Advances in kidney disease and health最新文献

英文中文

Path to Achieving Equity in Kidney Care 实现肾脏护理公平之路

IF 2.6 0 UROLOGY & NEPHROLOGY

Advances in kidney disease and health

Pub Date : 2025-05-01 Epub Date: 2025-08-14 DOI: 10.1053/j.akdh.2025.07.001

Silvi Shah MD, MS, Valerie Luyckx

引用次数: 0

Regional Perspectives of Inequities in Chronic Kidney Disease: Beyond the Obvious 慢性肾脏疾病不平等的区域视角：超越显而易见的

IF 2.6 0 UROLOGY & NEPHROLOGY

Advances in kidney disease and health

Pub Date : 2025-05-01 Epub Date: 2025-08-14 DOI: 10.1053/j.akdh.2025.05.005

Ifeoma Ulasi , Ernest Kiswaya Sumaili , Divya Bajpai , Rolando Claure-Del Granado , Jaquelyne T. Hughes

Chronic kidney disease (CKD) is a growing global health burden, with significant disparities in incidence, progression, and outcomes across regions—especially in Africa, Asia, and Latin America. This review explores regional perspectives of CKD inequities, going beyond socioeconomic determinants to examine the roles of genetics, environmental exposures, health infrastructure, and cultural factors. In high-income countries, disparities often stem from unequal access to advanced diagnostics and therapies. In low- and middle-income countries, challenges include limited health care resources, poor screening programs, high prevalence of infectious diseases, and environmental toxins. The article highlights rural–urban and indigenous health disparities and emphasizes how cultural and systemic factors exacerbate poor outcomes. We also assess how current global health frameworks, such as the WHO's noncommunicable disease agenda, have inadequately addressed kidney disease. The review underscores the need for targeted policy interventions, health education, and community engagement to reduce CKD disparities. By synthesizing data from diverse regions and populations, we argue for a multifaceted equity-focused approach—combining improved access, culturally appropriate care, and public health strategies—to address kidney health inequities globally. This comprehensive understanding aims to inform action and foster a more equitable landscape in kidney care and outcomes.

慢性肾脏疾病（CKD）是一个日益严重的全球健康负担，在发病率、进展和结果上存在显著差异，特别是在非洲、亚洲和拉丁美洲。本综述探讨了CKD不平等的区域视角，超越了社会经济决定因素，考察了遗传、环境暴露、卫生基础设施和文化因素的作用。在高收入国家，差距往往源于获得先进诊断和治疗的机会不平等。在低收入和中等收入国家，面临的挑战包括卫生保健资源有限、筛查方案不完善、传染病流行率高以及环境毒素。这篇文章强调了城乡和土著居民的健康差异，并强调了文化和系统因素如何加剧了不良结果。我们还评估了当前的全球卫生框架（如世卫组织的非传染性疾病议程）如何未能充分解决肾脏疾病问题。该综述强调需要有针对性的政策干预、健康教育和社区参与来减少CKD的差异。通过综合来自不同地区和人群的数据，我们主张采用多方面的以公平为重点的方法——结合改善获取、文化上适当的护理和公共卫生战略——来解决全球肾脏健康不平等问题。这种全面的理解旨在为行动提供信息，并促进肾脏护理和结果的更公平的环境。

