Objective To assess changes in key measures of kidney care using data reported in 2019 and 2023. Design Cross sectional survey in 148 countries. Setting Surveys from International Society of Nephrology Global Kidney Health Atlas between 2019 and 2023 that included participants from countries in Africa (n=36), Eastern and Central Europe (n=16), Latin America (n=18), the Middle East (n=11), Newly Independent States and Russia (n=10), North America and the Caribbean (n=8), North and East Asia (n=6), Oceania and South East Asia (n=15), South Asia (n=7), and Western Europe (n=21). Participants Countries that participated in both surveys (2019 and 2023). Main outcome measures Comparison of 2019 and 2023 data for availability of kidney replacement treatment services, access, health financing, workforce, registries, and policies for kidney care. Data for countries that participated in both surveys (2019 and 2023) were included in our analysis. Country data were aggregated by International Society of Nephrology regions and World Bank income levels. Proportionate changes in the status of these measures across both periods were reported. Results Data for 148 countries that participated in both surveys were available for analysis. The proportions of countries that provided public funding (free at point of delivery) increased from 27% in 2019 to 28% in 2023 for haemodialysis, 23% to 28% for peritoneal dialysis, and 31% to 36% for kidney transplantation services. Centres for these treatments increased from 4.4 per million population (pmp) to 4.8 pmp (P<0.001) for haemodialysis, 1.4 pmp to 1.6 pmp for peritoneal dialysis, and 0.43 pmp to 0.46 pmp for kidney transplantation services. Overall, access to haemodialysis and peritoneal dialysis improved, however, access to kidney transplantation decreased from 30 pmp to 29 pmp. The global median prevalence of nephrologists increased from 9.5 pmp to 12.4 pmp (P<0.001). Changes in the availability of kidney registries and in national policies and strategies for kidney care were variable across regions and country income levels. The reporting of specific barriers to optimal kidney care by countries increased from 55% to 59% for geographical factors, 58% to 68% (P=0.043) for availability of nephrologists, and 46% to 52% for political factors. Conclusions Important changes in key areas of kidney care delivery were noted across both periods globally. These changes effected the availability of, and access to, kidney transplantation services. Countries and regions need to enact enabling strategies for preserving access to kidney care services, particularly kidney transplantation. ISN-GKHA 2019 data are available from [doi:10.1136/bmj.l5873][1] (PMID: 31672760). ISN-GKHA 2023 data are available from: [doi:10.1016/S2214-109X(23)00570-3][2] (PMID: 38365413). Full data are available from the corresponding author at iokpechi{at}ualberta.ca [1]: https://www.bmj.com/content/367/bmj.l5873 [2]: https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(23)00570-3/fulltext

中文翻译：

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2019 年至 2023 年各国在肾脏护理服务和结构方面的进展：148 个国家的横断面调查


目的 使用 2019 年和 2023 年报告的数据评估肾脏护理关键指标的变化。设计 在 148 个国家/地区进行横断面调查。2019 年至 2023 年期间国际肾脏病学会全球肾脏健康地图集的背景调查，包括来自非洲 （n=36）、东欧和中欧 （n=16）、拉丁美洲 （n=18）、中东 （n=11）、新独立国家和俄罗斯 （n=10）、北美和加勒比地区 （n=8）、北亚和东亚 （n=6） 的参与者， 大洋洲和东南亚 （n=15）、南亚 （n=7） 和西欧 （n=21）。参与者 参与两项调查的国家（2019 年和 2023 年）。主要结局指标 2019 年和 2023 年肾脏替代治疗服务可用性、可及性、健康融资、劳动力、登记和肾脏护理政策的数据比较。我们的分析包括参与两项调查（2019 年和 2023 年）的国家的数据。国家数据按国际肾脏病学会地区和世界银行收入水平汇总。报告了这两个时期这些措施的状态发生成比例的变化。结果 参与这两项调查的 148 个国家的数据可用于分析。提供公共资金（分娩时免费）的国家比例从 2019 年的 27% 增加到 2023 年的 28%，用于腹膜透析的 23% 增加到 28%，用于肾移植服务达到 31% 到 36%。血液透析的这些治疗中心从每百万人口 4.4 人 （pmp） 增加到 4.8 pmp （P<0.001），腹膜透析从 1.4 pmp 增加到 1.6 pmp，肾移植服务从 0.43 pmp 增加到 0.46 pmp。 总体而言，血液透析和腹膜透析的可及性有所改善，然而，肾移植的可及性从 30 pmp 下降到 29 pmp。肾病科医生的全球中位患病率从 9.5 pmp 增加到 12.4 pmp （P<0.001）。肾脏登记处的可用性以及国家肾脏保健政策和策略的变化因地区和国家收入水平而异。由于地理因素，各国报告的最佳肾脏护理的具体障碍从 55% 增加到 59%，在肾病学家的可用性方面从 58% 增加到 68% （P=0.043），在政治因素方面从 46% 增加到 52%。结论 在这两个时期，全球肾脏护理服务的关键领域都发生了重要变化。这些变化影响了肾移植服务的可用性和可及性。各国和各地区需要制定有利战略，以保持获得肾脏保健服务的机会，特别是肾移植。ISN-GKHA 2019 数据可从 [doi：10.1136/bmj.l5873][1] （PMID： 31672760） 获得。ISN-GKHA 2023 数据可从以下网址获得：[doi：10.1016/S2214-109X（23）00570-3][2] （PMID： 38365413）。完整数据可从 iokpechi{at} 的通讯作者处获得 ualberta.ca [1]：https://www.bmj.com/content/367/bmj.l5873 [2]：https://www.thelancet。com/journals/langlo/article/PIIS2214-109X（23）00570-3/全文