KDOQI 2019 Vascular Access Guidelines: What Is New

Area of Science:

• Nephrology
• Vascular Surgery
• Interventional Radiology

Background:

• The Kidney Disease Outcomes Quality Initiative (KDOQI) has released updated Vascular Access Guidelines.
• Previous guidelines were more prescriptive, lacking patient-centered flexibility.
• Managing vascular access is critical for End Stage Kidney Disease (ESKD) patients undergoing dialysis.

Purpose of the Study:

• To outline the new KDOQI Vascular Access Guidelines focusing on patient-centered care.
• To detail changes in vascular access management strategies for ESKD patients.
• To highlight new recommendations for interventionalists regarding vascular access creation and maintenance.

Main Methods:

• Comprehensive review of existing evidence on vascular access.
• Development of patient-centered targets and strategies for dialysis access.
• Inclusion of new recommendations for endovascular interventions and management of central venous stenosis.

Main Results:

• The guidelines adopt a patient-focused approach, integrating vascular access strategy with the patient's End Stage Kidney Disease (ESKD) Life-Plan.
• Recommendations are less prescriptive, allowing for clinician discretion and consideration of local resources.
• New guidance includes selective vessel mapping, consideration of endovascular access, and routine monitoring for endovascular treatment; preemptive angioplasty without clinical indicators is not advised.

Conclusions:

• The 2019 KDOQI Vascular Access Guidelines promote individualized, patient-centered dialysis access management.
• While incorporating new evidence and techniques like stent grafts, the guidelines acknowledge limitations in current research.
• Further high-quality research is essential to refine best practices in vascular access care for ESKD patients.