{"title":"Regional Perspectives of Inequities in Chronic Kidney Disease: Beyond the Obvious","authors":"Ifeoma Ulasi , Ernest Kiswaya Sumaili , Divya Bajpai , Rolando Claure-Del Granado , Jaquelyne T. Hughes","doi":"10.1053/j.akdh.2025.05.005","DOIUrl":"10.1053/j.akdh.2025.05.005","url":null,"abstract":"<div><div>Chronic kidney disease (CKD) is a growing global health burden, with significant disparities in incidence, progression, and outcomes across regions—especially in Africa, Asia, and Latin America. This review explores regional perspectives of CKD inequities, going beyond socioeconomic determinants to examine the roles of genetics, environmental exposures, health infrastructure, and cultural factors. In high-income countries, disparities often stem from unequal access to advanced diagnostics and therapies. In low- and middle-income countries, challenges include limited health care resources, poor screening programs, high prevalence of infectious diseases, and environmental toxins. The article highlights rural–urban and indigenous health disparities and emphasizes how cultural and systemic factors exacerbate poor outcomes. We also assess how current global health frameworks, such as the WHO's noncommunicable disease agenda, have inadequately addressed kidney disease. The review underscores the need for targeted policy interventions, health education, and community engagement to reduce CKD disparities. By synthesizing data from diverse regions and populations, we argue for a multifaceted equity-focused approach—combining improved access, culturally appropriate care, and public health strategies—to address kidney health inequities globally. This comprehensive understanding aims to inform action and foster a more equitable landscape in kidney care and outcomes.</div></div>","PeriodicalId":72096,"journal":{"name":"Advances in kidney disease and health","volume":"32 3","pages":"Pages 229-240"},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144842921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Inequities in the Care and Outcomes of Indigenous People Living With Kidney Failure 土著居民肾衰竭患者的护理和预后不公平

IF 2.6 0 UROLOGY & NEPHROLOGY

Advances in kidney disease and health

Pub Date : 2025-05-01 Epub Date: 2025-08-14 DOI: 10.1053/j.akdh.2024.10.008

Somkanya Tungsanga , Ikechi G. Okpechi , Swasti Chaturvedi , Maria Eugenia V. Bianchi , Jacqui Hughes , Harley Crowshoe , Aminu K. Bello

Kidney failure, defined as end-stage kidney disease requiring kidney replacement therapy, is a public health concern that disproportionately affects indigenous peoples around the world. Despite advancements in medical technologies and preventive public health interventions in kidney care, indigenous peoples continue to face significant barriers that limit their access to care. These barriers include limited availability of kidney care services in remote areas, cultural and language obstacles, systemic racism, low health literacy, geographic isolation, and mistrust in health care systems. Such challenges contribute to notable disparities in kidney disease outcomes and kidney replacement therapy access. Previous research in countries such as Canada, Australia, New Zealand, and the United States demonstrates a disproportionate burden of risk factors, chronic kidney disease, and the consequences of kidney failure and other complications among indigenous peoples. In this review, we explore the global landscape of kidney failure among indigenous populations, examining epidemiological data, barriers to care, and outcomes of kidney replacement therapy. The key objective is to provide a comprehensive overview of disparities in the burden of kidney failure and care inequities experienced by this high-risk population group. We propose culturally sensitive, community-driven solutions to mitigate various inequities. Addressing these issues requires acknowledging and overcoming the unique challenges faced by indigenous communities, including enhancing access to home dialysis and transplantation services and implementing culturally appropriate health care practices.

肾衰竭被定义为需要肾脏替代治疗的终末期肾脏疾病，是一个公共卫生问题，对世界各地土著人民的影响尤为严重。尽管医疗技术和预防性公共卫生干预措施在肾脏护理方面取得了进步，但土著人民仍然面临重大障碍，限制了他们获得护理的机会。这些障碍包括偏远地区肾脏护理服务的可得性有限、文化和语言障碍、系统性种族主义、低卫生素养、地理隔离以及对卫生保健系统的不信任。这些挑战导致了肾脏疾病结局和肾脏替代治疗的显著差异。先前在加拿大、澳大利亚、新西兰和美国等国进行的研究表明，土著人民在风险因素、慢性肾脏疾病以及肾衰竭和其他并发症方面的负担不成比例。在这篇综述中，我们探讨了全球土著人群肾衰竭的情况，检查了流行病学数据、护理障碍和肾脏替代治疗的结果。主要目的是全面概述这一高危人群在肾衰竭负担和护理不公平方面的差异。我们提出文化敏感、社区驱动的解决方案，以减轻各种不平等。要解决这些问题，就必须承认和克服土著社区面临的独特挑战，包括增加获得家庭透析和移植服务的机会，并实施文化上适当的保健做法。

