EBPG on Vascular Access

Extract

1. Patient referral

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Rationale

Early referral of CKD patients to the nephrologist and/or vascular surgeon is strongly recommended. This is to start a policy to preserve access sites and to allow adequate time for planning, creation and maturation of the vascular access. The planning stage involves examination and pre-operative vascular mapping. An autogenous fistula requires at least 6 weeks for maturation before it can be used. Additional time may be required for interventional or surgical revisions to enhance maturation. For these reasons, it is recommended that the fistula is created at least 2–3 months before the earliest likely date for starting haemodialysis. Prosthetic graft AVFs do not need a maturation period and can be cannulated 2–3 weeks after implantation. However, prosthetic graft AVFs are not recommended as primary vascular access. This approach is recommended to minimize the use of catheters and to reduce catheter-related morbidity and need for hospitalization. Early referral to the nephrologist is also required for psychological preparation for dialysis, discussion of all options for dialysis modality, interventions to delay progression of renal damage and to correct the hypertension, anaemia and metabolic effects of renal failure [1–5].