肾活检中可发现一般性小管间质性疾病。热点地区的发病率和死亡率都很高。大多数患者只有在迫切需要透析治疗时才会被诊断出来，即使该疾病具有相当明确、可识别的临床表现。男性是一种排除性诊断，主要在筛查期间、急性肾损伤事件后、或出现痉挛、麻木、刺痛、无力、排尿困难或“发热”史等症状后，在受影响地区的年轻男性个体中发现。实验室结果包括低钾血症、低钠血症、高尿酸血症和阴离子间隙改变代谢性酸中毒。几个风险因素已经被假设，尽管原因（或原因）仍然难以捉摸。由于早期诊断和治疗方面的障碍，许多患者仍未得到诊断，主要是人口和保健人员对该病缺乏认识，依赖于适应的肾功能阈值，以及在社区一级获得标准诊断测试的机会有限。另一方面，对早期诊断者的覆盖范围和治疗也需要改进，因为经验上使用的一些治疗方案在初级卫生保健一级并非常规可用，也没有得到充分验证。另一个相关障碍是围绕这种疾病的耻辱，社区几十年来一直遭受高死亡率的折磨，没有得到缓解，也看不到终结。传播关于该病如何被怀疑、诊断和治疗的知识，并充分加强地方初级卫生保健服务，将为受影响社区带来希望，增加早期诊断的机会，并为二级预防打开大门，最终减少透析发生率和死亡率。

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引用次数: 0

Pediatric Kidney Care in Northern Central America: A Survey of Pediatric Nephrologists 中美洲北部的儿科肾脏护理：儿科肾病专家的调查。

IF 2.8 3区医学 Q2 UROLOGY & NEPHROLOGY

Seminars in nephrology

Pub Date : 2025-01-01 DOI: 10.1016/j.semnephrol.2025.151611

Randall Lou-Meda MD , Mynor Patzán MD , Carlos Henríquez MD , Aída Funes MD , Carolina Rodríguez MD , Mabel Sandoval MD , Melvin Bonilla-Félix MD

Chronic kidney disease (CKD) is a public health problem worldwide. Guatemala, El Salvador, Honduras, and Nicaragua are among the top six countries of the continent with high mortality and years of life lost attributable to CKD. The magnitude of the gap in delivering pediatric kidney care in northern Central America has never been systematically documented, hindering the possibility of planning prevention and effective management. A survey was sent to the directors of pediatric kidney care referral centers in the aforementioned countries to understand the epidemiology and current state of the programs. The area has a total population of 40.4 million; 17 million (41%) are younger than 21 years. The median incidence of pediatric kidney failure (pKF) was 8.4 per million age-related population (pmarp), and the median prevalence was 34 pmarp. Peritoneal dialysis (PD) was the most prevalent kidney replacement therapy (KRT) in the form of continuous ambulatory peritoneal dialysis (CAPD). Hemodialysis (HD) was used in 26.5% of patients, and 30% had an arteriovenous fistula (AVF). Few children had access to transplantation (0.9 transplants pmarp). The rate of pediatric nephrologists pmarp ranged between 1.5 (Honduras) and 2.3 (Guatemala) pmarp. The public health system funds all four referral centers, but kidney foundations play an essential role. This article offers insight to support the development of a multinational plan for prevention, effective management, and strategic use of available resources for pediatric kidney care, including support from national and international initiatives.

慢性肾脏疾病（CKD）是一个全球性的公共卫生问题。危地马拉、萨尔瓦多、洪都拉斯和尼加拉瓜是非洲大陆因慢性肾病死亡率和寿命损失最高的六个国家之一。在中美洲北部提供儿科肾脏护理方面的差距之大从未有过系统的记录，这阻碍了规划预防和有效管理的可能性。向上述国家的儿童肾脏护理转诊中心主任发送了一份调查，以了解这些项目的流行病学和现状。该地区总人口为4040万；1700万（41%）年龄在21岁以下。儿童肾衰竭（pKF）的中位发病率为8.4 /百万年龄相关人群（pmarp），中位患病率为34pmarp。腹膜透析（PD）是最普遍的肾脏替代治疗（KRT）形式的连续动态腹膜透析（CAPD）。26.5%的患者使用血液透析（HD）， 30%的患者有动静脉瘘（AVF）。很少有儿童获得移植（0.9移植pmarp）。儿科肾病专家的pmarp比率在洪都拉斯的1.5到危地马拉的2.3之间。公共卫生系统为所有四家转诊中心提供资金，但肾脏基金会发挥着至关重要的作用。这篇文章提供了见解，以支持多国计划的发展，有效的管理和战略利用现有资源，为儿童肾脏护理，包括国家和国际倡议的支持。