{"title":"Inequities in the Care and Outcomes of Indigenous People Living With Kidney Failure","authors":"Somkanya Tungsanga , Ikechi G. Okpechi , Swasti Chaturvedi , Maria Eugenia V. Bianchi , Jacqui Hughes , Harley Crowshoe , Aminu K. Bello","doi":"10.1053/j.akdh.2024.10.008","DOIUrl":"10.1053/j.akdh.2024.10.008","url":null,"abstract":"<div><div>Kidney failure, defined as end-stage kidney disease requiring kidney replacement therapy, is a public health concern that disproportionately affects indigenous peoples around the world. Despite advancements in medical technologies and preventive public health interventions in kidney care, indigenous peoples continue to face significant barriers that limit their access to care. These barriers include limited availability of kidney care services in remote areas, cultural and language obstacles, systemic racism, low health literacy, geographic isolation, and mistrust in health care systems. Such challenges contribute to notable disparities in kidney disease outcomes and kidney replacement therapy access. Previous research in countries such as Canada, Australia, New Zealand, and the United States demonstrates a disproportionate burden of risk factors, chronic kidney disease, and the consequences of kidney failure and other complications among indigenous peoples. In this review, we explore the global landscape of kidney failure among indigenous populations, examining epidemiological data, barriers to care, and outcomes of kidney replacement therapy. The key objective is to provide a comprehensive overview of disparities in the burden of kidney failure and care inequities experienced by this high-risk population group. We propose culturally sensitive, community-driven solutions to mitigate various inequities. Addressing these issues requires acknowledging and overcoming the unique challenges faced by indigenous communities, including enhancing access to home dialysis and transplantation services and implementing culturally appropriate health care practices.</div></div>","PeriodicalId":72096,"journal":{"name":"Advances in kidney disease and health","volume":"32 3","pages":"Pages 279-289"},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144842926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Global Disparities in Access and Utilization of Dialysis – Africa, the Disadvantaged Continent 透析获取和利用的全球差异-非洲，弱势大陆

IF 2.6 0 UROLOGY & NEPHROLOGY

Advances in kidney disease and health

Pub Date : 2025-05-01 Epub Date: 2025-08-14 DOI: 10.1053/j.akdh.2024.11.002

Elliot Koranteng Tannor , Bianca Davidson , Yannick M. Nlandu , Victorine Ndaza , Mohammed Essam Elrggal , Robert Kalysubula , Ikechi G. Okpechi

As the burden of CKD continues to increase globally, there remains huge disparities in CKD management and access to treatment in Africa. This review highlights disparities in access and utilization of dialysis in Africa, comparing this with other regions as well as global median values. In-centre hemodialysis is available in all countries in Africa; however, there are significant gaps in its access and utilization across countries. Home hemodialysis is scarcely available in Africa. Peritoneal dialysis utilization is much lower than global medians. These disparities lead to poor health outcomes, poor quality of life, increased morbidity and preventable premature mortality with ethical, psychological and economic impact on the patient, family members and the community, and loss of skilled labor with its consequences on the national economy. Proposed solutions to decrease the impact of these disparities include implementing CKD prevention to reduce disease burden, improved access to essential medicines to slow disease progression, increased peritoneal dialysis utilization, training and retention of skilled nephrology workforce to maintain optimal delivery of care, increased access to kidney transplantation, local production of peritoneal dialysis and hemodialysis consumables, and increased government funding of kidney care to improve patient outcomes, especially in sub-Saharan Africa.

