K/DOQI Update 2000
 
NKF KDOQI GUIDELINES 2000
 
 
 

NKF-KDOQI Clinical Practice Guidelines
 
General Acknowledgements
NKF-DOQI Steering Committee
KDOQI Support Group
KDOQI Advisory Board

KDOQI Co-Chairs and Work Groups' Membership
Foreword
Disclaimer

I. NKF-KDOQI CLINICAL PRACTICE GUIDELINES FOR HEMODIALYSIS ADEQUACY:
UPDATE 2000


Acronyms and Abbreviations

Introduction

I. Measurement of Hemodialysis Adequacy
Guideline 1: Regular Measurement of the Delivered Dose of Hemodialysis
Guideline 2: Method of Measurement of Delivered Dose of Hemodialysis
Guideline 3: Uniformity of Method of Measurement

II. Hemodialysis Dose
Guideline 4: Minimum Delivered Dose of Hemodialysis
Guideline 5: Prescribed Dose of Hemodialysis
Guideline 6: Frequency of Measurement of Hemodialysis Adequacy

III. Blood Urea Nitrogen (BUN) Sampling
Guideline 7: Blood Urea Nitrogen (BUN) Sampling
Guideline 8: Acceptable Methods for BUN Sampling
Guideline 9: Standardization of BUN Sampling Procedure

IV. Hemodialyzer Reprocessing and Reuse
Guideline 10: Use of the Association for the Advancement of Medical Instrumentation (AAMI) Standards and Recommended Practices for Hemodialyzer Reprocessing
Guideline 11: Baseline Measurement of Total Cell Volume
Guideline 12: Monitoring Total Cell Volume
Guideline 13: Minimum Required Total Cell Volume

V. Hemodialysis Dose Troubleshooting
Guideline 14: Inadequate Delivery of Hemodialysis

VI. Maximizing Patient Adherence to the Hemodialysis Prescription
Guideline 15: Optimizing Patient Comfort and Adherence
Guideline 16: Strategies to Minimize Hypotensive Symptoms

VII. References

VIII. Appendices
A: RPA Guideline Ordering Information
B: Kinetic Determination of the Urea Distribution Volume
C: Anthropometric Determination of the Urea Distribution Volume
D: Contribution of Residual Kidney Function on Clearance With Thrice Weekly Dialysis Therapy
E: Detailed Error Analysis for Deficiencies in Delivered Kt/V or URR
F: Performance of Hydraulic Compression Test During Hemodialysis

IX. Biographical Sketches of the NKF-KDOQI Hemodialysis Adequacy Work Group Members

II. NKF-KDOQI CLINICAL PRACTICE GUIDELINES FOR PERITONEAL DIALYSIS ADEQUACY: UPDATE 2000

Acronyms and Abbreviations
Introduction

I. Initiation of Dialysis
Guideline 1: When to Initiate Dialysis Kt/Vurea Criterion
Guideline 2: Indications for Renal Replacement Therapy

II. Measures of Peritoneal Dialysis Dose
Guideline 3: Frequency of Delivered PD Dose and Total Solute Clearance Measurement Within Six Months of Initiation
Guideline 4: Measures of PD Dose and Total Solute Clearance
Guideline 5: Frequency of Measurement of Kt/Vurea, Total CCr, PNA, and Total Creatinine Appearance
Guideline 6: Assessing Residual Kidney Function
Guideline 7: PD Dose Troubleshooting

III. Measurement of Peritoneal Dialysis Dose
Guideline 8: Reproducibility of Measurement
Guideline 9: Estimating Total Body Water and Body Surface Area
Guideline 10: Timing of Measurement
Guideline 11: Dialysate and Urine Collections

IV. Assessment of Nutritional Status Specifically as It Relates to Peritoneal Dialysis
Guideline 12: Assessment of Nutritional Status
Guideline 13: Determining Fat-Free, Edema-Free Body Mass
Guideline 14: Use of the Modified Borah Equation to Assess Nutritional Status of Pediatric PD Patients

