title: 2005 Japanese Society for Dialysis Therapy guidelines for vascular access construction and repair for chronic hemodialysis.
abstract: The guideline committee of Japanese Society for Dialysis Therapy (JSDT), chaired by Dr Ohira, has published an original Japanese guideline, 'Guidelines for Vascular Access Construction and Repair for Chronic Hemodialysis'. The guideline was created mainly because of the existence of numerous factors characteristic of Japanese hemodialysis therapy, which are described in this report, and because we recognized the necessity for standardization in vascular access-related surgeries. This guideline consists of 10 chapters, each of which includes guidelines, explanations or comments and references. The first chapter discusses informed consent of vascular access (VA)-related surgeries, which often resulted in trouble between dialysis staff and patients. The second chapter describes the fundamentals of VA construction and timing of the introduction of hemodialysis with emphasis on the avoidance of catheter indwelling if at all possible. In the third chapter, arteriovenous fistula (AVF) construction and management are discussed from the viewpoint of the most preferable type of VA. The fourth chapter deals with arteriovenous grafts (AVG) which has recently increased in clinical applications. The factors which improve the AVG patency rate are discussed and postoperative management methods are emphasized to avoid possible complications. The fifth chapter deals with short and long-term vascular catheters. It is emphasized that these methods are definitely effective but, at the same time, are apt to be associated with several serious complications and might result in vascular damage. In the sixth chapter, superficialization of an artery is explained. This was originally for emergency use or backup but has been used permanently in 2-3% of Japanese hemodialysis patients. In the seventh chapter, methods for the use of VA are described and the buttonhole method is referred to as one of the options for patients who complain of intense pain at every cannulation. In the eighth chapter, the importance of continuous monitoring is stressed for maintaining appropriate function of VA. As a rule, the internal shunt type VA (AVF, AVG) places a burden on cardiac function. Thus, in the ninth chapter, it is stressed that VA construction, maintenance and repair should always be carried out with consideration of cardiac function which is not constant but variable. The 10th chapter forms one of the cores of this guideline and deals with repair and timing of VA. It is shown how to select a surgical or interventional repair method. In the final 11th chapter, VA types and resultant morbidity and mortality of hemodialysis patients are reviewed.
authors.affiliation: Sapporo Kita Clinic, Sapporo, Hokkaido, Japan. seiji.ohira@sk-clinic.or.jp
authors.forename: Seiji
authors.initials: S
authors.lastname: Ohira
authors.forename: Hidemune
authors.initials: H
authors.lastname: Naito
authors.forename: Izumi
authors.initials: I
authors.lastname: Amano
authors.forename: Nakanobu
authors.initials: N
authors.lastname: Azuma
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Ikeda
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Kukita
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Goto
authors.forename: Shinji
authors.initials: S
authors.lastname: Sakai
authors.forename: Takahiro
authors.initials: T
authors.lastname: Shinzato
authors.forename: Tokuichiro
authors.initials: T
authors.lastname: Sugimoto
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Takemoto
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Haruguchi
authors.forename: Ichiro
authors.initials: I
authors.lastname: Hino
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Hiranaka
authors.forename: Jun
authors.initials: J
authors.lastname: Mizuguchi
authors.forename: Akira
authors.initials: A
authors.lastname: Miyata
authors.forename: Noriyoshi
authors.initials: N
authors.lastname: Murotani
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000379:methods; D002406:Catheterization, Peripheral; D006801:Humans; D007258:Informed Consent; D007564:Japan; D007676:Kidney Failure, Chronic / Q000628:therapy*; D006435:Renal Dialysis; D014654:Vascular Patency