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International Society of Nephrology Global Kidney Health Atlas: structures, organization, and services for the management of kidney failure in Africa 国际肾脏病学会全球肾脏健康地图集:非洲肾衰竭管理的结构、组织和服务
IF 5.5 2区 医学 Q1 Medicine Pub Date : 2021-05-01 DOI: 10.1016/j.kisu.2021.01.009
Fidelis Oguejiofor , Daniel S. Kiggundu , Aminu K. Bello , Charles R. Swanepoel , Gloria Ashuntantang , Vivekanand Jha , David C.H. Harris , Adeera Levin , Marcello Tonelli , Abdou Niang , Nicola Wearne , Mothusi Walter Moloi , Ifeoma Ulasi , Fatiu A. Arogundade , Syed Saad , Deenaz Zaidi , Mohamed A. Osman , Feng Ye , Meaghan Lunney , Timothy O. Olanrewaju , Ikechi G. Okpechi

Despite positive economic forecasts, stable democracies, and reduced regional conflicts since the turn of the century, Africa continues to be afflicted by poverty, poor infrastructure, and a massive burden of communicable diseases such as HIV, malaria, tuberculosis, and diarrheal illnesses. With the rising prevalence of chronic kidney disease and kidney failure worldwide, these factors continue to hinder the ability to provide kidney care for millions of people on the continent. The International Society of Nephrology Global Kidney Health Atlas project was established to assess the global burden of kidney disease and measure global capacity for kidney replacement therapy (dialysis and kidney transplantation). The aim of this second iteration of the International Society of Nephrology Global Kidney Health Atlas was to evaluate the availability, accessibility, affordability, and quality of kidney care worldwide. We identified several gaps regarding kidney care in Africa, chief of which are (i) severe workforce limitations, especially in terms of the number of nephrologists; (ii) low government funding for kidney care; (iii) limited availability, accessibility, reporting, and quality of provided kidney replacement therapy; and (iv) weak national strategies and advocacy for kidney disease. We also identified that within Africa, the availability and accessibility to kidney replacement therapy vary significantly, with North African countries faring far better than sub-Sahara African countries. The evidence suggests an urgent need to increase the workforce and government funding for kidney care, collect adequate information on the burden of kidney disease from African countries, and develop and implement strategies to enhance disease prevention and control across the continent.

尽管自世纪之交以来,非洲经济前景乐观,民主稳定,地区冲突减少,但贫困、基础设施落后以及艾滋病毒、疟疾、结核病和腹泻等传染病的沉重负担继续困扰着非洲。随着世界范围内慢性肾脏疾病和肾衰竭的发病率不断上升,这些因素继续阻碍着为非洲大陆数百万人提供肾脏护理的能力。国际肾脏病学会全球肾脏健康地图集项目的建立是为了评估全球肾脏疾病负担并衡量全球肾脏替代疗法(透析和肾移植)的能力。国际肾脏病学会全球肾脏健康地图集第二次迭代的目的是评估全球肾脏护理的可用性、可及性、可负担性和质量。我们确定了非洲肾脏护理方面的几个差距,主要是:(i)严重的劳动力限制,特别是在肾脏科医生的数量方面;(ii)政府对肾脏护理的资助不足;(iii)提供的肾脏替代治疗的可获得性、可及性、报告和质量有限;(四)对肾病的国家战略和宣传薄弱。我们还发现,在非洲,肾脏替代疗法的可用性和可及性差异很大,北非国家的情况远远好于撒哈拉以南非洲国家。有证据表明,迫切需要增加肾脏护理的人力和政府资金,从非洲国家收集有关肾脏疾病负担的充分信息,并制定和实施战略,以加强整个非洲大陆的疾病预防和控制。
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引用次数: 13
International Society of Nephrology Global Kidney Health Atlas: structures, organization, and services for the management of kidney failure in Eastern and Central Europe 国际肾脏病学会全球肾脏健康地图集:东欧和中欧肾衰竭管理的结构、组织和服务
IF 5.5 2区 医学 Q1 Medicine Pub Date : 2021-05-01 DOI: 10.1016/j.kisu.2021.01.008
Alicja Dębska-Ślizień , Aminu K. Bello , David W. Johnson , Vivekanand Jha , David C.H. Harris , Adeera Levin , Marcello Tonelli , Syed Saad , Deenaz Zaidi , Mohamed A. Osman , Feng Ye , Maryam Khan , Meaghan Lunney , Ikechi G. Okpechi , Rumeyza Turan Kazancioglu , ISN Eastern and Central Europe Regional Board