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引用次数: 0

Cardiovascular and Renal Risk Factors in the Argentine First Nations: A Study of the Qom and Wichi Indigenous Groups 阿根廷第一民族的心血管和肾脏危险因素：库姆和威奇土著群体的研究。

IF 2.8 3区医学 Q2 UROLOGY & NEPHROLOGY

Seminars in nephrology

Pub Date : 2025-01-01 DOI: 10.1016/j.semnephrol.2025.151604

María Eugenia Bianchi MD, PhD

The “10 Recommendations for Global Kidney Health” developed at the Global Policy 2017 constitute a commitment by and challenge to all stakeholders. Achieving these goals in disadvantaged population such as the First Nation Peoples (FNP) is even more challenging. Qom and Wichi ethnics are isolated Argentine FNP with poor access to health care. Research on chronic kidney disease (CKD) in Qom FNP in the Chaco Province, Argentina showed high rates of proteinuria without a decrease of the glomerular filtration rate in a group of 385 persons in 2003. In 2018, a subsequent cross-sectional evaluation in those individuals still living in the area revealed that diabetes mellitus (DM) increased sixfold (from 2% to 14%) and obesity increased threefold (from 21% to 61%). Infections (tuberculosis) and cardiovascular disease were the main causes of mortality in the whole sample, whereas gynecologic cancer was the first cause of death in women and cardiovascular disease in men. In 2018, a new group of subjects (not those originally assessed in 2003) showed a remarkably high prevalence of renal risk factors despite being as young as those originally evaluated in 2003 but with a prevalence of renal risk factors as high as when the latter were assessed 15 years afterward. Wichi FNP, in 2020, showed lower proteinuria rates (14%) with virtually no presence of DM. FNP deserve the creation of public policies for CKD detection and treatment, but they must be based on local scientific evidence, with continuous monitoring and learning and scalable strategies.

2017年全球政策制定的“全球肾脏健康10项建议”是对所有利益攸关方的承诺和挑战。在诸如第一民族（FNP）这样的弱势群体中实现这些目标更具挑战性。库姆族和威奇族是与世隔绝的阿根廷民族自由主义者，很难获得保健服务。2003年，阿根廷查科省Qom FNP对慢性肾脏疾病（CKD）的研究表明，385人的蛋白尿率很高，但肾小球滤过率没有下降。2018年，随后对仍生活在该地区的人进行的横断面评估显示，糖尿病（DM）增加了6倍（从2%增加到14%），肥胖增加了3倍（从21%增加到61%）。感染（肺结核）和心血管疾病是整个样本中死亡的主要原因，而妇科癌症是妇女和男性心血管疾病的第一死因。2018年，一组新的受试者（不是2003年最初评估的受试者）显示，尽管他们与2003年最初评估的受试者一样年轻，但肾脏风险因素的患病率与15年后评估的受试者一样高。在2020年，Wichi FNP显示出较低的蛋白尿率（14%），几乎没有DM的存在。FNP应该建立CKD检测和治疗的公共政策，但它们必须基于当地的科学证据，持续监测和学习以及可扩展的策略。

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引用次数: 0

Acute Kidney Injury in Latin America 拉丁美洲的急性肾损伤。

IF 2.8 3区医学 Q2 UROLOGY & NEPHROLOGY

Seminars in nephrology

Pub Date : 2025-01-01 DOI: 10.1016/j.semnephrol.2025.151609

Rolando Claure-Del Granado MD, FASN, FISN , Raúl Lombardi MD , Jonathan Chávez-Íñiguez MD , Lilia Rizo-Topete MD , Daniela Ponce MD

