Division of Nephrology, Kidney C.A.R.E. (Clinical Advancement, Research and Education) Program, University of Cincinnati, Cincinnati, OH.
Interventional Nephrology, Division of Nephrology, University of Wisconsin, Madison, WI.
Adv Chronic Kidney Dis. 2020 May;27(3):183-190. doi: 10.1053/j.ackd.2020.03.004.
The vascular access is the lifeline for the hemodialysis patient. Previous national vascular access guidelines have emphasized placement of arteriovenous fistulas in most hemodialysis patients. However, the new Kidney Disease Outcomes Quality Initiative guidelines for vascular access, soon to be published, will focus on a patient's end-stage kidney disease "life plan" and take a patient "first" approach. One of the major themes of the new Kidney Disease Outcomes Quality Initiative guidelines is selecting the "right access, for the right patient, at the right time, for the right reason". Given the availability of new advances in biomedical technologies, techniques, and devices in the vascular access field, this shift to a more patient-centered vascular access approach presents unique opportunities to individualize the solutions and care for patients requiring a dialysis vascular access. This review article will address 3 potential areas where there is an unmet need to individualize solutions for dialysis vascular access care: (1) biological approaches to improve vascular access selection and selection of therapies, (2) vascular access care for the post-transplant patient, and (3) vascular access disparities in race, gender, and the elderly patient.
血管通路是血液透析患者的生命线。以往的国家血管通路指南强调在大多数血液透析患者中放置动静脉瘘。然而，即将发布的新肾脏病预后质量倡议血管通路指南将关注患者的终末期肾脏病“生活计划”，并采取“以患者为中心”的方法。新肾脏病预后质量倡议指南的主要主题之一是为“合适的患者，在合适的时间，出于合适的原因”选择“合适的通路”。鉴于血管通路领域的生物医学技术、技术和设备的新进展，这种向更加以患者为中心的血管通路方法的转变为需要透析血管通路的患者提供了个性化解决方案和护理的独特机会。这篇综述文章将探讨在个性化透析血管通路护理解决方案方面存在未满足需求的 3 个潜在领域：（1）改善血管通路选择和治疗选择的生物学方法；（2）移植后患者的血管通路护理；（3）种族、性别和老年患者的血管通路差异。
