title: Vascular Access Guidelines: Summary, Rationale, and Controversies.
abstract: Dialysis vascular access management in the United States changed significantly after National Kidney Foundation-Kidney Disease Outcome Quality Initiative (NKF-KDOQI) clinical practice guidelines were first published in 1997. The Centers for Medicare and Medicaid Service adopted these guidelines and in collaboration with the End-Stage Renal Disease Networks established the Fistula First Breakthrough Initiative (FFBI) in 2003 to improve the rate of arteriovenous fistula use over arteriovenous graft and central venous catheter in the dialysis population. The implementation of guidelines and FFBI has led to a significant increase in the arteriovenous fistula use in the prevalent dialysis population. The guidelines are criticized for being opinion based and often impractical. Over the past 2 decades, the patient population undergoing dialysis has become older with complex comorbidities and challenges for creating an ideal vascular access. Advancing knowledge about access pathophysiology, improved treatment options, and improved process of care with team approach model point toward diminishing relevance of few of the existing guidelines. Moreover, several guidelines remain controversial and may be leading to clinical decisions that may be unfavorable to the patients. The review discusses the historical aspect of vascular access care in the United States and evolution of current practice standards and controversies surrounding few of these guidelines in the current time.
authors.affiliation: Department of Nephrology, Louisiana State University Health Sciences Center, Shreveport, LA.
authors.forename: Adrian
authors.initials: A
authors.lastname: Sequeira
authors.affiliation: Department of Nephrology, Louisiana State University Health Sciences Center, New Orleans, LA.
authors.forename: Mihran
authors.initials: M
authors.lastname: Naljayan
authors.affiliation: Department of Nephrology, W.G. (Bill) Hefner Veterans Affairs Medical Center, Salisbury, NC. Electronic address: Tushar.vachharajani@va.gov.
authors.forename: Tushar J
authors.initials: TJ
authors.lastname: Vachharajani
mesh_terms: D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000266:history / Q000592:standards*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000266:history / Q000592:standards*; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000266:history / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000592:standards; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000453:epidemiology / Q000266:history / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards; D006435:Renal Dialysis / Q000266:history / Q000592:standards*; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: Arteriovenous fistula; Arteriovenous graft; Central venous catheter; K/DOQI; Vascular access; Vascular access guidelines