Provision of adequate kidney care for patients with chronic kidney disease or kidney failure (KF) is costly and requires extensive resources. There is an inequality in the global distribution of wealth and resources needed to provide this care. In this second iteration of the International Society of Nephrology Global Kidney Health Atlas, we present data for countries in Eastern and Central Europe. In the region, the median prevalence of chronic kidney disease was 13.15% and treated KF was 764 per million population, respectively, slightly higher than the global median of 759 per million population. In most countries in the region, over 90% of dialysis patients were on hemodialysis and patients with a functioning graft represented less than one-third of total patients with treated KF. The median annual costs for maintenance hemodialysis were close to the global median, and public funding provided nearly universal coverage of the costs of kidney replacement therapy. Nephrologists were primarily responsible for KF care. All countries had the capacity to provide long-term hemodialysis, and 95% had the capacity to provide peritoneal dialysis. Home hemodialysis was generally not available. Kidney transplantation and conservative care were available across most of the region. Almost all countries had official dialysis and transplantation registries. Eastern and Central Europe is a region with a high burden of chronic kidney disease and variable capacity to deal with it. Insufficient funding and workforce shortages coupled with increasing comorbidities among aging patients and underutilization of cost-effective dialysis therapies such as peritoneal dialysis and kidney transplantation may compromise the quality of care for patients with KF. Some workforce shortages could be addressed by improving the organization of nephrological care in some countries of the region.

为慢性肾病或肾衰竭患者提供适当的肾脏护理费用高昂,需要大量资源。提供这种护理所需的财富和资源的全球分配存在不平等。在国际肾脏病学会全球肾脏健康地图集的第二次迭代中,我们提供了东欧和中欧国家的数据。在该地区,慢性肾脏疾病的中位患病率为13.15%,治疗后的KF患病率分别为每百万人口764例,略高于每百万人口759例的全球中位数。在该区域的大多数国家,90%以上的透析患者进行血液透析,移植物功能正常的患者占接受治疗的KF患者总数的不到三分之一。维持性血液透析的年费用中位数接近全球中位数,公共资金几乎覆盖了肾脏替代治疗的费用。肾科医生主要负责KF护理。所有国家都有能力提供长期血液透析,95%的国家有能力提供腹膜透析。家庭血液透析一般不可行。肾移植和保守治疗在大部分地区都是可行的。几乎所有国家都有官方的透析和移植登记。东欧和中欧是一个慢性肾脏疾病负担沉重且应对能力不一的区域。资金不足和劳动力短缺,加上老年患者中合并症的增加,以及低成本透析疗法(如腹膜透析和肾移植)的利用不足,可能会损害KF患者的护理质量。在该区域的一些国家,可以通过改进肾病护理的组织来解决一些劳动力短缺问题。
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引用次数: 5
International Society of Nephrology Global Kidney Health Atlas: structures, organization, and services for the management of kidney failure in Western Europe 国际肾脏病学会全球肾脏健康地图集:西欧肾衰竭管理的结构、组织和服务
IF 5.5 2区 医学 Q1 Medicine Pub Date : 2021-05-01 DOI: 10.1016/j.kisu.2021.01.007
Dearbhla M. Kelly , Hans-Joachim Anders , Aminu K. Bello , Gabriel Choukroun , Rosanna Coppo , Gavin Dreyer , Kai-Uwe Eckardt , David W. Johnson , Vivekanand Jha , David C.H. Harris , Adeera Levin , Meaghan Lunney , Valerie Luyckx , Hans-Peter Marti , Piergiorgio Messa , Thomas F. Mueller , Syed Saad , Benedicte Stengel , Raymond C. Vanholder , Talia Weinstein , Eric Rondeau

