nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.24884/1561-6274-2019-23-2-9-17nefr-1674Research ArticleПЕРЕДОВАЯ СТАТЬЯLEADING ARTICLEЗАБОЛЕВАНИЯ ПОЧЕК: БРЕМЯ БОЛЕЗНИ И ДОСТУПНОСТЬ МЕДИЦИНСКОЙ ПОМОЩИBURDEN, ACCESS, AND DISPARITIES IN KIDNEY DISEASEКрюДейдраCrewsDeidra C.

Отдел нефрологии, медицинский факультет

Division of Nephrology, Department of Medicine

dcrews1@jhmi.eduБеллоАминуBelloAminu K.

отдел нефрологии и трансплантационной иммунологии, медицинский факультет

СаадиГамальSaadiGamal

отделение нефрологии, отдел внутренних болезней, медицинскийфакультет

Медицинская школа Университета Джона Хопкинса, г. Балтимор, Мэриленд, США; Научно-исследовательский центр Уэлч по профилактике, эпидемиологии и клиническим исследованиям, Медицинский институт Университета Джона Хопкинса, г. Балтимор, Мэриленд, США; Центр Джона Хопкинса по обеспечению равенства в вопросах здравоохранения, Медицинский институт Университета Джона Хопкинса, г. Балтимор, Мэриленд, СШАСоединённые Штаты АмерикиJohns Hopkins University School of Medicine, Baltimore, Maryland, USA; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland; Johns Hopkins Center for Health Equity, Johns Hopkins Medical Institutions, Baltimore, MarylandUnited StatesАльбертский ниверситет, Эдмонтон, КанадаКанадаDivision of Nephrology & Transplant Immunology, Department of Medicine, University of Alberta, EdmontonCanadaКаирский университет, г. Гиза, ЕгипетЕгипетNephrology Unit, Department of Internal Medicine, Faculty of Medicine, Cairo University, GizaEgypt201920022019232917Copyright © Крю Д.C., Белло А.K., Саади Г., 20192019Крю Д., Белло А., Саади Г.Crews D.C., Bello A.K., Saadi G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/1674

Расовые/этнические и социально-экономические различия при хронических заболеваниях почек известны на протяжении десятилетий, однако прогресс в их коррекции недостаточно высокий. В нескольких недавних исследованиях предлагается новое понимание коренных причин этих различий, отмечаются области, в которых необходимы будущие исследования, и определяются возможности для изменений в политике и клинической практике. Географические различия в распространенности ХБП существуют и варьируют в зависимости от расы. Прогрессирование ХБП является более быстрым для групп расовых/этнических меньшинств по сравнению с белыми и может быть в значительной степени, но не полностью, объяснено генетическими факторами. Существуют серьезные социально-экономические различия для пациентов, находящихся на диализе, и они варьируют в зависимости от расы, места проживания и лечебного учреждения. Различия в доступе к трансплантации почки от живого донора могут быть обусловлены, прежде всего, социально-экономическим статусом донора, а не факторами реципиента. Необходимо устранить различия в помощи пациентам с ХБП, в том числе в отношении направления ресурсов в районы и группы населения, где различия наиболее распространены, направить усилия к пониманию того, как наилучшим образом использовать появляющуюся информацию о вкладе генетических факторов в отмеченные диспропорции, и продолжить работу по выявлению модифицируемых факторов риска окружающей среды, а также социальных и поведенческих для целенаправленных вмешательств среди групп высокого риска.

Racial/ethnic and socioeconomic disparities in chronic kidney disease (CKD) have been documented for decades, yet little progress has been made in mitigating them. Several recent studies offer new insights into the root causes of these disparities, point to areas where future research is warranted and identify opportunities for changes in policy and clinical practice. Recently published evidence suggests that geographic disparities in CKD prevalence exist and vary by race. CKD progression is more rapid for racial/ethnic minority groups as compared to whites and may be largely, but not completely, explained by genetic factors. Stark socioeconomic disparities in outcomes for dialysis patients exist, and vary by race, place of residence and treatment facility. Disparities in access to living kidney donation may be driven primarily by the socioeconomic status of the donor as opposed to recipient factors. Recent studies highlight opportunities to eliminate disparities in CKD, including efforts to direct resources to areas and populations where disparities are most prevalent, efforts to understand how to best use emerging information on the contribution of genetic factors to disparities, and continued work to identify modifiable environmental, social, and behavioral factors for targeted interventions among high-risk populations.

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The authors declare that there are no conflicts of interest present.