Acute kidney injury (AKI) is a major global health issue with significant morbidity and mortality, particularly in low- and middle-income regions like Latin America. AKI prevalence varies across Latin America, with higher rates in rural and underserved areas. Key risk factors include socioeconomic disparities, comorbid conditions such as diabetes and hypertension, and environmental hazards. Infections, especially tropical diseases, and exposure to nephrotoxins, including herbal remedies, are common causes of AKI. Management of AKI faces significant hurdles because of limited access to diagnostic tools, variability in clinical practices, and a shortage of trained health care professionals. The availability of dialysis and renal replacement therapies is often constrained by economic and infrastructural limitations. Public health initiatives focusing on prevention, screening, and early detection are critical to mitigate the impact of AKI. Research in AKI across Latin America is hampered by data gaps and limited funding. Multicenter collaborations and the development of region-specific guidelines are essential to improving outcomes. Addressing these challenges will help reduce the burden of AKI and improve health care systems across the region. This review examines the unique epidemiology, risk factors, and health care challenges surrounding AKI in the region.

急性肾损伤（AKI）是一个主要的全球健康问题，发病率和死亡率很高，特别是在拉丁美洲等低收入和中等收入地区。拉丁美洲的AKI患病率各不相同，农村和服务不足地区的患病率较高。主要风险因素包括社会经济差异、糖尿病和高血压等合并症以及环境危害。感染，特别是热带疾病，以及接触肾毒素，包括草药，是AKI的常见原因。由于诊断工具的获取有限、临床实践的可变性以及训练有素的卫生保健专业人员的短缺，AKI的管理面临着重大障碍。透析和肾脏替代疗法的可用性常常受到经济和基础设施限制的制约。关注预防、筛查和早期发现的公共卫生倡议对于减轻AKI的影响至关重要。拉丁美洲的AKI研究受到数据缺口和资金有限的阻碍。多中心合作和制定针对特定区域的指导方针对于改善成果至关重要。解决这些挑战将有助于减轻急性呼吸道感染的负担，并改善整个区域的卫生保健系统。本综述探讨了该地区AKI的独特流行病学、危险因素和卫生保健挑战。

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引用次数: 0

Kidney Disease in Latin America: The Hottest Spot on the Globe 肾病在拉丁美洲：全球最热门的地方。

IF 2.8 3区医学 Q2 UROLOGY & NEPHROLOGY

Seminars in nephrology

Pub Date : 2025-01-01 DOI: 10.1016/j.semnephrol.2025.151599

Alfonso M. Cueto-Manzano MD, MSc, PhD , Valerie A. Luyckx MBBCh (Wits), MSc Public Health (LSHTM), PhD Biomedical Ethics and Law (UZH) , Marina Wainstein MBBS, MA, PhD

引用次数: 0

Group Medical Care Models Transforming Access to Kidney Disease Treatment: An Argentine Experience 团体医疗模式改变了肾病治疗：阿根廷的经验。

IF 2.8 3区医学 Q2 UROLOGY & NEPHROLOGY

Seminars in nephrology

Pub Date : 2025-01-01 DOI: 10.1016/j.semnephrol.2025.151612

Marina Wainstein , Paula Andrea Marioli , Lilia Cervantes

As the prevalence of kidney disease rises in Latin America, there is increasing awareness of the importance of early detection and prevention. However, in a region characterized by socioeconomic inequality, variable access to care, and an overwhelmed primary health system, health professionals must find new and innovative ways of delivering care that is cost effective and mindful of patients’ needs and social determinants of health. Group medical care (GMC), a model combining group visits and peer support with personalized care, has emerged as an intervention with proven benefits in clinical outcomes, patient satisfaction, and cost effectiveness in the management of chronic illnesses. In this article we present the case of Renalida, a kidney clinic in Argentina that has adopted GMC to improve access, engagement, and standards of care for older patients with chronic kidney disease (CKD). Beyond it being the first documented case of GMC for CKD in Latin America, Renalida brings to light many of the common barriers to effective early CKD care throughout the region and proposes a viable and holistic solution. In addition, we explore future directions, including the application of implementation science to leverage strategies such as GMC to improve both access to and quality of CKD care.

