A Patient Navigation System to Minimize Barriers for Peritoneal Dialysis in Rural, Low-Resource Settings: Case Study From Guatemala

BACKGROUND: CHRONIC KIDNEY DISEASE IN GUATEMALA Guatemala is a lowerto middle-income, Latin American nation with a population of 16 million people and a growing need for rural dialysis services due to a confluence of factors. First, although the epidemiology and risk factors for chronic kidney disease (CKD) in Guatemala are not well understood, there is evidence that CKD mortality is among the highest in the Americas. The emerging entity “chronic kidney disease of nontraditional causes” may be a CKD risk factor in rural Guatemala, and regional data show that diabetic renal disease is a significant driver of population mortality. Second, approximately 40% of the population are rural indigenous Maya, a group that faces significant socioeconomic, geographic, and language barriers in accessing specialty nephrology care that is available only in urban tertiary centers. Finally, Guatemala’s population is growing and aging rapidly, greatly increasing the absolute number of people at risk for CKD.