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Capacity for the management of kidney failure in the International Society of Nephrology North and East Asia region: report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA) 国际肾脏病学会北亚和东亚地区肾衰竭管理能力:2023 年国际肾脏病学会全球肾脏健康地图集(ISN-GKHA)报告
IF 5.5 2区 医学 Q1 Medicine Pub Date : 2024-04-01 DOI: 10.1016/j.kisu.2024.02.001
Winston Wing-Shing Fung , Hyeong Cheon Park , Yosuke Hirakawa , Silvia Arruebo , Aminu K. Bello , Fergus J. Caskey , Sandrine Damster , Jo-Ann Donner , Vivekanand Jha , David W. Johnson , Adeera Levin , Charu Malik , Masaomi Nangaku , Ikechi G. Okpechi , Marcello Tonelli , Seiji Ueda , Feng Ye , Yusuke Suzuki , Angela Yee-Moon Wang , Lili Zhou

Globally, there remain significant disparities in the capacity and quality of kidney care, as evidenced by the third edition of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA). In the ISN North and East Asia region, the chronic kidney disease (CKD) burden varied widely; Taiwan had the heaviest burden of treated kidney failure (3679 per million population [pmp]) followed by Japan and South Korea. Except in Hong Kong, hemodialysis (HD) was the main dialysis modality for all other countries in the region and was much higher than the global median prevalence. Kidney transplantation services were generally available in the region, but the prevalence was much lower than that of dialysis. Most countries had public funding for kidney replacement therapy (KRT). The median prevalence of nephrologists was 28.7 pmp, higher than that of any other ISN region, with variation across countries. Home HD was available in only 17% of the countries, whereas conservative kidney management was available in 50%. All countries had official registries for dialysis and transplantation; however, only China and Japan had CKD registries. Advocacy groups for CKD, kidney failure, and KRT were uncommon throughout the region. Overall, all countries in the region had capacity for KRT, albeit with some shortages in their kidney care workforce. These data are useful for stakeholders to address gaps in kidney care and to reduce workforce shortages through increased use of multidisciplinary teams and telemedicine, policy changes to promote prevention and treatment of kidney failure, and increased advocacy for kidney disease in the region.

国际肾脏病学会全球肾脏健康地图集》(ISN-GKHA)第三版显示,在全球范围内,肾脏护理的能力和质量仍然存在巨大差异。在 ISN 北亚和东亚地区,慢性肾脏病(CKD)的负担差异很大;台湾的肾衰竭治疗负担最重(每百万人口 3679 例),其次是日本和韩国。除香港外,该地区所有其他国家均以血液透析(HD)为主要透析方式,且远高于全球发病率的中位数。该地区普遍提供肾移植服务,但普及率远低于透析。大多数国家都为肾脏替代疗法(KRT)提供公共资金。肾病专家的中位普及率为 28.7pmp,高于任何其他 ISN 地区,但各国之间存在差异。只有 17% 的国家提供家庭 HD,而 50% 的国家提供保守肾脏管理。所有国家都有透析和移植的官方登记,但只有中国和日本有 CKD 登记。在该地区,有关慢性肾脏病、肾衰竭和 KRT 的宣传团体并不常见。总体而言,该地区所有国家都有能力进行 KRT,尽管在肾脏护理人员方面存在一些不足。这些数据对利益相关者很有帮助,他们可以通过增加多学科团队和远程医疗的使用、改变政策以促进肾衰竭的预防和治疗,以及加强对该地区肾脏疾病的宣传,来弥补肾脏护理方面的不足并减少劳动力短缺。
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引用次数: 0
Capacity for the management of kidney failure in the International Society of Nephrology Newly Independent States and Russia region: report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA) 国际肾脏病学会新独立国家和俄罗斯地区肾衰竭管理能力:2023 年国际肾脏病学会全球肾脏健康地图集(ISN-GKHA)报告
IF 5.5 2区 医学 Q1 Medicine Pub Date : 2024-04-01 DOI: 10.1016/j.kisu.2024.01.005
Larisa Prikhodina , Kirill Komissarov , Nikolay Bulanov , Silvia Arruebo , Aminu K. Bello , Fergus J. Caskey , Sandrine Damster , Jo-Ann Donner , Vivekanand Jha , David W. Johnson , Adeera Levin , Charu Malik , Masaomi Nangaku , Ikechi G. Okpechi , Marcello Tonelli , Feng Ye , Abduzhappar Gaipov

