A review of the current recommendations and practices for hemodialysis access monitoring and maintenance procedures.
This review summarizes current recommendations and practices for hemodialysis arteriovenous access monitoring and maintenance, noting that the 2019 KDOQI guidelines de-emphasized routine surveillance in favor of clinical monitoring and dialysis adequacy assessment.
Background
The growing number of prevalent arteriovenous accesses has been associated with an increase in procedures performed to maintain patency. Vascular access dysfunction, particularly stenosis and thrombosis, remains a leading cause of morbidity, repeated interventions, and access failure in hemodialysis patients.
Key recommendations
The review outlines current arteriovenous access monitoring and maintenance recommendations as described by the Centers for Medicare and Medicaid Services and the 2019 KDOQI guidelines. The 2019 KDOQI update addended its surveillance recommendations to rely on clinical monitoring and assessment of dialysis adequacy alone, with abnormal clinical findings prompting follow-up angiography with or without confirmatory duplex ultrasound. Increased surveillance schedules have been proposed to identify stenosis early and potentially prevent acute thrombotic events and access failure.
Clinical implications
The authors aim to reduce unnecessary procedures while preserving access patency, and highlight findings from recently published randomized controlled trials examining increased surveillance schedules. The evidence base for routine instrument-based surveillance remains limited, so structured clinical monitoring stays central to access maintenance.
Category
Guidelines
Source
Semin Vasc Surg
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