V. Adequate Dose of Peritoneal Dialysis
Guideline 15: Weekly Dose of CAPD
Guideline 16: Weekly Dose of NIPD and CCPD
Guideline 17: PD Dose in Subpopulations
Guideline 18: Use of Empiric and Computer Modeling of PD Dose

VI. Strategies for Increasing the Likelihood of Achieving the Prescribed Dose of Peritoneal Dialysis
Guideline 19: Identify and Correct Patient-Related Failure to Achieve Prescribed PD Dose
Guideline 20: Identify and Correct Staff-Related Failure to Achieve Prescribed PD Dose

VII. Clinical Outcome Goals for Adequate Peritoneal Dialysis
Guideline 21: Measurement of PD Patient Survival
Guideline 22: Measurement of PD Technique Survival
Guideline 23: Measurement of Hospitalizations
Guideline 24: Measurement of Patient-Based Assessment of Quality of Life
Guideline 25: Measurement of School Attendance, Growth, and Developmental Progress in Pediatric PD Patients
Guideline 26: Measurement of Albumin Concentration in PD Patients
Guideline 27: Measurement of Hemoglobin/Hematocrit in PD Patients
Guideline 28: Measurement of Normalized PNA in PD Patients

VIII. Suitable Patients for Peritoneal Dialysis
Guideline 29: Indications for PD
Guideline 30: Absolute Contraindications for PD
Guideline 31: Relative Contraindications for PD
Guideline 32: Indications for Switching from PD to HD

IX. References

X. Appendices
A: Detailed Rationale for Guideline 1
B.
C: Detailed Rationale for Guideline 6
D: Detailed Rationale for Guideline 8
E: Detailed Rationale for Guideline 9
F: Detailed Rationale for Guideline 12
G: Detailed Rationale for Guideline 15
H: Detailed Rationale for Guideline 19


XI. Biographical Sketches of the NKF-KDOQI Peritoneal Dialysis Adequacy Work Group Members

III. NKF-KDOQI CLINICAL PRACTICE GUIDELINES FOR VASCULAR ACCESS: UPDATE 2000

Acronyms and Abbreviations

Introduction

I. Patient Evaluation Prior to Access Placement
Guideline 1: Patient History and Physical Examination Prior to Permanent Access Selection
Guideline 2: Diagnostic Evaluation Prior to Permanent Access Selection
Guideline 3: Selection of Permanent Vascular Access and Order of Preference for Placement of AV Fistulae
Guideline 4: Type and Location of Dialysis AV Graft Placement
Guideline 5: Type and Location of Tunneled Cuffed Catheter Placement
Guideline 6: Acute Hemodialysis Vascular Access—Noncuffed Catheters
Guideline 7: Preservation of Veins for AV Access
Guideline 8: Timing of Access Placement
Guideline 9: Access Maturation

II. Monitoring, Surveillance, and Diagnostic Testing
Guideline 10: Definition of Terms
Guideline 11: Monitoring Primary AV Fistulae for Stenosis
Guideline 12: Recirculation Methodology, Limits, Evaluation, and Follow-Up

III. Prevention of Complications: Infection
Guideline 13: Infection Control Measures
Guideline 14: Skin Preparation Technique for Permanent AV Accesses
Guideline 15: Catheter Care and Accessing the PatientĚs Circulation

IV. Management of Complications: When to Intervene
Guideline 16: Managing Potential Ischemia in a Limb Bearing an AV Access
Guideline 17: When to Intervene—Dialysis AV Grafts for Venous Stenosis, Infection, Graft Degeneration, and Pseudoaneurysm Formation
Guideline 18: When to Intervene—Primary AV Fistulae