随着CKD负担在全球范围内的持续增加，非洲在CKD管理和获得治疗方面仍然存在巨大差异。本综述强调了非洲在透析获取和利用方面的差异，并将其与其他区域以及全球中位数进行了比较。非洲所有国家都提供中心血液透析；然而，各国在其获取和利用方面存在重大差距。家庭血液透析在非洲几乎不存在。腹膜透析使用率远低于全球中位数。这些差异导致健康状况不佳、生活质量差、发病率增加和可预防的过早死亡，对患者、家庭成员和社区造成道德、心理和经济影响，并导致熟练劳动力流失，对国民经济造成影响。减少这些差异影响的建议解决方案包括实施CKD预防以减轻疾病负担，改善基本药物的获取以减缓疾病进展，增加腹膜透析的利用，培训和保留熟练的肾病学工作人员以保持最佳的护理提供，增加肾移植的获取，当地生产腹膜透析和血液透析耗材，并增加政府对肾脏护理的资助，以改善患者的预后，特别是在撒哈拉以南非洲地区。

{"title":"Global Disparities in Access and Utilization of Dialysis – Africa, the Disadvantaged Continent","authors":"Elliot Koranteng Tannor , Bianca Davidson , Yannick M. Nlandu , Victorine Ndaza , Mohammed Essam Elrggal , Robert Kalysubula , Ikechi G. Okpechi","doi":"10.1053/j.akdh.2024.11.002","DOIUrl":"10.1053/j.akdh.2024.11.002","url":null,"abstract":"<div><div>As the burden of CKD continues to increase globally, there remains huge disparities in CKD management and access to treatment in Africa. This review highlights disparities in access and utilization of dialysis in Africa, comparing this with other regions as well as global median values. In-centre hemodialysis is available in all countries in Africa; however, there are significant gaps in its access and utilization across countries. Home hemodialysis is scarcely available in Africa. Peritoneal dialysis utilization is much lower than global medians. These disparities lead to poor health outcomes, poor quality of life, increased morbidity and preventable premature mortality with ethical, psychological and economic impact on the patient, family members and the community, and loss of skilled labor with its consequences on the national economy. Proposed solutions to decrease the impact of these disparities include implementing CKD prevention to reduce disease burden, improved access to essential medicines to slow disease progression, increased peritoneal dialysis utilization, training and retention of skilled nephrology workforce to maintain optimal delivery of care, increased access to kidney transplantation, local production of peritoneal dialysis and hemodialysis consumables, and increased government funding of kidney care to improve patient outcomes, especially in sub-Saharan Africa.</div></div>","PeriodicalId":72096,"journal":{"name":"Advances in kidney disease and health","volume":"32 3","pages":"Pages 241-248"},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144842922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Sex and Gender Disparities in Kidney Transplantation 肾移植中的性别差异

IF 2.6 0 UROLOGY & NEPHROLOGY

Advances in kidney disease and health

Pub Date : 2025-05-01 Epub Date: 2025-08-14 DOI: 10.1053/j.akdh.2025.01.003

Mythri Shankar , Silvi Shah

Sex refers to biological traits, while gender involves socially constructed roles and behaviors. Globally, women face disparities in access to kidney transplants, and outcomes, driven by sociocultural and systemic factors. Females have a higher prevalence of kidney disease, start dialysis at lower glomerular filtration rates, and receive lower dialysis doses than males. Fewer females are refered for kidney transplants than males, and females have lower rates of preemptive transplantation than males. There are significant disparities in waitlisting, with fewer females being placed on kidney transplant waiting list and females having longer median wait time, as compared to males. Studies indicate variable outcomes in kidney allograft survival in males and females due to differences in immune response, hormonal effects, and nephron mismatch. Socioeconomic, cultural, and psychosocial factors exacerbate these gaps, alongside healthcare provider biases. Females constitute over 75% of donors, often reflecting caregiving roles. Addressing these disparities requires equitable organ allocation systems, strengthened donor exchange programs, financial support, and culturally sensitive education. Research and policy reforms remain critical to bridging the sex and gender gap in kidney transplantation.

