KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update
Abstract
The National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (KDOQI) has provided evidence-based guidelines for hemodialysis vascular access since 1996. Since the last update in 2006, there has been a great accumulation of new evidence and sophistication in the guidelines process. The 2019 update to the KDOQI Clinical Practice Guideline for Vascular Access is a comprehensive document intended to assist multidisciplinary practitioners care for chronic kidney disease patients and their vascular access. New topics include the end-stage kidney disease "Life-Plan" and related concepts, guidance on vascular access choice, new targets for arteriovenous access (fistulas and grafts) and central venous catheters, management of specific complications, and renewed approaches to some older topics. Appraisal of the quality of the evidence was independently conducted by using a Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach, and interpretation and application followed the GRADE Evidence to Decision frameworks. As applicable, each guideline statement is accompanied by rationale/background information, a detailed justification, monitoring and evaluation guidance, implementation considerations, special discussions, and recommendations for future research.
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Existing studies have confirmed that rope ladder puncture results in fewer complications, and many guidelines recommend rope ladder puncture as the preferred puncture method.
“As existing studies have confirmed that rope ladder puncture will result in fewer complications, many guidelines recommend rope ladder puncture as the preferred puncture method (Jin Qizhuang & Chaoyang, 2019; Lok et al., 2020).”
From Construction of haemodialysis nursing‐sensitive quality indicators based on Donabedian theory: A Delphi method study (2023) · cites this paper as Lok et al., 2020
The incidence of CRBSI has long been a core indicator highlighted in international clinical guidelines.
“Notably, the incidence of CRBSI has long been a core indicator highlighted in international clinical guidelines (45, 46).”
From Construction of nursing-sensitive quality indicators for hemodialysis vascular access: a Delphi study (2026) · cites this paper as [46]
Cites
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Bioengineering human tissues and the future of vascular replacement
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Association of Anaesthetists guidelines: safe vascular access 2025
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“As existing studies have confirmed that rope ladder puncture will result in fewer complications, many guidelines recommend rope ladder puncture as the preferred puncture method (Jin Qizhuang & Chaoyang, 2019; Lok et al., 2020).”
MethodVenous access devices (Review)
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Zhang, Y., He, L., Tang, S., Gao, Y., Chen, H., Shi, M., & Chen, L. (2026) · Frontiers in Public Health · doi:10.3389/fpubh.2026.1858484
- Authors
- Lok, C. E., Huber, T. S., Lee, T., Shenoy, S., Yevzlin, A. S., Abreo, K., Allon, M., Asif, A., Astor, B. C., Glickman, M. H., Graham, J., Moist, L. M., Rajan, D. K., Roberts, C., Vachharajani, T. J., & Valentini, R. P.
- ORCID
- Venue
- American Journal of Kidney Diseases
- Publisher
- Elsevier BV
- Published
- 2020-04
- Volume
- 75
- Issue
- 4
- Pages
- S1-S164
- ISSN
- 0272-6386 (ISSN-L)
- OpenAlex
- W3012497879
- Cited by
- 2,590
- References
- 4
- Citations by year
- 2026: 467 · 2025: 501 · 2024: 464 · 2023: 390 · 2022: 341 · 2021: 332 · 2020: 84 · 2019: 7 · 2018: 1
- FWCI
- 268.64
- Type
- journal article
- Language
- en
- Update notices
- erratum (2021-04-01)
- Open access
- closed
- Locations
- American Journal of Kidney Diseases (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › Emergency Medical Services › Central Venous Catheters and Hemodialysis
- Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
- Health Sciences › Medicine › Nephrology › Parathyroid Disorders and Treatments
- Keywords
- hemodialysis vascular access, arteriovenous fistula, arteriovenous graft, central venous catheters, chronic kidney disease, end-stage renal disease, life project, vascular access complications, vascular access selection
- MeSH terms
- Renal Dialysis, Humans, Kidney Failure, Chronic, Nephrology, Societies, Medical, Vascular Access Devices
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