Populations in the high-income countries of Western Europe are aging due to increased life expectancy. As the prevalence of diabetes and obesity has increased, so has the burden of kidney failure. To determine the global capacity for kidney replacement therapy and conservative kidney management, the International Society of Nephrology conducted multinational, cross-sectional surveys and published the findings in the International Society of Nephrology Global Kidney Health Atlas. In the second iteration of the International Society of Nephrology Global Kidney Health Atlas, we aimed to describe the availability, accessibility, quality, and affordability of kidney failure care in Western Europe. Among the 29 countries in Western Europe, 21 (72.4%) responded, representing 99% of the region’s population. The burden of kidney failure prevalence varied widely, ranging from 760 per million population (pmp) in Iceland to 1612 pmp in Portugal. Coverage of kidney replacement therapy from public funding was nearly universal, with the exceptions of Germany and Liechtenstein where part of the costs was covered by mandatory insurance. Fourteen (67%) of 21 countries charged no fees at the point of care delivery, but in 5 countries (24%), patients do pay some out-of-pocket costs. Long-term dialysis services (both hemodialysis and peritoneal dialysis) were available in all countries in the region, and kidney transplantation services were available in 19 (90%) countries. The incidence of kidney transplantation varied widely between countries from 12 pmp in Luxembourg to 70.45 pmp in Spain. Conservative kidney care was available in 18 (90%) of 21 countries. The median number of nephrologists was 22.9 pmp (range: 9.47–55.75 pmp). These data highlight the uniform capacity of Western Europe to provide kidney failure care, but also the scope for improvement in disease prevention and management, as exemplified by the variability in disease burden and transplantation rates.

由于预期寿命的延长,西欧高收入国家的人口正在老龄化。随着糖尿病和肥胖症患病率的增加,肾衰竭的负担也在增加。为了确定肾脏替代治疗和保守肾脏管理的全球能力,国际肾脏病学会进行了多国横断面调查,并在国际肾脏病学会全球肾脏健康地图集上发表了研究结果。在国际肾脏病学会全球肾脏健康地图集的第二次迭代中,我们旨在描述西欧肾衰竭护理的可用性、可及性、质量和可负担性。在西欧的29个国家中,有21个(72.4%)做出了回应,占该地区人口的99%。肾衰竭患病率的负担差异很大,从冰岛的760 /百万人口(pmp)到葡萄牙的1612 /百万人口。除了德国和列支敦士登的部分费用由强制性保险支付外,几乎所有人都用公共资金支付肾脏替代疗法的费用。在21个国家中,有14个国家(67%)在提供护理时不收取费用,但在5个国家(24%),患者确实支付了一些自付费用。该区域所有国家都提供长期透析服务(血液透析和腹膜透析),19个(90%)国家提供肾移植服务。肾移植的发生率在各国之间差异很大,从卢森堡的12pmp到西班牙的70.45 pmp。在21个国家中,有18个国家(90%)提供保守的肾脏护理。肾内科医生的中位数为22.9 pmp(范围:9.47-55.75 pmp)。这些数据强调了西欧提供肾衰竭护理的统一能力,但也强调了疾病预防和管理方面的改进范围,如疾病负担和移植率的差异所示。
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引用次数: 11
Global variation in kidney care: national and regional differences in the care and management of patients with kidney failure 肾脏护理的全球差异:国家和地区对肾衰竭患者的护理和管理的差异
IF 5.5 2区 医学 Q1 Medicine Pub Date : 2021-05-01 DOI: 10.1016/j.kisu.2020.11.003
Aminu K. Bello , Ikechi G. Okpechi , Vivekanand Jha , David C.H. Harris , Adeera Levin , David W. Johnson
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引用次数: 2
Subscription Information 订阅信息
IF 5.5 2区 医学 Q1 Medicine Pub Date : 2021-05-01 DOI: 10.1016/S2157-1716(21)00049-6
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引用次数: 0
Treatment of anemia in difficult-to-manage patients with chronic kidney disease 难治性慢性肾病患者贫血的治疗
IF 5.5 2区 医学 Q1 Medicine Pub Date : 2021-04-01 DOI: 10.1016/j.kisu.2020.12.006
Ritesh Raichoudhury , Bruce S. Spinowitz