The International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) was established to aid understanding of the status and capacity of countries to provide optimal kidney care worldwide. This report presents the current characteristics of kidney care in the ISN Newly Independent States (NIS) and Russia region. Although the median prevalence of chronic kidney disease (CKD) was higher (11.4%) than the global median (9.5%), the median CKD-related death rate (1.4%) and prevalence of treated kidney failure (KF) in the region (411 per million population [pmp]) were lower than they are globally (2.5% and 822.8 pmp, respectively). Capacity to provide an adequate frequency of hemodialysis (HD) and kidney transplantation services is present in all the countries (100%). In spite of significant economic advancement, the region has critical shortages of nephrologists, dietitians, transplant coordinators, social workers, palliative care physicians, and kidney supportive care nurses. Home HD remains unavailable in any country in the region. Although national registries for dialysis and kidney transplantation are available in most of the countries across the ISN NIS and Russia region, few registries exist for nondialysis CKD and acute kidney injury. Although a national strategy for improving care for CKD patients is presented in more than half of the countries, no country in the region had a CKD-specific policy. Strategies that incorporate workforce training, planning, and development for all KF caregivers could help ensure sustainable kidney care delivery in the ISN NIS and Russia region.

建立国际肾脏病学会全球肾脏健康地图集(ISN-GKHA)的目的是帮助了解各国在全球范围内提供最佳肾脏保健服务的现状和能力。本报告介绍了 ISN 新独立国家 (NIS) 和俄罗斯地区肾脏保健的现状。虽然慢性肾脏病(CKD)发病率的中位数(11.4%)高于全球中位数(9.5%),但该地区CKD相关死亡率的中位数(1.4%)和肾衰竭(KF)治疗率的中位数(每百万人口411例)却低于全球中位数(分别为2.5%和822.8例)。所有国家都有能力提供足够频率的血液透析(HD)和肾移植服务(100%)。尽管经济有了长足的发展,但该地区仍然严重缺乏肾科医生、营养师、移植协调员、社会工作者、姑息治疗医生和肾脏支持护理护士。该地区任何一个国家都没有家庭血液透析服务。虽然 ISN NIS 和俄罗斯地区的大多数国家都有透析和肾移植的国家登记,但非透析慢性肾脏病和急性肾损伤的登记却很少。虽然半数以上的国家制定了改善 CKD 患者护理的国家战略,但该地区没有一个国家制定了专门针对 CKD 的政策。为所有 KF 护理人员提供劳动力培训、规划和发展的战略有助于确保在 ISN NIS 和俄罗斯地区提供可持续的肾脏护理服务。
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引用次数: 0
Capacity for the management of kidney failure in the International Society of Nephrology Africa region: report from the 2023 ISN Global Kidney Atlas (ISN-GKHA) 国际肾脏病学会非洲地区肾衰竭管理能力:2023 年国际肾脏病学会全球肾脏地图集(ISN-GKHA)报告
IF 5.5 2区 医学 Q1 Medicine Pub Date : 2024-04-01 DOI: 10.1016/j.kisu.2024.01.002
Elliot Koranteng Tannor , Bianca Davidson , Yannick Nlandu , Peace Bagasha , Workagegnehu Hailu Bilchut , M. Razeen Davids , Hassane M. Diongole , Udeme E. Ekrikpo , Ehab O.A. Hafiz , Kwaifa Salihu Ibrahim , Robert Kalyesubula , Aisha M. Nalado , Timothy O. Olanrewaju , Ugochi Chika Onu , Nikhil Pereira-Kamath , Aminu Muhammad Sakajiki , Mohamed Salah , Lloyd Vincent , Silvia Arruebo , Aminu K. Bello , Deenaz Zaidi

