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. 2023 May 12;13(5):e062321.
doi: 10.1136/bmjopen-2022-062321.

Nephrologists' perspectives on the impact of COVID-19 on caring for patients undergoing dialysis in Latin America: a qualitative study

Andrea Matus Gonzalez  1   2 , Eduardo Lorca  3 , Sebastian Cabrera  3 , Alejandra Hernandez  4 , Carlos Zúñiga-Sm  5   6 , Laura Sola  7 , Luis Michea  3 , Alejandro Ferreiro Fuentes  8 , Lilia Cervantes  9 , Magdalena Madero  10 , Armando Teixeira-Pinto  11   2 , Germaine Wong  11   2 , Jonathan Craig  12 , Allison Jaure  11   2
Affiliations

Nephrologists' perspectives on the impact of COVID-19 on caring for patients undergoing dialysis in Latin America: a qualitative study

Andrea Matus Gonzalez et al. BMJ Open. .

Abstract

Objective: To describe the experiences of nephrologists on caring for patients undergoing in-centre haemodialysis during the COVID-19 pandemic in Latin America.

Design: Twenty-five semistructured interviews were conducted by Zoom videoconference in English and Spanish languages during 2020 until data saturation. Using thematic analysis, we conducted line-by-line coding to inductively identify themes.

Setting: 25 centres across nine countries in Latin America.

Participants: Nephrologists (17 male and 8 female) were purposively sampled to include diverse demographic characteristics and clinical experience.

Results: We identified five themes: shock and immediate mobilisation for preparedness (overwhelmed and distressed, expanding responsibilities to manage COVID-19 infection and united for workforce resilience); personal vulnerability (being infected with COVID-19 and fear of transmitting COVID-19 to family); infrastructural susceptibility of dialysis units (lacking resources and facilities for quarantine, struggling to prevent cross-contamination, and depletion of personal protective equipment and cleaning supplies); helplessness and moral distress (being forced to ration life-sustaining equipment and care, being concerned about delayed and shortened dialysis sessions, patient hesitancy to attend to dialysis sessions, being grieved by socioeconomic disparities, deterioration of patients with COVID-19, harms of isolation and inability to provide kidney replacement therapy); and fostering innovative delivery of care (expanding use of telehealth, increasing uptake of PD and shifting focus on preventing syndemics).

Conclusion: Nephrologists felt personally and professionally vulnerable and reported feeling helpless and morally distressed because they doubted their capacity to provide safe care for patients undergoing dialysis. Better availability and mobilisation of resources and capacities to adapt models of care, including telehealth and home-based dialysis, are urgently needed.

Keywords: COVID-19; chronic renal failure; dialysis; qualitative research.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Thematic schema. PD, peritoneal dialysis.
See this image and copyright information in PMC

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