Opportunities and challenges in expanding access to peritoneal dialysis: A qualitative study in Latin America.

Abstract

IntroductionAcross Latin America (LA), accessibility and affordability of kidney replacement therapy varies, but the prevalence of treated kidney failure generally lags behind higher income regions. Hemodialysis (HD) is more common than peritoneal dialysis (PD) in most LA countries. Expanding PD may help increase dialysis access in acute and chronic kidney disease. This study explored trends in existing kidney replacement therapy programs in LA and the opportunities and challenges for improving PD services from the perspective of physicians.MethodsQualitative data were collected using open-ended, semistructured interviews. Physician participants were recruited from trainees attending a Saving Young Lives workshop on acute kidney injury and acute PD. Thematic analysis was used to identify emergent themes.ResultsThere were 15 study participants. We identified and explored two main themes: (1) Physicians face many barriers to adequately caring for all dialysis patients, including high costs, geography, equipment and supply limitations, and lack of specialists; and (2) Increasing dialysis access through PD presents opportunities and challenges.ConclusionsWhile there are some dialysis programs in LA in which all patients have access to adequate care and dialysis is fully funded, there are many programs with inadequate capacity and funding. PD presents an opportunity to improve dialysis access in LA, particularly for currently underserved patient populations, but challenges related to staff training, supply access, and patient factors must be addressed for PD programs to be sustainable.