The burden of chronic kidney disease and associated risk of kidney failure are increasing in Africa. The management of people with chronic kidney disease is fraught with numerous challenges because of limitations in health systems and infrastructures for care delivery. From the third iteration of the International Society of Nephrology Global Kidney Health Atlas, we describe the status of kidney care in the ISN Africa region using the World Health Organization building blocks for health systems. We identified limited government health spending, which in turn led to increased out-of-pocket costs for people with kidney disease at the point of service delivery. The health care workforce across Africa was suboptimal and further challenged by the exodus of trained health care workers out of the continent. Medical products, technologies, and services for the management of people with nondialysis chronic kidney disease and for kidney replacement therapy were scarce due to limitations in health infrastructure, which was inequitably distributed. There were few kidney registries and advocacy groups championing kidney disease management in Africa compared with the rest of the world. Strategies for ensuring improved kidney care in Africa include focusing on chronic kidney disease prevention and early detection, improving the effectiveness of the available health care workforce (e.g., multidisciplinary teams, task substitution, and telemedicine), augmenting kidney care financing, providing quality, up-to-date health information data, and improving the accessibility, affordability, and delivery of quality treatment (kidney replacement therapy or conservative kidney management) for all people living with kidney failure.

在非洲,慢性肾病的负担和相关的肾衰竭风险正在增加。由于医疗系统和医疗基础设施的限制,慢性肾脏病患者的管理面临诸多挑战。根据国际肾脏病学会全球肾脏健康地图集的第三次迭代,我们采用世界卫生组织的卫生系统构件描述了 ISN 非洲地区的肾脏护理现状。我们发现,政府的医疗支出有限,这反过来又导致肾病患者在接受服务时的自付费用增加。整个非洲的医护人员队伍并不理想,而训练有素的医护人员大量涌出非洲大陆又进一步加剧了这一问题。由于医疗基础设施的限制,用于非透析慢性肾病患者管理和肾脏替代疗法的医疗产品、技术和服务非常稀缺,而且分布不均。与世界其他地区相比,非洲很少有肾脏登记处和倡导肾脏疾病管理的团体。确保改善非洲肾脏护理的战略包括:重点关注慢性肾脏病的预防和早期发现,提高现有医疗队伍的效率(如多学科团队、任务替代和远程医疗),增加肾脏护理资金,提供高质量的最新健康信息数据,以及改善所有肾衰竭患者获得高质量治疗(肾替代疗法或保守的肾脏管理)的机会、可负担性和提供。
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引用次数: 0
Capacity for the management of kidney failure in the International Society of Nephrology Oceania and South East Asia (OSEA) region: report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA) 国际肾脏病学会大洋洲和东南亚(OSEA)地区肾衰竭管理能力:2023 年 ISN 全球肾脏健康图集(ISN-GKHA)报告
IF 5.5 2区 医学 Q1 Medicine Pub Date : 2024-04-01 DOI: 10.1016/j.kisu.2024.01.004
Anna Francis , Marina Wainstein , Georgina Irish , Muhammad Iqbal Abdul Hafidz , Titi Chen , Yeoungjee Cho , Htay Htay , Talerngsak Kanjanabuch , Rowena Lalji , Brendon L. Neuen , Emily See , Anim Shah , Brendan Smyth , Somkanya Tungsanga , Andrea Viecelli , Emily K. Yeung , Silvia Arruebo , Aminu K. Bello , Fergus J. Caskey , Sandrine Damster , Deenaz Zaidi