随着拉丁美洲肾脏疾病患病率的上升，人们越来越意识到早期发现和预防的重要性。然而，在一个以社会经济不平等、获得医疗服务的机会不同和初级卫生系统不堪重负为特征的地区，卫生专业人员必须找到新的和创新的方式来提供具有成本效益的医疗服务，并考虑到患者的需求和健康的社会决定因素。团体医疗（GMC）是一种将团体就诊和同伴支持与个性化护理相结合的模式，已被证明在慢性疾病管理的临床结果、患者满意度和成本效益方面具有益处。在这篇文章中，我们介绍了阿根廷肾诊所Renalida的案例，该诊所采用GMC来改善老年慢性肾病（CKD）患者的可及性、参与度和护理标准。Renalida是拉丁美洲第一个记录在案的慢性肾病GMC病例，它揭示了整个地区有效的早期慢性肾病治疗的许多常见障碍，并提出了一个可行的整体解决方案。此外，我们还探讨了未来的发展方向，包括应用实施科学来利用GMC等策略来改善CKD护理的可及性和质量。

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引用次数: 0

Kidney Health Programs in Latin America: Results of the SLANH Survey 2024 拉丁美洲肾脏健康项目：2024年SLANH调查结果

IF 2.8 3区医学 Q2 UROLOGY & NEPHROLOGY

Seminars in nephrology

Pub Date : 2025-01-01 DOI: 10.1016/j.semnephrol.2025.151606

Alfonso M. Cueto-Manzano , María C. Carlino-Bauza , Pablo G. Ríos-Sarro , Augusto C. Vallejos , Carlos A. Zúñiga-San Martín , Eric A. Zúñiga-Saravia , Jessica Bravo-Zúñiga , Alberto M. Alles-Gamberale , Laura Solá-Schnir , Vicente Sánchez-Polo , Adriana Robayo , Jorge Rico-Fontalvo , Guillermo Álvarez-Estévez , Comité de Salud Renal, Sociedad Latinoamericana de Nefrología e Hipertensión

Chronic kidney disease (CKD) is a health problem worldwide, but it is overexpressed in Latin America.

With the aim of understanding the status of kidney health programs (KHP) and provide information to help create or direct kidney health policies, the Kidney Health Committee of the Latin American Society of Nephrology and Hypertension (SLANH) developed an electronic survey that was sent (February 1–May 30, 2024) to the national nephrology society, the Ministry of Health or a policymaker, and a recognized local nephrology leader of all SLANH member countries. Thirteen of 20 (65%) member countries had a KHP. Although with variability, most covers individuals with and without social security, targeting people with risk factors with or without CKD (61%) or general population (39%). In all but two countries with KHP, it is integrated into another noncommunicable disease program (diabetes, hypertension, obesity, and/or cardiovascular disease), and the national nephrology society is involved (except in three). Virtually all countries perform educative interventions for multidisciplinary health professionals and general population, the latter mainly in connection with World Kidney Day. Only eight (40%) countries have a registry of CKD stage 1-4 (seven of them had a KHP), and nine (45%) have a kidney health law, which was not different between countries with or without KHP. Only 25% of countries have active patient participation in kidney issues, regardless of the country having KHP or not. The SLANH-KHP survey showed heterogeneity in the way Latin American countries address kidney health. These findings could guide the implementation of strategies aimed at reducing the burden of CKD toward equitable and sustainable kidney disease care.

慢性肾脏疾病（CKD）是一个世界性的健康问题，但它在拉丁美洲过度表达。为了了解肾脏健康计划（KHP）的现状，并提供信息以帮助制定或指导肾脏健康政策，拉丁美洲肾病和高血压学会（SLANH）肾脏健康委员会开发了一项电子调查，该调查于2024年2月1日至5月30日发送给国家肾脏病学会、卫生部或政策制定者，以及所有SLANH成员国公认的当地肾脏病学领导者。20个成员国中有13个（65%）拥有KHP。尽管存在差异，但大多数涵盖了有或没有社会保障的个体，针对有CKD或无CKD风险因素的人群（61%）或一般人群（39%）。除两个国家外，所有存在KHP的国家都将其纳入另一个非传染性疾病规划（糖尿病、高血压、肥胖症和/或心血管疾病），并且国家肾病学会也参与其中（三个国家除外）。几乎所有国家都对多学科保健专业人员和普通民众进行教育干预，后者主要与世界肾脏日有关。只有8个（40%）国家有CKD 1-4期登记（其中7个有KHP）， 9个（45%）国家有肾脏健康法，这在有无KHP的国家之间没有区别。只有25%的国家患者积极参与肾脏问题，无论国家是否患有KHP。slan - khp调查显示拉丁美洲国家处理肾脏健康的方式存在差异。这些发现可以指导实施旨在减少CKD负担的策略，以实现公平和可持续的肾脏疾病护理。

