Abstract
The new Kidney Disease Outcomes Quality Initiative (KDOQI) Vascular Access Guidelines
have a patient focus for comprehensive vascular access management. The patient's unique
circumstances and individualized needs are the foundation of their dialysis access
strategy, which is interlinked with the patient's End Stage Kidney Disease (ESKD)
Life-Plan. The ESKD Life-Plan is an individualized and comprehensive map for dialysis
modalities and vascular access for the lifetime of the patient. New targets are introduced
that align with this patient-centered approach. They are less detail prescriptive
than prior vascular access guidelines, giving opportunity for vascular access management
at the clinician's discretion, partly in consideration of constraints of local resources
and available expertise; however, the guidelines also emphasize the importance of
high-quality standards with defined targets for achieving the guideline's overarching
goal for vascular access care. The guidelines made significant changes relevant to
the interventionalist, including selective use of vessel mapping in planning for vascular
access, choice of vascular access that allows for considering endovascular access
creations, and endovascular treatment (e.g., angioplasty, stent graft insertions)
based on clinical indicators found on routine clinical monitoring. To that end, preemptive
angioplasty of fistulas and grafts with stenosis, not associated with clinical indicators,
is not recommended. New content in these guidelines also includes the use of stent
grafts and management of central venous stenosis. The new KDOQI Vascular Access Guidelines
2019 represent a rigorous review of the evidence; however, the available evidence
to guide vascular access practice remains limited. There is a significant need and
opportunity for new and ongoing high-quality research to inform best practice.
Keywords
hemodialysis - vascular access - chronic kidney disease - end-stage kidney disease
- guideline - interventional radiology
