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Cuba is an 11-million-population Caribbean Island with 471 Nephrologists that currently treat 2952 hemodialysis and 102 peritoneal dialysis patients in 58 dialysis units all around the country. Despite all the advances made in Nephrology Training in Cuba, specific trainings in most subspecialty areas of Nephrology remains as a current need. This issue is particularly important for Interventional Nephrology Development.
A nationwide online survey was conducted in all Dialysis Units in Cuba, between March and July 2023. A total of 88 from 471 Nephrologists and Nephrology Fellows responded to the survey. SPSS 24 was used for statistical analysis of the results. The aim of this study is to identify and analyze the need to develop Interventional Nephrology training in Cuba, with consideration of its current state.
Data from 88 participants (n=64 Nephrologists and n=24 Nephrology Fellows) were analyzed, 63 (71.6%) were female, and the mean age was 34.7 ± 8.7 years old. All responders had received or are currently receiving their Nephrology Fellowship in Cuba, and even if they are authorized to perform invasive procedures in patients with kidney disease, most of them do not have the proper training to do so. Around 82 (93.2%) participants usually place non-tunneled hemodialysis catheter, but only 46 (52.3%) had received any proper training. Forty-three participants (48.9%) occasionally place tunneled hemodialysis catheters, with 31 trained in this procedure, which is 35.2% of all surveyed. With regards to peritoneal dialysis catheter insertion, only one Nephrologist performs it, even though 16 (18.2%) received some training in performing this procedure. The arterio-venous fistula (AVF) creation is only performed by vascular surgeon. No Nephrologist in the country has the proper training to create AVF. Native or allograft kidney biopsy is particularly a current need, with only 16 (18.2%) participants reported having been trained in doing this procedure, however only four (4.5%) frequently perform it. Regarding the technique on how these procedures are conducted, 30 participants do it under ultrasound-guidance, which represents 34.1% of all surveyed; however, only 8% of participants had received any training in ultrasonography. This means that most of the Interventional Nephrology procedures are performed without ultrasound-guidance or only uses blind/landmark technique. For those who had received training in any Interventional Nephrology procedure (62.5% of all participants), only 15 (27.3%) responded having sufficient or adequate training. All the participants would like to receive more Interventional Nephrology Training, 55 (62.5%) and 27 (30.7%) preferred a hybrid and in-person design, respectively.
Results demonstrated that it is absolutely necessary to develop Interventional Nephrology Training in Cuba, because the results of the survey showed it is insufficient in tunneled hemodialysis catheter placement, peritoneal dialysis catheter insertion and kidney biopsy. Due to economic limitations, Cubans Nephrologists do not have the opportunity to receive specific trainings in this field, hence national training strategies and joint initiatives with international societies must be implemented.
Acknowledgment: this work has been made possible through my ISN-funded Interventional Nephrology Scholarship