Заболевания почек: бремя болезни и доступность медицинской помощи*

Крю Д., Белло А., Саади Г. Заболевания почек: бремя болезни и доступность медицинской помощи. Терапевтический архив. 2019; 91 (6):34–39. DOI: 10.26442/00403660.2019.06.000251

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Crews C.D., Bello A.K., Saadi G. Burden, access, and disparities in kidney disease. Therapeutic Archive. 2019; 91 (6): 34–39. DOI: 10.26442/00403660.2019.06.000251

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Аннотация

Заболевания почек – глобальная проблема общественного здравоохранения, затрагивающая более 750 млн человек во всем мире Распространенность заболеваний почек, а также их диагностика и лечение в разных странах существенно различаются. Значение и последствия заболеваний почек наиболее хорошо изучены в развитых странах, но в последнее время появляется все больше данных, свидетельствующих об аналогичной и даже более высокой распространенности заболеваний почек и в развивающихся странах. Во многих ситуациях частота заболеваний почек и обеспечение медицинской помощью определяются социально-экономическими, культурными и политическими факторами, что даже в развитых странах приводит к существенным различиям наносимого болезнью ущерба. Эти различия наблюдаются на разных этапах оказания помощи при заболеваниях болезнях почек: от профилактических мероприятий, направленных на предотвращение развития острого повреждения почек и хронической болезни почек, до скрининга на наличие болезни почек у лиц с высоким риском заболевания и доступа к специализированной медицинской помощи и проведению заместительной почечной терапии для лечения почечной недостаточности. Всемирный день почки – 2019 дает возможность повысить осведомленность о заболеваниях почек, а также осветить несоответствия между причиняемым ими ущербом и потенциальными возможностями их профилактики и лечения. В публикуемой передовой статье мы хотим заострить внимание на этих несоответствиях и подчеркиваем роль общественной политики и организационных структур в их устранении. Мы намечаем пути улучшения понимания этих различий, определяем основные подходы к достижению этого понимания, а также возможности оптимизации усилий для обеспечения равенства в вопросах поддержания здоровья почек во всем мире.

Ключевые слова: острое повреждение почек, терминальная почечная недостаточность, охрана здоровья населения мира, социальные детерминанты здоровья.

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Kidney disease is a global public health problem that affects more than 750 million persons worldwide. The burden of kidney disease varies substantially across the world, as does its detection and treatment. Although the magnitude and impact of kidney disease is better defined in developed countries, emerging evidence suggests that developing countries have a similar or even greater kidney disease burden. In many settings, rates of kidney disease and the provision of its care are defined by socioeconomic, cultural, and political factors, leading to significant disparities in disease burden, even in developed countries. These disparities exist across the spectrum of kidney disease – from preventive efforts to curb development of acute kidney injury or chronic kidney disease, to screening for kidney disease among persons at high risk, to access to subspecialty care and treatment of kidney failure with renal replacement therapy. World Kidney Day 2019 offers an opportunity to raise awareness of kidney disease and highlight disparities in its burden and current state of global capacity for prevention and management. In this editorial, we highlight these disparities and emphasize the role of public policies and organizational structures in addressing them. We outline opportunities to improve our understanding of disparities in kidney disease, the best ways for them to be addressed, and how to streamline efforts toward achieving kidney health equity across the globe.

Keywords: acute kidney injury, end stage renal disease, global health, health equity, social determinants of health.

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Авторы

Д. Крю1-3, А. Белло4, Г. Саади5; для Организационного комитета Всемирного дня почки6

1 Отдел нефрологии, медицинский факультет, Медицинская школа Университета Джонса Хопкинса, Балтимор, Мэриленд, США;
2 Научно-исследовательский центр Уэлч по профилактике, эпидемиологии и клиническим исследованиям, Медицинский институт Университета Джонса Хопкинса, Балтимор, Мэриленд, США;
3 Центр Джонса Хопкинса по обеспечению равенства в вопросах здравоохранения, Медицинский институт Университета Джонса Хопкинса, Балтимор, Мэриленд, США;
4 Отдел нефрологии и трансплантационной иммунологии, медицинский факультет, Альбертский университет, Эдмонтон, Канада;
5 Отделение нефрологии, отдел внутренних болезней, медицинский факультет, Каирский университет, Гиза, Египет;
6 cписок членов Организационного комитета Всемирного дня почки см. в Приложении

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Deidra C. Crews1-3, Aminu K. Bello4, Gamal Saadi5; for the World Kidney Day Steering Committee6

1 Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;
2 Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA;
3 Johns Hopkins Center for Health Equity, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA;
4 Division of Nephrology & Transplant Immunology, Department of Medicine, University of Alberta, Edmonton, Canada;
5 Nephrology Unit, Department of Internal Medicine, Faculty of Medicine, Cairo University, Giza, Egypt;
6 See Appendix for list of members of the World Kidney Day Steering Committee

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