Clinical Practice Guideline for Vascular Access: Update
KDOQI is updating the Clinical Practice Guideline for Vascular Access. The last revision of this guideline was completed 10 years ago. Since then, changes in patient demographics and increasing patient longevity, as well as a growing body of literature on improved ESRD care, have renewed interest in access management. Our Vascular Access update is chaired by Charmaine Lok MD, with vice chairs Alexander Yevzlin MD, and Surendra Shenoy MD. The multidisciplinary workgroup includes members in fields including nephrology, surgery, interventional radiology, nursing, and epidemiology.
The Vascular Access update is now in public review and has an anticipated publication date of early 2020.
Clinical Practice Guideline for Nutrition in CKD: Update
KDOQI, in collaboration with the Academy of Nutrition and Dietetics, is updating its Clinical Practice Guideline on Nutrition in CKD. The guideline will provide evidence-based recommendations for assessment, prevention and treatment of protein-energy wasting, mineral and electrolyte disorders, and other metabolic disorders associated with kidney disease, as well as provision of medical nutrition therapy. The evidence review will cover macronutrients (protein, carbohydrate and fats/lipids), micronutrients (e.g. Vitamins B1, B6, C; folic acid; riboflavin; and Zinc), and electrolytes (sodium, magnesium, calcium, potassium and phosphorous, as well as net acid base intake). Research questions will be varied and include, for example, "Is there evidence to support the use of visceral protein stores (albumin, pre-albumin, transferrin, retinol-binding protein, IGF-1, creatinine) as indicators of protein nutritional status?" and "What are the clinical complications associated with serum calcium levels (by excess or deficit) in patients with CKD stages 1-5?" Populations of interest are patients in CKD stages 1-5, those on dialysis, and post-transplant. The international, multidisciplinary workgroup is chaired by T. Alp Ikizler MD and Lillian Cuppari PhD. We are aiming for publication in mid 2020.
Controversies in Care
KDOQI leadership continues to publish a series of small, targeted commentaries on current topics in nephrology for which there is not enough evidence to issue clinical practice guidance. These papers begin with a literature review of currently available evidence on each side of the issue and discuss both the theoretical and practical implications for patient care.
Recent publications include:
One way we test how controversial topics are among the renal care community is through our continually updated KDOQI poll, seen on the right-hand side of the NFK web site 'Guidelines' page.
The National Kidney Foundation develops clinical tools and apps using the latest KDOQI guidelines.
In November 2017 and November 2018, NKF convened multi-stakeholder groups of patients, clinicians, researchers, health payers, policy makers and representatives from dialysis equipment and provider companies to discuss the benefits and challenges of home dialysis. The primary goals of this ongoing initiative are to facilitate the development of research designs that measure home dialysis quality and evaluate interventions to address the barriers to maintaining dialysis treatment at home. The findings from this two-year project will inform the development of a cross-organizational collaboration on a home dialysis quality improvement initiative headed by KDOQI leadership. A web-based information and advocacy hub will be created for patient-centered home dialysis quality improvement efforts, with a focus on connecting patients to relevant research and opportunities to engage in such projects. NKF's extensive patient and provider network will be used to connect researchers and interested patients, and to create and publicize educational resources for home dialysis patients relating to participating in and understanding research.
KDOQI Guideline Development Timeline
KDOQI continually updates a selection of its original clinical practice guidelines. Updates are initiated when enough new evidence becomes available of high enough quality to change current recommendations, e.g. a recommended intervention causes previously unknown substantial harm, a new intervention is significantly superior to a previously recommended intervention, or a recommendation can be applied to a new population.