性指的是生物特征，而性别则涉及社会建构的角色和行为。在全球范围内，由于社会文化和系统因素，妇女在获得肾脏移植和结果方面面临差异。女性有较高的肾脏疾病患病率，在较低的肾小球滤过率开始透析，并接受较低的透析剂量比男性。接受肾脏移植的女性比男性少，女性的抢先移植率也比男性低。在等待名单上存在显著差异，与男性相比，女性被放置在肾脏移植等待名单上的人数较少，女性的中位等待时间更长。研究表明，由于免疫反应、激素作用和肾元错配的差异，男性和女性的同种异体肾移植存活率存在差异。社会经济、文化和社会心理因素以及医疗保健提供者的偏见加剧了这些差距。女性占献血者的75%以上，她们往往扮演着照顾者的角色。解决这些差异需要公平的器官分配系统、加强捐赠者交换计划、财政支持和文化敏感的教育。研究和政策改革对于弥合肾移植中的性别差距仍然至关重要。

{"title":"Sex and Gender Disparities in Kidney Transplantation","authors":"Mythri Shankar , Silvi Shah","doi":"10.1053/j.akdh.2025.01.003","DOIUrl":"10.1053/j.akdh.2025.01.003","url":null,"abstract":"<div><div>Sex refers to biological traits, while gender involves socially constructed roles and behaviors. Globally, women face disparities in access to kidney transplants, and outcomes, driven by sociocultural and systemic factors. Females have a higher prevalence of kidney disease, start dialysis at lower glomerular filtration rates, and receive lower dialysis doses than males. Fewer females are refered for kidney transplants than males, and females have lower rates of preemptive transplantation than males. There are significant disparities in waitlisting, with fewer females being placed on kidney transplant waiting list and females having longer median wait time, as compared to males. Studies indicate variable outcomes in kidney allograft survival in males and females due to differences in immune response, hormonal effects, and nephron mismatch. Socioeconomic, cultural, and psychosocial factors exacerbate these gaps, alongside healthcare provider biases. Females constitute over 75% of donors, often reflecting caregiving roles. Addressing these disparities requires equitable organ allocation systems, strengthened donor exchange programs, financial support, and culturally sensitive education. Research and policy reforms remain critical to bridging the sex and gender gap in kidney transplantation.</div></div>","PeriodicalId":72096,"journal":{"name":"Advances in kidney disease and health","volume":"32 3","pages":"Pages 249-256"},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144842923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Policy Approaches to Improve Equitable Access Globally to Kidney Care 改善全球肾脏护理公平获取的政策途径

IF 2.6 0 UROLOGY & NEPHROLOGY

Advances in kidney disease and health

Pub Date : 2025-05-01 Epub Date: 2025-08-14 DOI: 10.1053/j.akdh.2025.05.001

Sri Lekha Tummalapalli , Somkanya Tungsanga , Laura Sola , Ricardo Silvariño , Gangadhar Taduri , M. Rafique Moosa , Ikechi G. Okpechi , Valerie Luyckx

There are substantial inequities both within and between countries in the availability of kidney replacement therapy (KRT), chronic kidney disease care, and a specialized nephrology workforce. Healthcare policies are the foundation for optimal population health and quality health care. In this article, we present 5 country case studies to illustrate how Thailand, Uruguay, India, South Africa, and the United States have made progress in reducing kidney health inequities through healthcare policy change. Lessons learned from these case studies include the importance of 1) universal KRT coverage, 2) access to care across the spectrum of kidney care, 3) investments in public health and reducing adverse social determinants of health, 4) systematic approaches such as health technology assessments to inform policy decisions given finite resources, and 5) prioritizing noncommunicable diseases. The international community can learn from individual country strategies to close policy gaps relating to kidney disease and create momentum toward improving kidney health for all.

