March 13, 2020
Comprehensive Guideline for Vascular Access in Dialysis Patients Published by Kidney Disease Outcomes Quality Initiative (KDOQI)
March 13, 2020—The National Kidney Foundation (NKF) announced the publication of the Kidney Disease Outcomes Quality Initiative (KDOQI) vascular access guideline. The "KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update" was drafted by Charmaine E. Lok, MD, et al, and is available online and as a supplement to the April edition of the American Journal of Kidney Diseases (2020;75:S1–S164).
"These guidelines emphasize an integrated, individualized approach to patient care that promotes optimal dialysis access management based on the best available evidence," commented Dr. Lok, the guideline workgroup chair, in NKF announcement. "It recognizes the need for further research, data, and timely revision that incorporates evolving practices, innovation, and new advances in vascular access. We are excited for clinicians to start using these Guidelines to help get the right access in the right patient at the right time for the right reasons."
According to NKF, this is the third time the KDOQI has developed a vascular access guideline and the first time the guideline has been updated since 2006. This comprehensive update was developed due to the significant growth in the evidentiary database for vascular access.
The document is a completely revamped set of 26 individual guidelines for clinicians that focuses on dialysis access choices tailored to individual patients' goals and preferences, as well as clinical outcomes. An evidence review team reviewed more than 4,600 peer-reviewed publications, of which 286 were included in the evidence tables. These evidence tables were used by the workgroup to develop a more patient-focused approach to vascular access care that takes into consideration each patient's needs and preferences.
The NKF noted that an important new approach introduced in this guideline is an individualized map for dialysis modalities for the lifetime of the patient to provide a comprehensive vascular access management plan that will best suit the patient throughout his or her time with end-stage kidney disease (ESKD). The "ESKD Life-Plan" is achieved by creating a "P-L-A-N" for each patient that considers the patient's life plan and corresponding access needs. For each access, the "Access Needs" part of the P-L-A-N includes designing and documenting the patient's access creation plan, contingency plan, succession plan, and underlying vessel preservation plan.
In the announcement, NKF Chief Scientific Officer Kerry Willis, PhD, commented, "It is gratifying to see how much progress has been made in understanding how to place and maintain the various types of vascular access to maximize the effectiveness and reduce complications. One of KDOQI's most important contributions to improving outcomes for dialysis patients has been the stimulation of new research such as the studies used in creating this groundbreaking update."
Additionally, KDOQI chair Michael Rocco, MD, stated, "The new guideline will have many benefits for patients on dialysis, including to help preserve vessels needed for successful future access creation and to minimize unnecessary access-related procedures and complications."