The International Society of Nephrology (ISN) region of Oceania and South East Asia (OSEA) is a mix of high- and low-income countries, with diversity in population demographics and densities. Three iterations of the ISN-Global Kidney Health Atlas (GKHA) have been conducted, aiming to deliver in-depth assessments of global kidney care across the spectrum from early detection of CKD to treatment of kidney failure. This paper reports the findings of the latest ISN-GKHA in relation to kidney-care capacity in the OSEA region. Among the 30 countries and territories in OSEA, 19 (63%) participated in the ISN-GKHA, representing over 97% of the region’s population. The overall prevalence of treated kidney failure in the OSEA region was 1203 per million population (pmp), 45% higher than the global median of 823 pmp. In contrast, kidney replacement therapy (KRT) in the OSEA region was less available than the global median (chronic hemodialysis, 89% OSEA region vs. 98% globally; peritoneal dialysis, 72% vs. 79%; kidney transplantation, 61% vs. 70%). Only 56% of countries could provide access to dialysis to at least half of people with incident kidney failure, lower than the global median of 74% of countries with available dialysis services. Inequalities in access to KRT were present across the OSEA region, with widespread availability and low out-of-pocket costs in high-income countries and limited availability, often coupled with large out-of-pocket costs, in middle- and low-income countries. Workforce limitations were observed across the OSEA region, especially in lower-middle–income countries. Extensive collaborative work within the OSEA region and globally will help close the noted gaps in kidney-care provision.

国际肾脏病学会(ISN)大洋洲和东南亚地区(OSEA)由高收入和低收入国家组成,人口结构和密度各不相同。ISN-全球肾脏健康图集(GKHA)已经进行了三次迭代,旨在对从早期发现慢性肾脏病到治疗肾衰竭的全球肾脏护理进行深入评估。本文报告了最新一期ISN-GKHA关于海外东南亚地区肾脏保健能力的调查结果。在欧亚经济区的30个国家和地区中,有19个(63%)参加了ISN-GKHA,占该地区人口的97%以上。OSEA地区接受过治疗的肾衰竭总发病率为每百万人口1203人,比全球中位数823人高出45%。相比之下,OSEA 地区肾脏替代疗法(KRT)的普及率低于全球中位数(慢性血液透析,OSEA 地区为 89%,全球为 98%;腹膜透析,72%,全球为 79%;肾移植,61%,全球为 70%)。只有 56% 的国家能够为至少一半的肾衰竭患者提供透析服务,低于全球 74% 的国家提供透析服务的中位数。整个欧亚经济区在获得 KRT 方面存在不平等现象,高收入国家普遍可获得 KRT,且自付费用较低,而中低收入国家则可获得 KRT 的机会有限,且自付费用往往较高。在整个欧亚经济区,特别是在中低收入国家,都发现了劳动力方面的限制。在海外东南亚地区和全球范围内广泛开展合作将有助于缩小肾脏保健服务方面的差距。
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引用次数: 0
The role of mineralocorticoid receptor activation in kidney inflammation and fibrosis. 矿皮质激素受体激活在肾脏炎症和纤维化中的作用。
IF 5.5 2区 医学 Q1 Medicine Pub Date : 2022-04-01 DOI: 10.1016/j.kisu.2021.11.006
J. Luther, A. Fogo
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引用次数: 16
Considerations for the future: current and future treatment paradigms with mineralocorticoid receptor antagonists-unmet needs and underserved patient cohorts. 对未来的考虑:矿皮质激素受体拮抗剂目前和未来的治疗模式——未满足的需求和服务不足的患者群体。
IF 5.5 2区 医学 Q1 Medicine Pub Date : 2022-04-01 DOI: 10.1016/j.kisu.2021.11.008
Murray Epstein
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引用次数: 7
Epidemiology of chronic kidney disease: an update 2022 慢性肾脏疾病流行病学:更新2022
IF 5.5 2区 医学 Q1 Medicine Pub Date : 2022-04-01 DOI: 10.1016/j.kisu.2021.11.003
Csaba P. Kovesdy

