Abstract
BackgroundChronic kidney disease (CKD) is increasing worldwide, and the majority of the CKD burden is in low- and middle-income countries (LMICs). However, there is wide variability in global access to kidney care therapies such as dialysis and kidney transplantation. The challenges health professionals experience while providing kidney care in LMICs have not been well described. The goal of this study is to elicit health professionals’ perceptions of providing kidney care in a resource-constrained environment, strategies for dealing with resource limitations, and suggestions for improving kidney care in Guatemala.MethodsSemi-structured interviews were performed with 21 health professionals recruited through convenience sampling at the largest public nephrology center in Guatemala. Health professionals included administrators, physicians, nurses, technicians, nutritionists, psychologists, laboratory personnel, and social workers. Interviews were recorded and transcribed in Spanish. Qualitative data from interviews were analyzed in NVivo using an inductive approach, allowing dominant themes to emerge from interview transcriptions.ResultsHealth professionals most frequently described challenges in providing high-quality care due to resource limitations. Reducing the frequency of hemodialysis, encouraging patients to opt for peritoneal dialysis rather than hemodialysis, and allocating resources based on clinical acuity were common strategies for reconciling high demand and limited resources. Providers experienced significant emotional challenges related to high patient volume and difficult decisions on resource allocation, leading to burnout and moral distress. To improve care, respondents suggested increased budgets for equipment and personnel, investments in preventative services, and decentralization of services.ConclusionsHealth professionals at the largest public nephrology center in Guatemala described multiple strategies to meet the rising demand for renal replacement therapy. Due to systems-level limitations, health professionals faced difficult choices on the stewardship of resources that are linked to sentiments of burnout and moral distress. This study offers important lessons in Guatemala and other countries seeking to build capacity to scale-up kidney care.
Highlights
Chronic kidney disease (CKD) incidence and prevalence are rising worldwide [1]
The majority of the global CKD burden is in low- and middle-income countries (LMICs) [2]
The government health system is marked by disparities in health care access and allegations of abuse within the country’s large indigenous Maya population [11]
Summary
Chronic kidney disease (CKD) incidence and prevalence are rising worldwide [1]. The majority of the global CKD burden is in low- and middle-income countries (LMICs) [2]. There is wide variability in access to kidney care treatments such as renal replacement therapy (RRT) for end-stage kidney disease (ESKD) in LMICs [3, 4]. These factors have led kidney disease to be described as a neglected chronic disease [5]. Chronic kidney disease (CKD) is increasing worldwide, and the majority of the CKD burden is in lowand middle-income countries (LMICs). The goal of this study is to elicit health professionals’ perceptions of providing kidney care in a resource-constrained environment, strategies for dealing with resource limitations, and suggestions for improving kidney care in Guatemala
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