Access planning using an ESKD Life-Plan and timing of referral/creation
Applied
Type
ReinforcementConfidence
85%
Created
Mar 20, 2026
Evidence
1 source
Rationale
The integration of the 2022 Chinese Clinical Practice Guideline reinforces the existing recommendations for early referral and the ESKD Life-Plan approach. It specifically highlights the 'peri-dialysis' period as a vital stage for vascular access preparation, which aligns with the section's focus on timing and planning. Abbreviations for DUS, AVF, and CVC were added to improve technical clarity and follow standard medical textbook formatting.
Evidence
Content Changes
removedadded
The ESKDend-stage kidney disease (ESKD) Life-Plan is an individualized approach to vascular access planning that integrates patient prognosis, comorbidities, and treatment goals. Patients should be referred for vascular access evaluation when the estimated glomerular filtration rate (eGFR) approaches 15–20 mL/min/1.73 m² or earlier if rapid decline is anticipated.anticipated, emphasizing the importance of structured management during the peri-dialysis period [@chinese2022]. Early vessel mapping using duplex ultrasound (DUS) identifies suitable anatomy and allows sufficient time for arteriovenous fistula (AVF) creation and maturation. Access choice should align with life expectancy, anticipated dialysis duration, modality preference (hemodialysis versus peritoneal dialysis), and patient-specific anatomic and functional considerations. This comprehensive planning minimizes reliance on central venous catheters (CVC) and optimizes long-term access durability. [@lok2020, @esvs2018-access]@esvs2018-access, @chinese2022]