Chronic kidney disease is a progressive condition that affects >10% of the general population worldwide, amounting to >800 million individuals. Chronic kidney disease is more prevalent in older individuals, women, racial minorities, and in people experiencing diabetes mellitus and hypertension. Chronic kidney disease represents an especially large burden in low- and middle-income countries, which are least equipped to deal with its consequences. Chronic kidney disease has emerged as one of the leading causes of mortality worldwide, and it is one of a small number of non-communicable diseases that have shown an increase in associated deaths over the past 2 decades. The high number of affected individuals and the significant adverse impact of chronic kidney disease should prompt enhanced efforts for better prevention and treatment.

慢性肾脏疾病是一种进行性疾病,影响全球10%的普通人群,总计8亿人。慢性肾病在老年人、妇女、少数民族以及患有糖尿病和高血压的人群中更为普遍。慢性肾脏疾病在低收入和中等收入国家是一个特别大的负担,这些国家最不具备应对其后果的能力。慢性肾病已成为世界范围内死亡的主要原因之一,也是过去20年来相关死亡人数有所增加的少数非传染性疾病之一。受影响的个体数量和慢性肾脏疾病的显著不良影响应促使加强努力,以更好地预防和治疗。
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引用次数: 400
Clinical perspective—evolving evidence of mineralocorticoid receptor antagonists in patients with chronic kidney disease and type 2 diabetes 临床前景——盐皮质激素受体拮抗剂在慢性肾脏病和2型糖尿病患者中的发展证据
IF 5.5 2区 医学 Q1 Medicine Pub Date : 2022-04-01 DOI: 10.1016/j.kisu.2021.11.005
Peter Rossing

Chronic kidney disease (CKD) in type 2 diabetes is a large and growing problem leading to end-stage kidney disease, atherosclerotic cardiovascular disease, and heart failure (HF). Aldosterone is a key risk factor in promoting inflammation and fibrosis, which causes cardiorenal failure. Treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers does not prevent overactivation of the mineralocorticoid receptor. Therapeutic options and challenges with blocking MR overactivation by aldosterone are reviewed herein. Whereas classic steroidal mineralocorticoid receptor antagonists (MRAs) reduced albuminuria in short-term studies of diabetic and nondiabetic CKD, long-term studies evaluating hard endpoints such as loss of kidney function were not conducted in CKD because of side effects (primarily hyperkalemia). Novel nonsteroidal MRAs reduce proteinuria and markers of HF, with lower risk of hyperkalemia and without renal impairment, in comparison to steroidal MRAs. Furthermore, recent clinical trials have demonstrated the efficacy of the novel, selective, nonsteroidal MRA finerenone to delay progression of kidney and cardiovascular disease, including HF, in patients with CKD and type 2 diabetes. Concomitantly, the safety profile of finerenone is good, with few patients discontinuing treatment because of hyperkalemia, even among study participants with a low estimated glomerular filtration rate (>25 ml/min per 1.73 m2). Novel nonsteroidal MRAs such as finerenone hold the potential to be an attractive addition to the treatment paradigm in the management of patients with CKD and type 2 diabetes, targeting the unmet need of managing increased inflammation and fibrosis attributable to MR overactivation.

