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New York, NY
July 5, 2006
Updates to the original National Kidney Foundation’s KDOQI (then called DOQI) clinical practice guidelines for hemodialysis, peritoneal dialysis and vascular access are now published as a supplement to the July 2006 American Journal of Kidney Diseases.
“Each of these guidelines has been enhanced by including new literature and studies into the body of evidence,” said Michael Rocco, MD, vice chair of NKF-KDOQI. “As a result, guidelines have been both revised and added, offering all members of the dialysis health care team new evidence-based guidelines to help make critical health care decisions to improve patient outcomes.”
The guidelines have been divided into three major categories: evidence based guidelines, opinion-based clinical practice recommendations and research recommendations. Research recommendations are now grouped into three categories: critically important, important, and of interest. This reorganization will assist funding agencies in prioritizing the use of research funds.
Chaired by Anatole Besarab, MD, FACP and Jack Work, MD, this guideline condenses the previous 38 guidelines into seven major topics for adults, one section for children and a section of clinical outcome goals. Key differences from the 2000 version include a new guideline on the cannulation of the vascular access. The list of preferred, acceptable and unacceptable methods for monitoring vascular access dysfunction has been updated and includes a statement that a physical examination of grafts and fistulas should be performed on a monthly basis. Methods for treating dysfunctional or nonfunctional catheters have also been updated. Finally, goals for autologous fistulas are revised upwards (from 40% to 60%) whereas the avoidance of catheters as permanent access is maintained at 10%.
Co-chairs Tom Depner, MD and John Daugirdas, MD managed the development of this guideline. The new version reorganizes the previous 16 guidelines to into eight major areas that are addressed by guidelines and/or clinical practice recommendations. Guidance is now provided on the recommended minimum dose of dialysis for patients who receive hemodialysis on a schedule other than three times per week. More specific recommendations are also given about how to adjust the dialysis prescription in patients with significant residual kidney function (RKF) and how to include measures of RKF into adequacy calculations. New areas covered in this clinical practice guideline include the preservation of residual kidney function and the maintenance of euvolemia.
Peritoneal Dialysis Adequacy
John Burkart, MD and Beth Piraino, MD chaired the work group that developed this guideline, comprising six clinical practice guidelines and several clinical practice recommendations. The old target dose of dialysis (a weekly total Kt/V urea of 2.0) has been replaced by a minimum weekly total Kt/V urea of 1.7. It is no longer necessary to obtain weekly creatinine clearance values to assess the adequacy of dialysis. It is recommended that patients with residual renal function be placed on either an angiotensin converting enzyme inhibitor or an angiotensin receptor blocker (except when contraindicated) to help preserve RKF if the patient's blood pressure permits. Finally, a new section on the importance of and approach to maintenance of euvolemia was added.
The guidelines will be available online in their entirety at www.kdoqi.org in August 2006.
About the National Kidney Foundation
The National Kidney Foundation is dedicated to preventing kidney and urinary tract diseases, improving the health and well being of individuals and families affected by these diseases, influencing public policy in support of the kidney community and increasing the availability of all organs for transplantation.
For more information, please call 800 622-9010.