A review of the current recommendations and practices for hemodialysis access monitoring and maintenance procedures

Semin Vasc Surg. 2024 Jun;37(2):133-149. doi: 10.1053/j.semvascsurg.2024.04.007. Epub 2024 May 1.

Abstract

The growing number of prevalent arteriovenous (AV) accesses has been associated with an increase in the incidence of procedures being performed to maintain patency. To reduce the rate of unnecessary procedures, the 2019 Kidney Disease Outcome Quality Initiative guidelines addended the AV access surveillance recommendations, which includes clinical monitoring and assessment of dialysis adequacy alone. Abnormal clinical findings would necessitate follow-up angiography with or without confirmatory duplex ultrasound. Due to poor patency, increased surveillance schedules have been proposed to identify stenosis early and potentially prevent acute thrombotic events and AV access failure. In this review, we outlined current AV access monitoring and maintenance procedure recommendations, as described by the Centers for Medicare and Medicaid Services and 2019 Kidney Disease Outcome Quality Initiative guidelines. In addition, we highlight the findings of recently published randomized controlled trials that have examined increased surveillance schedules.

Keywords: AVF; AVG; Clinical monitoring; KDOQI guidelines; Surveillance.

Publication types

  • Review

MeSH terms

  • Arteriovenous Shunt, Surgical* / adverse effects
  • Arteriovenous Shunt, Surgical* / standards
  • Graft Occlusion, Vascular* / diagnostic imaging
  • Graft Occlusion, Vascular* / etiology
  • Graft Occlusion, Vascular* / therapy
  • Humans
  • Practice Guidelines as Topic* / standards
  • Predictive Value of Tests
  • Renal Dialysis* / standards
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Vascular Patency*