2型糖尿病中的慢性肾脏疾病(CKD)是一个巨大且日益严重的问题,会导致终末期肾病、动脉粥样硬化性心血管疾病和心力衰竭(HF)。醛固酮是促进炎症和纤维化的关键风险因素,而炎症和纤维化会导致心肾功能衰竭。血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂的治疗不能防止盐皮质激素受体的过度激活。本文综述了醛固酮阻断MR过度激活的治疗选择和挑战。尽管在糖尿病和非糖尿病CKD的短期研究中,经典的甾体盐皮质激素受体拮抗剂(MRAs)可以减少蛋白尿,但由于副作用(主要是高钾血症),没有在CKD中进行评估肾功能丧失等硬终点的长期研究。与甾体MRA相比,新型非甾体MRAs可降低蛋白尿和HF标志物,高钾血症风险较低,且无肾损伤。此外,最近的临床试验已经证明,新型、选择性、非甾体MRA精细雷诺酮对CKD和2型糖尿病患者延缓肾脏和心血管疾病(包括HF)进展的疗效。同时,finerenone的安全性良好,很少有患者因高钾血症而停止治疗,即使在肾小球滤过率估计较低(>25ml/min/1.73m2)的研究参与者中也是如此。在CKD和2型糖尿病患者的治疗模式中,新的非甾体MRA(如finerenone)有可能成为一个有吸引力的补充,旨在满足因MR过度激活而导致的炎症和纤维化增加的未满足需求。
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引用次数: 11
The renin–angiotensin system biomolecular cascade: a 2022 update of newer insights and concepts 肾素-血管紧张素系统生物分子级联:2022年更新的新见解和概念
IF 5.5 2区 医学 Q1 Medicine Pub Date : 2022-04-01 DOI: 10.1016/j.kisu.2021.11.002
Carlos M. Ferrario , Leanne Groban , Hao Wang , Xuming Sun , Jessica L. VonCannon , Kendra N. Wright , Sarfaraz Ahmad

A large body of evidence implicates the renin–angiotensin system in the pathogenesis of cardiovascular disease. However, not everyone understands that the magnitude of the risk reduction achieved in clinical trials with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers is only a fraction of the residual risk for cardiovascular events and death. This paper addresses limitations of current therapeutic approaches based on renin–angiotensin system blockade for hypertension and cardiovascular disease by illustrating the complex biochemical physiology and mechanism of classical and alternate angiotensin peptide formation. Emerging evidence of alternate mechanisms that bypass both renin and angiotensin-converting enzyme to produce the angiotensins in tissues and cells is not currently universally recognized. Currently available treatment would benefit from further insights to help fully meet the aims of patient care, and the challenge is to delve more deeply into the renin–angiotensin system cascade, with the aim of enhancing therapeutics for renin–angiotensin system inhibition. This article provides a reappraisal of the renin–angiotensin–aldosterone cascade, highlighting newly elucidated intermediary components and interplay, and their consequent implications and relevance for understanding the long-term contribution of angiotensin II in cardiovascular diseases and their therapy.

大量证据表明肾素-血管紧张素系统与心血管疾病的发病机制有关。然而,并不是每个人都明白,在血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂的临床试验中,风险降低的幅度只是心血管事件和死亡的残余风险的一小部分。本文通过阐明经典和替代血管紧张素肽形成的复杂生化生理学和机制,阐述了目前基于肾素-血管紧张素系统阻断的高血压和心血管疾病治疗方法的局限性。绕过肾素和血管紧张素转换酶在组织和细胞中产生血管紧张素的替代机制的新证据目前尚未得到普遍认可。目前可用的治疗方法将受益于进一步的见解,以帮助完全实现患者护理的目标,挑战是更深入地研究肾素-血管紧张素系统级联反应,目的是增强肾素-血管紧缩素系统抑制的治疗方法。本文对肾素-血管紧张素-醛固酮级联反应进行了重新评估,强调了新阐明的中间成分和相互作用,以及它们对理解血管紧张素II在心血管疾病及其治疗中的长期作用的影响和相关性。
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引用次数: 21
Nonepithelial mineralocorticoid receptor activation as a determinant of kidney disease. 非上皮性矿皮质激素受体激活作为肾脏疾病的决定因素。
IF 5.5 2区 医学 Q1 Medicine Pub Date : 2022-04-01 DOI: 10.1016/j.kisu.2021.11.004
Toshifumi Nakamura, S. Girerd, F. Jaisser, J. Barrera-Chimal
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引用次数: 11
期刊
Kidney International Supplements
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