Achievement of equity in health requires development of a health system in which everyone has a fair opportunity to attain their full health potential. The current, large country-level variation in the reported incidence and prevalence of treated end-stage kidney disease indicates the existence of system-level inequities. Equitable implementation of kidney replacement therapy (KRT) programs must address issues of availability, affordability, and acceptability. The major structural factors that impact equity in KRT in different countries are the organization of health systems, overall health care spending, funding and delivery models, and nature of KRT prioritization (transplantation, hemodialysis or peritoneal dialysis, and conservative care). Implementation of KRT programs has the potential to exacerbate inequity unless equity is deliberately addressed. In this review, we summarize discussions on equitable provision of KRT in low- and middle-income countries and suggest areas for future research.

实现健康公平需要建立一个让每个人都有公平机会充分发挥健康潜力的卫生系统。目前，国家层面报告的已治疗终末期肾病发病率和患病率存在​​巨大差异，表明存在系统层面的不平等。公平实施肾脏替代疗法 (KRT) 计划必须解决可用性、负担能力和可接受性问题。影响不同国家 KRT 公平性的主要结构性因素是卫生系统的组织、总体医疗保健支出、资金和提供模式以及 KRT 优先顺序的性质（移植、血液透析或腹膜透析以及保守治疗）。除非刻意解决公平问题，否则 KRT 计划的实施有可能加剧不平等。在这篇综述中，我们总结了有关低收入和中等收入国家公平提供 KRT 的讨论，并提出了未来研究的领域。