A Korean perspective on the 2019 Kidney Disease Outcomes Quality Initiative guidelines for vascular access: what has changed and what should be changed in practice?

Abstract

The Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines are developed by the National Kidney Foundation in the United States; however, the guidelines have an impact on most international societies, including those in Korea. The KDOQI recently released the updated 2019 guidelines for vascular access based on numerous papers and controversies concerning vascular access since 2006, when the first guidelines were published. The new KDOQI guidelines have undergone significant changes compared to previous guidelines, including a change in the philosophy regarding a patient-centered approach using an end-stage kidney disease “Life-Plan.” In addition, there are newly developed or revised definitions and some key differences from previous guidelines. The process of adapting guidelines needs to be individualized to hemodialysis practice in each country, while agreeing with general principles and philosophy; therefore, we summarize changes in the updated guidelines and discuss the application and implementation of the new principles and concepts of the guidelines for vascular access care in Korea.

Renal Replacement Therapy For Elderly Patients with ESKD Through Shared Decision-Making

“…These interventions include medications to correct anemia and alleviate symptoms, consultations, blood tests, advance care planning, and psychological, environmental, and familial support 15 16) . Dialysis is a life-sustaining treatment 17) and can be withdrawn among patients in the end-of-life or dying process. However, dialysis for elderly patients is distinctive from other life-sustaining treatments due to a lack of consensus regarding whether dialysis itself is categorized as an end-of-life care, the meaning of maintenance dialysis, and whether dialysis is helpful for the survival rate or quality of life of elderly patients 8) .…”

“…This choice should be made through SDM, with appropriate consideration of the characteristics of the elderly, the speed of progression to ESKD, surgical problems, the policies of dialysis institutions, and the type of dialysis that family members want 4 8 23 26) . Moreover, The 2019 KDOQI guidelines recommend that nephrologists have extensive experience and insight in coordinating and integrating multidisciplinary vascular access teams based on the patient’s ESKD Life-Plan 17) .…”

A collaborative model between dialysis clinics and a hospital center improves the quality of vascular access care and intervention for hemodialysis patients

“…However, no clear consensus has been reached regarding optimal surveillance to identify a failing access route [ 13 ]. Subsequently, the 2019 K/DOQI guideline placed less emphasis on routine surveillance due to insufficient evidence to make a recommendation for surveillance in addition to routine clinical monitoring [ 14 ].…”

Venovenous Fistula Formation for Complete Venous Occlusion in Patient with Radiocephalic AVF

“…Radiocephalic fistula is often the preferred choice for creating an arteriovenous fistula (AVF) in patients with endstage renal disease (ESRD), primarily due to its lower incidence of steal syndrome compared to upper arm fistulas and the option to use the upper arm for future access should the initial site fail [1,2]. However, juxta-anastomotic or outflow vein stenosis is frequent in radiocephalic AVF [3].…”