The management of anemia of chronic kidney disease (CKD) is often challenging. In particular, for patients with underlying inflammation, comorbid type 2 diabetes or cancer, those hospitalized, and recipients of a kidney transplant, the management of anemia may be suboptimal. Responsiveness to iron and/or erythropoiesis-stimulating agents, the mainstay of current therapy, may be reduced and the risk of adverse reactions to treatment is increased in these difficult-to-manage patients with anemia of CKD. This review discusses the unique patient and disease characteristics leading to complications and suboptimal treatment response. New treatment options in clinical development, such as hypoxia-inducible factor-prolyl hydroxylase (HIF-PH) inhibitors, may be particularly useful for difficult-to-treat patients. In clinical studies, HIF-PH inhibitors provided increased hemoglobin levels and improved iron utilization in anemic patients with non–dialysis-dependent and dialysis-dependent CKD, and preliminary data suggest that HIF-PH inhibitors may be equally effective in patients with or without underlying inflammation. The availability of new treatment options, including HIF-PH inhibitors, may improve treatment outcomes in difficult-to-manage patients with anemia of CKD.

慢性肾脏疾病(CKD)贫血的管理往往是具有挑战性的。特别是,对于有潜在炎症、合并症2型糖尿病或癌症、住院和肾移植的患者,贫血的管理可能不是最佳的。在这些难以控制的CKD贫血患者中,对铁和/或促红细胞生成药物的反应性(目前治疗的主要方法)可能会降低,并且治疗不良反应的风险会增加。这篇综述讨论了导致并发症和次优治疗反应的独特患者和疾病特征。临床开发中的新治疗方案,如缺氧诱导因子-脯氨酸羟化酶(HIF-PH)抑制剂,可能对难以治疗的患者特别有用。在临床研究中,HIF-PH抑制剂在非透析依赖性和透析依赖性CKD的贫血患者中提供血红蛋白水平升高和铁利用改善,初步数据表明HIF-PH抑制剂可能对有或没有潜在炎症的患者同样有效。包括HIF-PH抑制剂在内的新治疗方案的可用性可能会改善难以控制的CKD贫血患者的治疗结果。
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引用次数: 12
Anemia management: a historical perspective 贫血管理:一个历史的视角
IF 5.5 2区 医学 Q1 Medicine Pub Date : 2021-04-01 DOI: 10.1016/j.kisu.2020.12.004
Steven Fishbane
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引用次数: 2
Subscription Information 订阅信息
IF 5.5 2区 医学 Q1 Medicine Pub Date : 2021-04-01 DOI: 10.1016/S2157-1716(21)00023-X
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引用次数: 0
Iron metabolism and management: focus on chronic kidney disease 铁代谢和管理:关注慢性肾脏疾病
IF 5.5 2区 医学 Q1 Medicine Pub Date : 2021-04-01 DOI: 10.1016/j.kisu.2020.12.003
Anil K. Agarwal

Anemia is common in patients with chronic kidney disease (CKD) and results from the dysregulation of iron metabolism and erythropoiesis. Hepcidin is a key regulator of iron availability and leads to iron sequestration during the state of iron repletion. Decreases in the level of hepcidin in the presence of hypoxia and/or iron limitation allow for greater iron availability for erythropoiesis. However, kidney excretion of hepcidin decreases as the severity of CKD increases, whereas production of hepcidin is increased under inflammatory conditions often present in patients with CKD, both of which contribute to anemia. Assessment of iron status is, therefore, essential in the treatment of anemia. However, current laboratory tests for the determination of the adequate supply of iron have many limitations, including diurnal variation in the levels of biomarkers, lack of standardized reference methods across laboratories, and confounding by the presence of inflammation. In addition, the current treatment paradigm for anemia of CKD can further disrupt iron homeostasis; for example, treatment with erythropoiesis-stimulating agents in the absence of supplemental iron can induce functional iron deficiency. Moreover, supplemental iron can further increase levels of hepcidin. Several novel therapies, including hypoxia-inducible factor prolyl hydroxylase inhibitors and hepcidin inhibitors/antagonists, have shown promise in attenuating the levels and/or activity of hepcidin in anemia of CKD, thus ensuring the availability of iron for erythropoiesis.