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引用次数: 0

Access to Care During Pregnancy for Patients With Chronic Kidney Disease and Kidney Failure in Latin America: A State of the Art with an International Comparison 拉丁美洲慢性肾脏疾病和肾衰竭患者孕期护理的可及性：国际比较的最新进展

IF 2.8 3区医学 Q2 UROLOGY & NEPHROLOGY

Seminars in nephrology

Pub Date : 2025-01-01 DOI: 10.1016/j.semnephrol.2025.151610

Alejandra Orozco MSc , Rasha Shemies MD , Luis Enrique Álvarez Rangel MD , Hernan Trimarchi MD , Guilherme Ribeiro Ramirez de Jesus MD , Iasmina M. Craici MD , Alice Schmidt MD , Ghada Ankawi MD , Nada Sellami MD , I Wen Wu MD , Wisit Cheungpasitporn MD , Natalia Kozlovskaya MD , Elena Zakharova MD, PhD , Ifeoma I. Ulasi MD , Shilpanjali Jesudason MD , Giorgina Barbara Piccoli MD, PhD

Access to kidney care is a problem in Latin America, similar to many other low- to medium-income countries. Uneven access and deep discrepancies in quality of care beset this large part of the world that encompasses North America (Mexico) and Central and South America.

Access to kidney care during pregnancy can be seen as a marker of overall achievements and needs in nephrology. We suggest that this issue should be systematically considered and compared across settings when health care systems are evaluated. If this were done, pregnancy would be in the spotlight, and this would increase awareness of the problems that need to be dealt with and could guide interventions to improve kidney care in young women.

This review discusses some epidemiological and clinical issues, as well as barriers to optimal care of pregnancy in patients with chronic kidney disease encountered in Mexico and other Latin American countries, contextualized with a brief overview on barriers and challenges in other continents.

与许多其他中低收入国家一样，获得肾脏护理在拉丁美洲也是一个问题。在包括北美（墨西哥）和中南美洲在内的世界广大地区，不均衡的获取和严重的保健质量差异困扰着这一地区。妊娠期间获得肾脏护理可被视为肾脏病学总体成就和需求的标志。我们建议在评估卫生保健系统时，应该系统地考虑和比较这一问题。如果做到了这一点，怀孕将成为人们关注的焦点，这将提高人们对需要处理的问题的认识，并可以指导干预措施，改善年轻女性的肾脏护理。这篇综述讨论了一些流行病学和临床问题，以及在墨西哥和其他拉丁美洲国家遇到的慢性肾脏疾病患者妊娠最佳护理的障碍，并简要概述了其他大陆的障碍和挑战。

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引用次数: 0

Special Situations in Argentina: Addressing the Challenges Faced by Individuals on Dialysis Without a Diagnosis 阿根廷的特殊情况：解决未经诊断的透析患者所面临的挑战。

IF 2.8 3区医学 Q2 UROLOGY & NEPHROLOGY

Seminars in nephrology

Pub Date : 2025-01-01 DOI: 10.1016/j.semnephrol.2025.151603

Guillermo Rosa-Diez MD, MSc

The third major subgroup requiring admission to dialysis in Argentina are individuals with kidney failure without a known cause, also known as chronic kidney disease of unknown origin (CKDUO). In this retrospective cohort study, the characteristics of this group were described using data from the National Dialysis and Transplant Registry. In Argentina, 113,352 patients commenced maintenance dialysis from April 1, 2004, to December 31, 2021 (213 months); 42% of patients were older than 65 years of age and 2.3% were younger than 18 years of age. There was a predominance of male patients (66,650 [58.8%]) and 6% were foreigners (6,688). Only 9.4% of patients (10,655) had a diagnosis confirmed by a kidney biopsy. The most common causes of kidney disease requiring dialysis admission were diabetic nephropathy (36%), hypertensive nephropathy (21%), and CKDUO (17%). The most frequent dialysis modality was hemodialysis and the majority were admitted with temporary vascular access. Mean survival time from the initiation of dialysis was 44.8 months, with 59.2 months (95% confidence interval, 58.0-60.4) for patients with CKDUO versus 48.6 months (95% confidence interval, 48.2-49.0) for others. Patients with CKDUO were younger and more frequently female, with fewer comorbidities, more precarious socioeconomic status, and indicators of late or absent renal health assistance. There was a heterogeneous renal biopsy rate by state related to the accessibility of diagnostic tools. Health policy and health actions are required to allow kidney health accessibility in earlier stages of chronic kidney disease.

