Guidelines

in Hemodialysis Access

Applied

Type

Reinforcement

Confidence

85%

Created

Mar 20, 2026

Evidence

1 source

Rationale

The integration of Heindel 2022 provides clinical context for the KDOQI 2019 guidelines. The study evaluates how well current practice aligns with the shift toward clinical monitoring rather than routine surveillance, specifically in the context of RCAVFs. This reinforces the existing text's discussion of the KDOQI 2019 recommendations. Additionally, all abbreviations were expanded on first use as required.

Evidence

Heindel P, et al. Evaluating national guideline concordance of recurrent interventions after radiocephalic arteriovenous fistula creation. Journal of Vascular Surgery. 2022. PMID: 36567000.
Verified source
PubMedDOI

Content Changes

<!-- type: guidelines -->
**KDOQI Guidelines (2019):** The Kidney Disease Outcomes Quality Initiative (KDOQI) 2019 guidelines advocate an individualized “ESKDend-stage Life-Plan”kidney disease (ESKD) Life-Plan that balances patient life expectancy, comorbidities, functional status, and vascular anatomy with the preference for autogenous access when appropriate. Key recommendations include timely referral (eGFR(estimated glomerular filtration rate [eGFR] 15–20 mL/min/1.73 m²), preoperative vessel mapping, emphasis on clinical monitoring over instrument-based surveillance, and avoidance of routine preemptive angioplasty based solely on abnormal surveillance metrics without clinical indicators of dysfunction.dysfunction [@lok2020][@lok2020]. National evaluations of guideline concordance have highlighted the importance of these recommendations, particularly in reducing the frequency of recurrent interventions after radiocephalic arteriovenous fistula (RCAVF) creation when clinical indicators of dysfunction are absent [@heindel2022].

**ESVS Guidelines (2018):** The European Society for Vascular Surgery (ESVS) 2018 guidelines recommend autogenous arteriovenous fistula as the first-choice access when feasible, given superior long-term patency and lower complication rates. The guidelines provide specific indications for stent-graft use, including recurrent graft-vein anastomotic stenosis, venous rupture during angioplasty, and selected pseudoaneurysms. Preoperative duplex ultrasound mapping is recommended to optimize access planning. [@esvs2018-access]

**SVS Guidelines (2008):** The Society for Vascular Surgery (SVS) 2008 practice guidelines established foundational standards for access creation, surveillance, and intervention. While these remain historically important, contemporary practice should align with the updated recommendations provided by KDOQI 2019 and ESVS 2018, which incorporate more recent evidence regarding surveillance strategies, endovascular techniques, and individualized access planning. [@svs2008]
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