NKF Releases Update to Clinical Practice Guideline for Hemodialysis
New York, NY – Updated clinical practice guidelines for hemodialysis adequacy, released today by the National Kidney Foundation and published in the November issue of the American Journal for Kidney Diseases (AJKD), put greater emphasis on shared decision making and patient-centered care. The update is intended to be used in conjunction with the 2006 version.
The Kidney Disease Outcomes Quality Initiative (KDOQI) Clinical Practice Guideline for Hemodialysis Adequacy impacts how care is delivered to over 400,000 hemodialysis patients in the United States. KDOQI guidelines are already used by professionals around the world to prescribe hemodialysis to end-stage renal disease patients.
Key elements in the 2015 update include:
More emphasis on shared, patient-physician decision making, and less emphasis on minimum or maximum thresholds.
Individualized care with prescription flexibility in dialysis initiation timing, frequency, duration, and ultrafiltration rate.
More emphasis on volume and blood pressure control
Considerations for using stdKt/V to measure frequent hemodialysis; adjusting for residual renal function, ultrafiltration rate, and body surface area.
Specific recommendations for high-frequency hemodialysis.
“Much of the newer evidence we’ve reviewed for this update supports the current guidelines,” said Thomas Depner, M.D., co-chair of the Hemodialysis Adequacy workgroup. “However, what we have seen over time is a lack of evidence for a one-size-fits-all approach to hemodialysis. Because of this, the updated guidelines call for flexibility in dialysis prescription.”
The guideline emphasizes patient education to allow for shared decision making regarding initiation, frequency and place of dialysis.
Variable evidence also led the authors to emphasize consideration of multiple clinical factors in developing individualized prescriptions. Of note, the workgroup found evidence to support high frequency dialysis in certain patients, but the guidelines do not include blanket recommendations for high frequency hemodialysis in all patients. Considerations for initiating high-frequency hemodialysis include: sleep apnea, pregnancy, metabolic derangements, uncontrolled hypertension and left ventricle hypertrophy and/or congestive heart failure.
The new guidelines are the culmination of two years’ work reviewing evidence published in peer-reviewed medical journals by the seven-member Hemodialysis Adequacy workgroup. Members of the workgroup include, John Daugirdas MD, Thomas A. Depner MD, Jula Inrig MD, Rajnish Mehrotra MD, Michael V. Rocco MD, Rita Suri MD, and Daniel E. Weiner MD. The literature review was carried out by the Minneapolis Veterans Affairs Center for Chronic Disease Outcomes Research at the University of Minnesota. The KDOQI Clinical Practice Guideline for Hemodialysis Adequacy was first published in 1997 and updated in 2000 and 2006.