National Kidney Foundation publishes new guidelines for vascular access
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The National Kidney Foundation has released the latest Kidney Disease Outcomes Quality Initiative Clinical Practice Guideline for Vascular Access.
Changes to the document – the first since 2006 – include 26 individual guidelines for clinicians that focus on dialysis access choices tailored to individual patients’ goals and preferences, as well as clinical outcomes, the NKF said in a statement.
“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,” Kerry Willis, PhD, chief scientific officer of the NKF, said in a press release. “One of [Kidney Disease Outcomes Quality Initiative] 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.”
A new approach introduced in the guidelines is an individualized and comprehensive map for dialysis modalities for the lifetime of the patient called the “ESKD Life-Plan,” which is achieved by creating a “PLAN” for each patient that considers the Patient’s Life-Plan and corresponding Access Needs, the NKF said. For each access, the “Access Needs” part of the PLAN includes designing and documenting the patient’s access creation plan, contingency plan, succession plan and underlying vessel preservation plan. The result is a vascular access management plan that will best suit the patient throughout his or her time with ESKD, according to the group.
The evidence review team for the guidelines from the University of Minnesota reviewed more than 4,600 peer-reviewed publications, of which 286 were included in the evidence tables. The evidence tables were used by the workgroup, chaired by Charmaine Lok, MD, from the University of Toronto, to develop the more patient-focused approach to vascular access care that takes into consideration each patient’s needs and preferences.
“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,” Michael Rocco, MD, KDOQI chair, said in the release.
The new guidelines represent the third iteration on vascular access.
“These guidelines emphasize an integrated, individualized approach to patient care that promotes optimal dialysis access management based on the best available evidence,” Lok said in the release. “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.”
The guidelines are being published in the American Journal of Kidney Diseases.
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