在肾脏替代疗法（KRT）、慢性肾脏疾病护理和专业肾脏病工作人员的可获得性方面，国家内部和国家之间都存在严重的不平等。卫生保健政策是实现最佳人口健康和高质量卫生保健的基础。在本文中，我们介绍了5个国家的案例研究，以说明泰国、乌拉圭、印度、南非和美国如何通过医疗保健政策的改变在减少肾脏健康不平等方面取得进展。从这些案例研究中吸取的经验教训包括：1)全面覆盖KRT； 2)获得各种肾脏护理；3)对公共卫生的投资和减少健康的不利社会决定因素；4)在资源有限的情况下为决策提供信息的卫生技术评估等系统方法；5)优先考虑非传染性疾病。国际社会可以借鉴个别国家的战略，以缩小与肾脏疾病有关的政策差距，并为改善所有人的肾脏健康创造势头。

{"title":"Policy Approaches to Improve Equitable Access Globally to Kidney Care","authors":"Sri Lekha Tummalapalli , Somkanya Tungsanga , Laura Sola , Ricardo Silvariño , Gangadhar Taduri , M. Rafique Moosa , Ikechi G. Okpechi , Valerie Luyckx","doi":"10.1053/j.akdh.2025.05.001","DOIUrl":"10.1053/j.akdh.2025.05.001","url":null,"abstract":"<div><div>There are substantial inequities both within and between countries in the availability of kidney replacement therapy (KRT), chronic kidney disease care, and a specialized nephrology workforce. Healthcare policies are the foundation for optimal population health and quality health care. In this article, we present 5 country case studies to illustrate how Thailand, Uruguay, India, South Africa, and the United States have made progress in reducing kidney health inequities through healthcare policy change. Lessons learned from these case studies include the importance of 1) universal KRT coverage, 2) access to care across the spectrum of kidney care, 3) investments in public health and reducing adverse social determinants of health, 4) systematic approaches such as health technology assessments to inform policy decisions given finite resources, and 5) prioritizing noncommunicable diseases. The international community can learn from individual country strategies to close policy gaps relating to kidney disease and create momentum toward improving kidney health for all.</div></div>","PeriodicalId":72096,"journal":{"name":"Advances in kidney disease and health","volume":"32 3","pages":"Pages 290-300"},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144842927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Global Inequities in Pregnancy in Women With Kidney Disease 肾病妇女妊娠中的全球不平等

IF 2.6 0 UROLOGY & NEPHROLOGY

Advances in kidney disease and health

Pub Date : 2025-05-01 Epub Date: 2025-08-14 DOI: 10.1053/j.akdh.2025.05.004

Priti Meena , Rasha Shemies , Prasoon Verma , Silvi Shah

Pregnancy in women with kidney disease is high risk and associated with adverse maternal and fetal outcomes. Kidney disease in pregnancy continues to remain under-recognized and underdiagnosed, and disparities exist in access to kidney care for pregnancy patients. Health disparities with kidney disease and pregnancy are connected to differences in social, economic, cultural, and environmental factors; geographical location; and race/ethnicity. The review discusses health disparities in conditions related to kidney disease and pregnancy. We aim to advocate for interventions and policies to mitigate or eliminate health disparities to help all pregnant people with kidney disease to improve pregnancy outcomes.

患有肾脏疾病的妇女怀孕是高风险的，并与不良的母体和胎儿结局有关。妊娠期肾脏疾病仍未得到充分认识和诊断，妊娠患者在获得肾脏护理方面存在差异。肾脏疾病和妊娠的健康差异与社会、经济、文化和环境因素的差异有关；地理位置;和种族。这篇综述讨论了与肾脏疾病和妊娠相关的健康差异。我们的目标是倡导干预措施和政策，以减轻或消除健康差距，帮助所有患有肾脏疾病的孕妇改善妊娠结局。

引用次数: 0

Inequities in Pediatric Nephrology: Disparities in Children's Kidney Health and Access to Care 儿童肾脏病的不公平：儿童肾脏健康和获得护理的差异

IF 2.6 0 UROLOGY & NEPHROLOGY

Advances in kidney disease and health

Pub Date : 2025-05-01 Epub Date: 2025-08-14 DOI: 10.1053/j.akdh.2025.01.001

Nivedita Kamath , Erica Bjornstad , Paul Mashanga , Patience Obiagwu , Anita van Zwieten , Priya Pais

