KDOQI Vascular Access Guideline 2019 Update

KDOQI CLINICAL PRACTICE GUIDELINE FOR VASCULAR
ACCESS: 2019 UPDATE
Charmaine E. Lok, Thomas S. Huber, Timmy Lee, Surendra Shenoy, Alexander S. Yevzlin, Kenneth Abreo,
Michael Allon, Arif Asif, Brad C. Astor, Marc H. Glickman, Janet Graham, Louise M. Moist, Dheeraj K. Rajan,
Cynthia Roberts, Tushar J. Vachharajani, and Rudolph P. Valentini
Abstract
The National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (KDOQI) has provided evidence-
based guidelines for hemodialysis vascular access since 1996. Since the last update in 2006, there has been a
great accumulation of new evidence and sophistication in the guidelines process. The 2019 update to the KDOQI
Clinical Practice Guideline for Vascular Access is a comprehensive document intended to assist multidisciplinary
practitioners care for chronic kidney disease patients and their vascular access. New topics include the 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, management of specific complications, and renewed
approaches to some older topics. Appraisal of the quality of the evidence was independently conducted by using a
Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach, and interpretation
and application followed the GRADE Evidence to Decision frameworks. As applicable, each guideline statement is
accompanied by rationale/background information, a detailed justification, monitoring and evaluation guidance,
implementation considerations, special discussions, and recommendations for future research.
In citing this document, the following format should be used: Lok CE, Huber TS, Lee T, et al; KDOQI Vascular
Access Guideline Work Group. KDOQI clinical practice guideline for vascular access: 2019 update. Am J
Kidney Dis. 2020;75(4)(suppl 2):S1-S164.
As they are designed to reflect the views and recommendations of the responsible KDOQI Work Group, based
on data from an independent evidence review team, and because they undergo both internal and public review,
KDOQI guidelines are not peer reviewed by AJKD.
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Disclaimer
SECTION I: USE OF THE CLINICAL PRACTICE GUIDELINE
This Clinical Practice Guideline document is based on the best information available as of October 2016. It is designed to
provide information and assist decision making. It is not intended to define a standard of care and should not be
construed as one, nor should it be interpreted as prescribing an exclusive course of management. Variations in practice
will inevitably and appropriately occur when clinicians take into account the needs of individual patients, available
resources, and limitations unique to an institution or type of practice. Every health care professional making use of these
recommendations is responsible for evaluating the appropriateness of applying them in the setting of any particular
clinical situation. The recommendations for research contained in this document are general and do not imply a specific
protocol.
SECTION II: DISCLOSURE
All reported information is provided in the “Biographical and Disclosure” section of this journal supplement and is on
file at the National Kidney Foundation (NKF).
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Work Group Membership
Charmaine E. Lok, MD, MSc, FRCP(C) (Chair, KDOQI Vascular Access Guidelines)
Professor of Medicine, University of Toronto
Director of Multi-care Kidney Clinics and Hemodialysis Program,
University Health Network
Senior Scientist, Toronto General Research Institute
Thomas S. Huber, MD, PhD (Editorial Committee) Timmy Lee, MD (Editorial Committee)
Professor of Surgery and Chief, Division of Vascular
Surgery, University of Florida College of Medicine
Professor of Medicine, Department of Medicine, Division of
Nephrology, and Department of Biomedical Engineering,
University of Alabama at Birmingham
Surendra Shenoy, MD, PhD (Vice Chair,
Guideline Scope)
Alexander S. Yevzlin, MD (Vice Chair, Guideline Scope)
Professor of Surgery and Director of the Living Donor
Transplantation Program, Washington University School of
Medicine
Professor of Medicine and Director of Interventional
Nephrology, University of Michigan
Kenneth Abreo, MD
Professor of Medicine, Chief, Division of Nephrology,
and Vice Chairman, Department of Medicine
LSU Health Shreveport School of Medicine
Michael Allon, MD
Professor of Medicine, Associate Director for Clinical Affairs
and Medical Director of Dialysis Operations, Division of Nephrology
University of Alabama at Birmingham
Arif Asif, MD, MHCM
Professor of Medicine, Chairman, Department of Medicine, Assistant Chief Medical Officer,
Jersey Shore Medical Center
Seton Hall-Hackensack Meridian School of Health
Neptune, New Jersey
Brad C. Astor, PhD, MPH
Professor, Departments of Medicine and Population Health Sciences
University of Wisconsin School of Medicine and Public Health
Marc H. Glickman, MD
Chief Medical Officer, Senior Vice President
Hancock Jaffe Laboratories
Irvine, California
Janet Graham, MHScN, CNeph(C)
Clinical Director of Nephrology, The Ottawa Hospital
Regional Director of Nephrology, Champlain LHIN Ontario Renal Network
Louise M. Moist, MD, MSc
Professor of Medicine, Epidemiology and Biostatistics
Associate Chair, Division of Nephrology
Western University
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Dheeraj K. Rajan, MD, FRCP(C)
Professor of Radiology and Division Chief of Vascular and Interventional Radiology
University of Toronto
Cynthia Roberts, RN, CNN
Vascular Access Coordinator, Renal Research Institute, University of North Carolina at Chapel Hill
Nephrology and Hypertension Division
Tushar J. Vachharajani, MD
Clinical Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University
Director of Interventional Nephrology and Director of Global Nephrology, Glickman Urological & Kidney Institute,
Cleveland Clinic
Rudolph P. Valentini, MD
Professor of Pediatrics, Chief Medical Officer, Children’s Hospital of Michigan (CHM), Wayne State University School
of Medicine
Evidence Review Team
University of Minnesota Department of Medicine
Minneapolis VA Center for Chronic Disease Outcomes Research, Minneapolis, MN, USA
Michelle Brasure, PhD, MSPH, MLIS, Program Manager and Medical Librarian
University of Minnesota School of Public Health
Nancy Greer, PhD, Senior Research Associate and Program Manager
Minneapolis VA Health Care System
Areef Ishani, MD, MS, Professor of Medicine, Chief of Primary Care at the Minneapolis VA Health Care System
Roderick MacDonald, MS, Senior Research Assistant
Minneapolis VA Health Care System
Victoria A Nelson, MSc, Research Fellow and Study Coordinator
University of Minnesota School of Public Health
Carin Olson, MD, MS, Medical Editor and Writer
University of Minnesota School of Public Health
Yelena Slinin, MD, MS, Nephrologist at Kaiser Permanente
Timothy J. Wilt, MD, MPH, Professor of Medicine and Project Director
Minneapolis VA Health Care System
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Organization Leadership
KDOQI LEADERSHIP
Michael V. Rocco, MD, MSCE
KDOQI Chair
Holly Kramer, MD, MPH
Vice Chair, Research, and President, National Kidney Foundation
Bernard Jaar, MD, MPH
Vice Chair, Education
Michael J. Choi, MD
Vice Chair, Policy, and Past President, National Kidney Foundation
KDOQI GUIDELINE DEVELOPMENT STAFF
Kerry Willis, PhD, Chief Scientific Officer
Jessica Joseph, MBA, Senior Vice President, Scientific Operations
Laura Brereton, MSc, KDOQI Project Director
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