在阿根廷，需要接受透析治疗的第三个主要亚群是原因不明的肾衰竭患者，也称为不明原因的慢性肾脏疾病（CKDUO）。在这项回顾性队列研究中，使用国家透析和移植登记处的数据描述了该组的特征。在阿根廷，从2004年4月1日至2021年12月31日（213个月），113352名患者开始了维持性透析；42%的患者年龄大于65岁，2.3%的患者年龄小于18岁。男性患者占多数（66,650例[58.8%]），外籍患者占6%（6,688例）。只有9.4%的患者（10655人）通过肾活检确诊。需要入院透析的肾脏疾病最常见的原因是糖尿病肾病（36%）、高血压肾病（21%）和CKDUO（17%）。最常见的透析方式是血液透析，大多数入院时有临时血管通路。开始透析后的平均生存时间为44.8个月，CKDUO患者为59.2个月（95%可信区间，58.0-60.4），其他患者为48.6个月（95%可信区间，48.2-49.0）。CKDUO患者较年轻，多为女性，合并症较少，社会经济地位更不稳定，并且有肾脏健康援助迟或缺乏的指标。不同州的肾活检率与诊断工具的可及性有关。需要制定卫生政策和卫生行动，以便在慢性肾病的早期阶段获得肾脏健康。

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引用次数: 0

Accessibility to Kidney Replacement Therapy in Latin America 拉丁美洲肾脏替代疗法的可及性。

IF 2.8 3区医学 Q2 UROLOGY & NEPHROLOGY

Seminars in nephrology

Pub Date : 2025-01-01 DOI: 10.1016/j.semnephrol.2025.151605

Alejandro Ferreiro-Fuentes

Latin America is made up of 21 countries with a population of around 660 million, of whom 550,000 receive kidney replacement therapy (KRT). The enormous burden of disease that KRT imposes can be attributed to multiple determinants of the disease, linked to the characteristics of the population: co-morbidity, social factors, limited access to the health care system, poverty, extreme working conditions, and low levels of education. In many countries, the health care system is fragmented, making it difficult to ensure the continuity of the health care process and to adress inequities in access to KRT. Differences among countries in the prevalence of KRT translate into thousands of lives lost each year. Differences in access to KRT are linked to structural and investment differences in health care systems, so financing and organization characteristicsmight have a major bearing on equitable access to KRT. One of the main objectives of the nephrology community should be to develop activities to reduce gaps in the burden of KRT. There is no doubt that alliances with health care policy makers, ministries of health, regional patient organizations, regional nursing organizations, health regulatory agencies, and international nephrology societies will achieve results by working together, in synergy.

拉丁美洲由21个国家组成，人口约6.6亿，其中55万人接受肾脏替代疗法（KRT）。KRT造成的巨大疾病负担可归因于该病的多个决定因素，这些因素与人口特征有关：合并症、社会因素、获得卫生保健系统的机会有限、贫困、极端工作条件和低教育水平。在许多国家，卫生保健系统是分散的，因此难以确保卫生保健进程的连续性和解决在获得KRT方面的不公平现象。各国之间KRT流行程度的差异导致每年有数千人丧生。获得KRT的差异与卫生保健系统的结构和投资差异有关，因此融资和组织特征可能对公平获得KRT有重大影响。肾脏学界的主要目标之一应该是开展活动，以减少KRT负担方面的差距。毫无疑问，与卫生保健决策者、卫生部、区域患者组织、区域护理组织、卫生监管机构和国际肾脏病学会结成联盟将通过协同合作取得成果。

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引用次数: 0