BACKGROUND Chronic 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. 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.

中文翻译：

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危地马拉最大的公共肾脏病学中心在提供肾脏护理方面面临的挑战：与卫生专业人员进行的定性研究。

背景技术慢性肾脏病（CKD）在世界范围内正在增加，并且大部分CKD负担在中低收入国家（LMIC）中。但是，在全球范围内获得肾脏护理疗法（如透析和肾脏移植）的方法差异很大。卫生专业人员在为中低收入国家提供肾脏护理时遇到的挑战尚未得到很好的描述。这项研究的目的是唤起卫生专业人员在资源有限的环境中提供肾脏护理的观念，应对资源限制的策略以及在危地马拉改善肾脏护理的建议。方法在危地马拉最大的公共肾脏病中心，对21名通过便利抽样招募的卫生专业人员进行了半结构化访谈。卫生专业人员包括管理员，医师，护士，技术人员，营养师，心理学家，实验室人员和社会工作者。采访记录并以西班牙语记录。使用归纳法在NVivo中分析了采访的定性数据，使主导主题从采访转录中浮现。结果由于资源有限，卫生专业人员最经常描述提供高质量护理的挑战。减少血液透析的频率，鼓励患者选择腹膜透析而不是血液透析以及根据临床敏锐度分配资源是调和高需求和有限资源的常见策略。提供者经历了与高患者人数有关的重大情感挑战，并且在资源分配方面做出了艰难的决定，从而导致职业倦怠和精神困扰。为了改善护理，受访者建议增加设备和人员预算，预防服务投资以及服务分散化。结论危地马拉最大的公共肾脏病学中心的卫生专业人员描述了多种策略，以满足对肾脏替代疗法不断增长的需求。由于系统级的限制，卫生专业人员在管理与倦怠和道德困扰感相关的资源方面面临艰难的选择。这项研究在危地马拉和其他寻求建立扩大肾脏护理能力的国家中提供了重要的教训。结论危地马拉最大的公共肾脏病学中心的卫生专业人员描述了多种策略，以满足对肾脏替代疗法不断增长的需求。由于系统级的限制，卫生专业人员在管理与倦怠和道德困扰感相关的资源方面面临艰难的选择。这项研究在危地马拉和其他寻求建立扩大肾脏护理能力的国家中提供了重要的教训。结论危地马拉最大的公共肾脏病学中心的卫生专业人员描述了多种策略，以满足对肾脏替代疗法不断增长的需求。由于系统级的限制，卫生专业人员在管理与倦怠和道德困扰感相关的资源方面面临艰难的选择。这项研究在危地马拉和其他寻求建立扩大肾脏护理能力的国家中提供了重要的教训。