贫血在慢性肾脏疾病(CKD)患者中很常见,是铁代谢和红细胞生成失调的结果。Hepcidin是铁可用性的关键调节因子,并在铁补充状态下导致铁的固存。在缺氧和/或铁限制的情况下,hepcidin水平的降低为红细胞生成提供了更大的铁可用性。然而,随着CKD严重程度的增加,hepcidin的肾脏排泄会减少,而在CKD患者中经常出现的炎症条件下,hepcidin的产生会增加,这两种情况都会导致贫血。因此,评估铁的状态在贫血的治疗中是必不可少的。然而,目前用于确定铁的充足供应的实验室测试有许多局限性,包括生物标志物水平的日变化,实验室间缺乏标准化的参考方法,以及炎症的存在造成混淆。此外,目前CKD贫血的治疗模式可能进一步破坏铁稳态;例如,在缺乏补充铁的情况下使用促红细胞生成剂治疗可引起功能性铁缺乏。此外,补充铁可以进一步提高肝磷脂水平。一些新疗法,包括缺氧诱导因子脯氨酰羟化酶抑制剂和hepcidin抑制剂/拮抗剂,已经显示出在CKD贫血中降低hepcidin水平和/或活性的希望,从而确保铁的可用性。
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引用次数: 21
Anemia management for home dialysis including the new US public policy initiative 家庭透析的贫血管理,包括新的美国公共政策倡议
IF 5.5 2区 医学 Q1 Medicine Pub Date : 2021-04-01 DOI: 10.1016/j.kisu.2020.12.005
Anjay Rastogi , Edgar V. Lerma

Patients with end-stage kidney disease (ESKD) requiring kidney replacement therapy are often treated in conventional dialysis centers at substantial cost and patient inconvenience. The recent United States Executive Order on Advancing American Kidney Health, in addition to focusing on ESKD prevention and reforming the kidney transplantation system, focuses on providing financial incentives to promote a shift toward home dialysis. In accordance with this order, a goal was set to have 80% of incident dialysis patients receiving home dialysis or a kidney transplant by 2025. Compared with conventional in-center therapy, home dialysis modalities, including both home hemodialysis and peritoneal dialysis, appear to offer equivalent or improved mortality, clinical outcomes, hospitalization rates, and quality of life in patients with ESKD in addition to greater convenience, flexibility, and cost-effectiveness. Treatment of anemia, a common complication of chronic kidney disease, may be easier to manage at home with a new class of agents, hypoxia-inducible factor-prolyl hydroxylase inhibitors, which are orally administered in contrast to the current standard of care of i.v. iron and/or erythropoiesis-stimulating agents. This review evaluates the clinical, quality-of-life, economic, and social aspects of dialysis modalities in patients with ESKD, including during the coronavirus disease 2019 pandemic; explores new therapeutics for the management of anemia in chronic kidney disease; and highlights how the proposed changes in Advancing American Kidney Health provide an opportunity to improve kidney health in the United States.

需要肾脏替代治疗的终末期肾病(ESKD)患者通常在传统透析中心接受治疗,费用高昂,给患者带来不便。最近颁布的《关于促进美国肾脏健康的行政命令》,除了关注ESKD的预防和肾脏移植系统的改革外,还侧重于提供财政激励措施,以促进向家庭透析的转变。根据这一命令,制定的目标是到2025年,80%的意外透析患者接受家庭透析或肾脏移植。与传统的中心治疗相比,家庭透析方式,包括家庭血液透析和腹膜透析,除了更方便、灵活性和成本效益外,似乎还能提供相同或改善的ESKD患者的死亡率、临床结果、住院率和生活质量。贫血是慢性肾脏疾病的一种常见并发症,使用一类新的药物治疗贫血可能更容易在家中管理,即缺氧诱导因子-丙氨酸羟化酶抑制剂,与目前静脉注射铁和/或促红细胞生成药物的护理标准相比,口服给药。本综述评估了ESKD患者透析方式的临床、生活质量、经济和社会方面,包括2019年冠状病毒病大流行期间;探讨慢性肾脏疾病贫血管理的新疗法;并强调了《推进美国肾脏健康》中提出的变化如何为改善美国的肾脏健康提供了机会。
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引用次数: 2
期刊
Kidney International Supplements
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