Pediatric kidney diseases have a lower prevalence compared to adults but contribute to the high global burden of non-communicable diseases. Children with kidney disease (congenital or acquired, acute kidney injury, or chronic kidney disease) encounter unfair disparities in morbidity, burdens, and clinical outcomes due to sociodemographic and economic inequalities rather than true biological differences. Inequity occurs in the global distribution of disease burden, in the access to adequate primary care and specialized pediatric nephrology services, in disease data equity, and in participation in clinical research. The inequity in access to renal replacement therapy is especially severe, resulting in high mortality rates for children with kidney failure in low and low-middle-income countries. The causes for inequity in pediatric kidney diseases begin at the level of the individual child and their family circumstances, extend to the resources and health literacy of a community, and finally result from disparity in national wealth and a country's health care investment and allocation policies for children. Several actions to mitigate these inequities can be successfully implemented by health care providers and society at large. Ultimately, it is the moral obligation of the global nephrology community to advocate for the rights and well-being of every child with kidney disease.

与成人相比，儿童肾脏疾病的患病率较低，但造成了全球非传染性疾病的高负担。患有肾脏疾病（先天性或后天性、急性肾损伤或慢性肾脏疾病）的儿童在发病率、负担和临床结果方面遇到不公平的差异，这是由于社会人口和经济的不平等，而不是真正的生物学差异。在疾病负担的全球分布、获得适当的初级保健和儿科肾病专业服务、疾病数据的公平性以及参与临床研究方面都存在不公平现象。在获得肾脏替代疗法方面的不平等尤其严重，导致低收入和中低收入国家肾衰竭儿童的死亡率很高。儿童肾脏疾病不平等的原因始于儿童个人及其家庭情况，延伸到社区的资源和卫生素养，最终源于国家财富的差异以及国家对儿童的卫生保健投资和分配政策。卫生保健提供者和整个社会可以成功地实施若干减轻这些不平等现象的行动。最终，倡导每一个患有肾脏疾病的儿童的权利和福祉是全球肾脏病学界的道德义务。

{"title":"Inequities in Pediatric Nephrology: Disparities in Children's Kidney Health and Access to Care","authors":"Nivedita Kamath , Erica Bjornstad , Paul Mashanga , Patience Obiagwu , Anita van Zwieten , Priya Pais","doi":"10.1053/j.akdh.2025.01.001","DOIUrl":"10.1053/j.akdh.2025.01.001","url":null,"abstract":"<div><div>Pediatric kidney diseases have a lower prevalence compared to adults but contribute to the high global burden of non-communicable diseases. Children with kidney disease (congenital or acquired, acute kidney injury, or chronic kidney disease) encounter unfair disparities in morbidity, burdens, and clinical outcomes due to sociodemographic and economic inequalities rather than true biological differences. Inequity occurs in the global distribution of disease burden, in the access to adequate primary care and specialized pediatric nephrology services, in disease data equity, and in participation in clinical research. The inequity in access to renal replacement therapy is especially severe, resulting in high mortality rates for children with kidney failure in low and low-middle-income countries. The causes for inequity in pediatric kidney diseases begin at the level of the individual child and their family circumstances, extend to the resources and health literacy of a community, and finally result from disparity in national wealth and a country's health care investment and allocation policies for children. Several actions to mitigate these inequities can be successfully implemented by health care providers and society at large. Ultimately, it is the moral obligation of the global nephrology community to advocate for the rights and well-being of every child with kidney disease.</div></div>","PeriodicalId":72096,"journal":{"name":"Advances in kidney disease and health","volume":"32 3","pages":"Pages 266-278"},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144842925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Inequities in Research and Publication: A Call for Equity, Diversity, and Inclusion 研究和出版中的不公平：呼吁公平、多样性和包容性

IF 2.6 0 UROLOGY & NEPHROLOGY

Advances in kidney disease and health

Pub Date : 2025-05-01 Epub Date: 2025-08-14 DOI: 10.1053/j.akdh.2025.03.003

Divya Bajpai , Eranga Wijewickrama , Urmila Anand , Arpita Ray Chaudhury , Shaifali Sandal

