Comprehensive Guidelines for Vascular Disease in Dialysis Patients
The National Kidney Foundation (NKF) announced the publication of the Kidney Disease Outcomes Quality Initiative (KDOQI) vascular access guideline update for 2019. These guidelines are evidence-based and serve to assist practitioners in efforts to care for Chronic Kidney Disease (CKD)/End Stage Kidney Disease (ESKD) patients and their vascular access needs. The update is available online as a supplement to the American Journal of Kidney Diseases. This is the first time the guideline has been updated since 2006.
The focus is to provide an individualized and comprehensive vascular access management plan for the ESKD patient, referred to as “ESKD Life-Plan”. This plan starts in the pre-dialysis period and moves from CKD to ESKD, with the purpose to maximize modality choices. Considerations include a patient’s medical, social and other life circumstances and goals, with corresponding alterations to the plan as needed.
The document is 164 pages long and there are 26 guidelines in total. Each guideline includes rationale, background, detailed justification, monitoring and evaluation guidance, implementation considerations, special discussions, and recommendations for future research as appropriate. New topics include:
- End-stage kidney disease “Life-Plan” and related concepts
- Guidance on vascular access choice
- New targets for arteriovenous access (fistulas and grafts) and central venous catheters (CVC)
- Management of specific complications
- Renewed approaches to some older topics
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