Hemodialysis access: What we know

Abstract

Abstract Kidney failure continues to be a significant cause of morbidity and mortality in the United States. With hemodialysis (HD) as the leading modality for renal replacement in patients with kidney failure, vascular access is paramount to a patient’s survival. Through the National Kidney Foundation (NKF), the Kidney Disease Outcomes Quality Initiative (KDOQI) clinical guidelines have been developed to decrease the morbidity associated with vascular access, improve quality of life, and increase efficiency of care for patients with kidney failure. Before 2019, these guidelines focused on early placement of native arteriovenous fistula and surveillance of vascular access for complications. The updated KDOQI guidelines released ahead of print in 2019 no longer support “fistula first” but instead focus on the “right patient, right access, right time” through the development of the end-stage kidney disease life plan. A major driver of this guideline change stems from the discrepancies found in available outcomes data for HD vascular access. No where is this more evident than when assessing the outcomes of HD vascular access in female patients with kidney failure. The purpose of this chapter is to review data in HD vascular access in women to understand and illustrate the new recommendations for vascular access from the NKF KDOQI 2019 clinical update.