The KDOQI 2006 Vascular Access Update and Fistula First Program Synopsis

Abstract

The optimal care of patients with end stage renal disease on hemodialysis involves a multidisciplinary approach involving nephrologists, vascular surgeons, transplant surgeons and interventional radiologists. A collaborative effort by these groups of physicians was used to create the KDOQI guidelines and the Fistula First program, which have served as the template for the management of dialysis patients. This article will briefly review the recent updates for vascular access in the KDOQI guidelines and summarize the highlights of the Fistula First program.

Haemodialysis access: clinical and epidemiological profile of patients and their vascular access in interior of Brazil

“…The access should be placed distally and in the upper extremities whenever possible. It's preferred primary radiocephalic fistula, an elbow (brachiocephalic) primary fistula, to a transposed brachial basilic, vein fistula [10].…”

“…In our study, there was a predilection to implant catheters in the jugular veins, especially the right as the main guidelines recommend and it was represented to 63% of all catheters. [10].…”

“…Thus, subclavian vein catheterization should be avoided for temporary access in patients with kidney disease. [10] All these catheters were implanted in the largest hospital in the region. Therefore, this finding mischaracterizes the actual statistics of the haemodialysis service.…”

“…[3,9] They should be made 6 months prior to initiating haemodialysis. [10] If an AVF cannot be created, an AVF graft or venous catheter may be needed [11,12] but they should be avoided [6,13]. The studies showed that the native access presents the best patency (4 to 5 years) and lower rate of reoperation when compared with other accesses [14,15].…”

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“…Only two, single center studies from Singapore and Japan were included in our review. These studies suggest that the "Fistula First" initiative, recommended by Kidney Disease Outcomes Quality Initiative guidelines, is a viable option among the elderly population [32]. Large scale, multi-center studies are needed in order to determine optimal access choice, reasons of failure to mature, and complication rates among the elderly.…”