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.

Keywords: Guideline; Hemodialysis; Kidney Disease Outcomes Quality Initiative; Vascular access.

Fig. 1.. Individualized P-L-A-N (Patient Life-Plan and their Access Needs).

The 2019 Kidney Disease Outcomes Quality Initiative guidelines for vascular access suggest considering the patient first, followed by planning vascular access consistent with their individual ESKD Life-Plan, which is the anticipated continuum of kidney replacement treatments (peritoneal dialysis, hemodialysis, transplantation, or conservative care). “Access Needs” include three main components: an access creation plan, access contingency plan, and access succession plan. Concurrently, there must always be a vessel preservation plan, to ensure viability for future access. ESKD, end-stage kidney disease.