V. Management of Complications: Optimal Approaches for Treating Complications
Guideline 19: Treatment of Stenosis Without Thrombosis in Dialysis AV Grafts and Primary AV Fistulae
Guideline 20: Treatment of Central Vein Stenosis
Guideline 21: Treatment of Thrombosis and Associated Stenosis in Dialysis AV Grafts
Guideline 22: Treatment of Thrombosis in Primary AV Fistulae
Guideline 23: Treatment of Tunneled Cuffed Catheter Dysfunction
|Guideline 24: Treatment of Infection of Dialysis AV Grafts
Guideline 25: Treatment of Infection of Primary AV Fistulae
Guideline 26: Treatment of Infection of Tunneled Cuffed Catheters
Guideline 27: Treatment of Pseudoaneurysm of Dialysis AV Grafts
Guideline 28: Aneurysm of Primary AV Fistulae

VI. Potential Quality of Care Standards
Guideline 29: Goals of Access Placement—Maximizing Primary AV Fistulae
Guideline 30: Goals of Access Placement—Use of Catheters for Chronic Dialysis
Guideline 31: Center-Specific Thrombosis Rate
Guideline 32: Infection Rate
Guideline 33: Primary Access Failure Rate—AV Grafts
Guideline 34: Primary Access Failure Rate—Tunneled Cuffed Catheters
Guideline 35: Primary Access Failure—Native AV Fistulae

Guideline 36: Cumulative Patency Rate of Dialysis AV Grafts
Guideline 37: Cumulative Patency Rate of Tunneled Cuffed Catheters
Guideline 38: Cumulative Patency Rate of Primary AV Fistulae

VII. References

VIII. Biographical Sketches of the NKF-KDOQI Vascular Access Work Group Members

IV. NKF-KDOQI CLINICAL PRACTICE GUIDELINES FOR ANEMIA OF CHRONIC KIDNEY DISEASE: UPDATE 2000

Acronyms and Abbreviations

Introduction

I. Anemia Work-Up
Guideline 1: When to Initiate the Work-Up of Anemia
Guideline 2: Anemia Evaluation
Guideline 3: Erythropoietin Deficiency

II. Target Hemoglobin/Hematocrit
Guideline 4: Target Hemoglobin/Hematocrit for Epoetin Therapy

III. Iron Support
Guideline 5: Assessment of Iron Status
Guideline 6: Target Iron Level
Guideline 7: Monitoring Iron Status
Guideline 8: Administration of Supplemental Iron
Guideline 9: Administration of a Test Dose of IV Iron
Guideline 10: Oral Iron Therapy

IV. Administration of Epoetin
Guideline 11: Route of Administration of Epoetin
Guideline 12: Initial Epoetin Administration
Guideline 13: Switching From Intravenous to Subcutaneous Epoetin
Guideline 14: Strategies for Initiating and Converting to Subcutaneous Epoetin Administration
Guideline 15: Monitoring of Hemoglobin/Hematocrit During Epoetin Therapy
Guideline 16: Titration of Epoetin Dosage
Guideline 17: Inability to Tolerate Subcutaneous Epoetin; IV Epoetin Dose
Guideline 18: Intraperitoneal Epoetin Administration
Guideline 19: Epoetin Dosage Perioperatively or During Intercurrent Illness

V. Inadequate Epoetin Response
Guideline 20: Causes for Inadequate Response to Epoetin
Guideline 21: When to Obtain a Hematology Consultation
Guideline 22: Epoetin-Resistant Patients

VI. Role of Red Blood Cell Transfusions
Guideline 23: Red Blood Cell Transfusions in Patients With Chronic Renal Failure

VII. Possible Adverse Effects Related to Epoetin Therapy
Guideline 24: Possible Adverse Effects Related to Epoetin Therapy: Hypertension
Guideline 25: Possible Adverse Effects Related to Epoetin Therapy: Seizures
Guideline 26: Possible Adverse Effects Related to Epoetin Therapy: Increased Clotting Tendency
Guideline 27: Possible Adverse Effects Related to Epoetin Therapy: Hyperkalemia

VIII. Endnotes

IX. References

X. Biographical Sketches of the NKF-KDOQI Anemia Work Group Members

© 2001 National Kidney Foundation, Inc

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