Treatment of end-stage renal disease with continuous ambulatory peritoneal dialysis in rural Guatemala

Moore, J. W.; García, Pablo; Rohloff, Peter; Flood, David

doi:10.1136/bcr-2017-223641

Cited by 6 publications

(6 citation statements)

References 37 publications

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“…In Guatemalan rural communities, we have observed a wasting phenotype in very poor individuals with diabetes or other chronic illnesses that precedes progressive kidney disease. 48 Some studies have evaluated the association between BMI and progression of CKD. 49 , 50 , 51 , 52 , 53 , 54 Studies from China and Taiwan, for example, have found that low BMI is an independent risk factor for disease progression in individuals with CKD.…”

Section: Discussionmentioning

confidence: 99%

Population Estimates of GFR and Risk Factors for CKD in Guatemala

Miller

Tuiz²,

Shaw³

et al. 2021

Kidney International Reports

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Introduction Chronic kidney disease (CKD) is an emerging public health priority in Central America. However, data on the prevalence of CKD in Guatemala, Central America’s most populous country, are limited, especially for rural communities. Methods We conducted a population-representative survey of 2 rural agricultural municipalities in Guatemala. We collected anthropometric data, blood pressure, serum and urine creatinine, glycosylated hemoglobin, and urine albumin. Sociodemographic, health, and exposure data were self-reported. Results We enrolled 807 individuals (63% of all eligible, 35% male, mean age 39.5 years). An estimated 4.0% (95% confidence interval [CI] 2.4–6.6) had CKD, defined as an estimated glomerular filtration rate (eGFR) less than 60 ml/min per 1.73 m 2 . Most individuals with an eGFR below 60 ml/min per 1.73 m 2 had diabetes or hypertension. In multivariable analysis, the important factors associated with risk for an eGFR less than 60 ml/min per 1.73 m 2 included a history of diabetes or hypertension (adjusted odds ratio [aOR] 11.21; 95% CI 3.28–38.24), underweight (body mass index [BMI] <18.5) (aOR 21.09; 95% CI 2.05–217.0), and an interaction between sugar cane agriculture and poverty (aOR 1.10; 95% CI 1.01–1.19). Conclusions In this population-based survey, most observed CKD was associated with diabetes and hypertension. These results emphasize the urgent public health need to address the emerging epidemic of diabetes, hypertension, and CKD in rural Guatemala. In addition, the association between CKD and sugar cane in individuals living in poverty provides some circumstantial evidence for existence of CKD of unknown etiology in the study communities, which requires further investigation.

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Section: Discussionmentioning

confidence: 99%

Population Estimates of GFR and Risk Factors for CKD in Guatemala

Miller

Tuiz²,

Shaw³

et al. 2021

Kidney International Reports

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“…However, our goal was to understand the challenges of providing kidney care to a large number of uninsured adults in Guatemala, and UNAERC is the dominant institution providing such care. Third, while this study did not include patient perspectives, it complements the authors' prior work studying CKD in Guatemala from the perspective of both children and adults [10,25,26,67,68].…”

Section: Discussionmentioning

confidence: 98%

“…First, the institution's budget outlays have not risen in proportion to meet the population-level increase in demand for RRT [24]. Second, UNAERC serves a diverse and impoverished population with socioeconomic, geographic, and linguistic barriers to care [25,26]. Finally, the institution resides in a complex, high-pressure political environment [27,28].…”

Section: Introductionmentioning

confidence: 99%

Challenges in the provision of kidney care at the largest public nephrology center in Guatemala: a qualitative study with health professionals

Flood

Wilcox

Ferro³

et al. 2020

BMC Nephrol

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Background: Chronic kidney disease (CKD) is increasing worldwide, and the majority of the CKD burden is in lowand 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. Methods: Semi-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. Results: Health 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. Conclusions: Health 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.

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“…Body pain had previously been found to be one of the factors that had a significant impact on the quality of life of dialysis patients (Bipath, Govender, & Viljoen, 2014). Individuals do CAPD four times a day for 3 years, clinically these individuals have more energy, can be ambulated and have gained 10 kg (Moore et al, 2018). One study explained that there was a phase of non-compliance in individuals with PD therapy.…”

Section: Discussionmentioning

confidence: 99%

Quality of Life for End-Stage Renal Disease (ESRD) PatientsUndergoing Peritoneal Dialysis (PD) Therapy: A Literature Review

Adhi

Trisyani

Emaliyawati

2019

PACNJ

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Introduction: ESRD adalah diagnosis akhir yang membutuhkan terapi pengganti ginjal seumur hidup seperti hemodialisa, peritoneal dialysis (PD) dan transplantasi ginjal. Populasi di dunia dan prevalensi penyakit ginjal stadium akhir terus meningkat, pasien semakin dihadapkan dengan keputusan untuk memulai terapi pengganti ginjal. Penelitian dan literature review yang menilai dampak perawatan terapi PD pada pasien ESRD masih terbatas. Tujuan dari literature review ini untuk menganalisis terapi CAPD pada pasien ESRD. Pencarian terbatas pada database elektronik seperti Pubmed, Proquest, dan Google Scholar, dengan kata kunci “ESRD”,”CAPD”,“Peritoneal Dialysis”,“Quality of Life” disusun berdasarkan MeSH Database dari NCBI. Methods: Strategi review artikel menggunakan PRISMA (Preferred Reporting Items for Systematic Reviews and Meta Analyses) dan dianalisa menggunakan konten analisis. Studi yang diterbitkan antara tahun 2009-2019, artikel penelitian dengan bahasa inggris, dipertimbangkan sebagai kriteria inklusi dalam tinjauan ini. Results: Didapatkan 25 artikel; 15 kuantitatif, 7 kualitatif, 2 case report dan 1 mixed methods. Discussion: Domain fisik; PD memberikan kelebihan pada peran-fisik, vitalitas, energik, dan bebas nyeri. Domain psikologis; PD menimbulkan depresi dan kecemasan yang lebih rendah daripada HD, bahkan 1 studi menyebutkan HD dapat menyebabkan depresi berat. Hubungan sosial; PD memberikan kemandirian pada gaya hidup, efikasi diri, kebebasan beraktivitas, fleksibilitas, dan mempertahankan kehidupan normal. Hubungan terkait lingkungan; pasien dengan PD lebih mungkin untuk melanjutkan pekerjaan mereka sehingga mereka secara finansial lebih baik dan lebih bebas untuk bepergian daripada HD, penghasilan terus dapat secara signifikan berkontribusi pada kesejahteraan pasien CAPD. Conclusion: PD terbukti memberikan kualitas hidup yang lebih baik. Dengan demikian, penting untuk mengembangkan terapi PD pada pasien ESRD yang membutuhkan dialisis jangka panjang, bahkan seumur hidup.

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Treatment of end-stage renal disease with continuous ambulatory peritoneal dialysis in rural Guatemala

Cited by 6 publications

References 37 publications

Population Estimates of GFR and Risk Factors for CKD in Guatemala

Population Estimates of GFR and Risk Factors for CKD in Guatemala

Challenges in the provision of kidney care at the largest public nephrology center in Guatemala: a qualitative study with health professionals

Quality of Life for End-Stage Renal Disease (ESRD) PatientsUndergoing Peritoneal Dialysis (PD) Therapy: A Literature Review

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