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Treatment of end-stage renal disease with continuous ambulatory peritoneal dialysis in rural Guatemala
  1. Jillian Moore1,2,
  2. Pablo Garcia2,3,
  3. Peter Rohloff2,4,
  4. David Flood2,5
  1. 1Harvard Medical School, Boston, Massachusetts, USA
  2. 2Wuqu' Kawoq, Santiago Sacatepéquez, Guatemala
  3. 3Department of Medicine, Saint Peter’s University Hospital, New Brunswick, New Jersey, USA
  4. 4Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
  5. 5Departments of Medicine and Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
  1. Correspondence to Dr Peter Rohloff, prohloff{at}


A 42-year-old indigenous Maya man presented to a non-profit clinic in rural Guatemala with signs, symptoms and laboratory values consistent with uncontrolled diabetes. Despite appropriate treatment, approximately 18 months after presentation, he was found to have irreversible end-stage renal disease (ESRD) of uncertain aetiology. He was referred to the national public nephrology clinic and subsequently initiated home-based continuous ambulatory peritoneal dialysis. With primary care provided by the non-profit clinic, his clinical status improved on dialysis, but socioeconomic and psychological challenges persisted for the patient and his family. This case shows how care for people with ESRD in low- and middle-income countries requires scaling up renal replacement therapy and ensuring access to primary care, mental healthcare and social work services.

  • diabetes
  • global health
  • healthcare improvement and patient safety
  • dialysis
  • chronic disease / disability nursing

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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  • Contributors JM and DF conceptualised the manuscript and wrote the first draft. DF and PR led clinical care of the patient. PR and PG critically revised the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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