In the realm of academic medicine and scientific research, systemic inequities exist both at the participant or patient level and at the level of the researcher. In this paper, we outline sex, gender, geographical, ethnic, and racial inequities in those who participate as subjects in research, which often leads to the exclusion of vulnerable populations. In addition, we highlight inequities in research funding, mentorship, publications, language, career stage, and leadership roles that lead to disparities in who conducts the research or decides on research priorities. We also report algorithmic bias and artificial intelligence as an emerging source of inequities in research. We conclude by proposing strategies to promote diversity, equity, and inclusion in research and publication and provide a framework for achieving this when conducting clinical trials.

在学术医学和科学研究领域，在参与者或患者层面和研究人员层面都存在系统性的不平等。在本文中，我们概述了作为研究对象参与研究的性别、性别、地理、民族和种族不平等，这往往导致弱势群体被排除在外。此外，我们还强调了研究经费、指导、出版物、语言、职业阶段和领导角色方面的不平等，这些不平等导致了谁进行研究或决定研究重点方面的差异。我们还报告了算法偏见和人工智能作为研究中不公平的新来源。最后，我们提出了促进研究和出版的多样性、公平性和包容性的策略，并提供了在进行临床试验时实现这一目标的框架。

引用次数: 0

Navigating the Complex Pathogenesis of Acute Kidney Injury: Exploring Macrophage Dynamics, Mitochondrial Dysfunction, and Ferroptosis Pathways 探索急性肾损伤的复杂发病机制：探索巨噬细胞动力学、线粒体功能障碍和铁蛋白沉积途径

0 UROLOGY & NEPHROLOGY

Advances in kidney disease and health

Pub Date : 2025-03-01 Epub Date: 2025-04-11 DOI: 10.1053/j.akdh.2024.12.004

Tanima Chatterjee, Abolfazl Zarjou

Acute kidney injury, a rapid decline in kidney function coupled with physiological and homeostatic perturbations, is an independent risk factor for both short-term and long-term health outcomes. As incidence of acute kidney injury continues to rise globally, the significant clinical and economic challenge of acute kidney injury underscores the need for its prompt recognition and application of novel and germane strategies to reduce its severity and facilitate recovery. Understanding the multifaceted cascade of events engaged in pathogenesis of acute kidney injury is pivotal for the development of effective preventive and therapeutic strategies. To facilitate an in-depth discussion on emerging therapeutic targets, this review will examine the role of macrophages in kidney injury and repair, explore the alterations in mitochondrial biogenesis dynamics induced by acute kidney injury, and provide insights into the molecular mechanisms underlying the contribution of ferroptosis to kidney injury.

急性肾损伤是指肾功能急剧下降，同时伴有生理和体内平衡紊乱，是影响短期和长期健康的一个独立风险因素。随着全球急性肾损伤发病率的持续上升，急性肾损伤所带来的重大临床和经济挑战凸显了及时识别急性肾损伤的必要性，并需要应用新颖、前沿的策略来降低其严重程度并促进康复。了解急性肾损伤发病机制的多层面级联事件对于制定有效的预防和治疗策略至关重要。为便于深入探讨新出现的治疗靶点，本综述将研究巨噬细胞在肾损伤和修复中的作用，探讨急性肾损伤诱导的线粒体生物生成动力学的改变，并深入探讨铁蛋白沉积对肾损伤所起作用的分子机制。

引用次数: 0

首页上一页

下一页尾页

类型

全部化学•材料生命科学医学物理工程技术环境•农林材料科学地球科学法学管理学化学环境科学与生态学计算机科学教育学经济学农林科学人文科学生物学数学物理与天体物理心理学综合性期刊其他工业工程理学历史学农学文学信息工程

数据库

全部 ACS Publications Elsevier ieeexplore Springer The Royal Society of Chemistry Wiley

期刊

Advances in kidney disease and health

全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.

﹀