18-04-16 So Whats New: The Outline Preliminary Update of the KDOQI - PDF document

18-04-16 So What’s New: The Outline Preliminary Update of the KDOQI Vascular • The Process Access Guidelines o Building blocks and development over time 2018 o Timelines • Who’s involved • Where we’re at and next steps Charmaine Lok, MD • What it looks like Professor of Medicine, University of Toronto • The Statements UCSF Vascular Symposium 2018 • The Concepts April 19, 2018 San Francisco The Process Timelines Internal Review Evidence Review Team (ERT) Older Guidelines Literature Data Retrieval & Quality of review Analysis Evidence External Review Scope of Interpretation & Strength of Review & Work Clinical relevance Recommendation Synthesis Implementation Great necessary foundation KDOQI Workgroup ERT Data ERT has high standards! 1

18-04-16 KDOQI “Statement” New Concepts OUR PATIENTS 4 Kinds: “KDOQI recommends ” Based on ERT extracted data, meeting their ESRD “KDOQI suggests ” search, extraction and analysis criteria “There is inadequate evidence … ” “In the opinion of the KDOQI Workgroup … ” Data available in the literature but did not meet ERT criteria, retrieved by workgroup and extensively discussed Photos taken with consent, permission to share given Recommendation for Vascular Access ESKD Life-Plan for Hemodialysis – Looks the Same?? RRT RRT RRT Modality Modality Modality HD PD HD Transplant Stages: I II III IV V (HD/PD/ (HD/PD/ (HD/PD/ Transplant) Transplant) Transplant) Remember: CKD is a continuum ESKD is part of the CKD continuum Within ESKD, a patient is anticipated to have a continuum of therapies to help optimize their life - their ESKD Life-Plan Our Approach New Philosophy • Focus on a “Life-Plan” for a Patient’s Dialysis Access Needs RIGHT ACCESS RIGHT PATIENT Example only: 4 Nocturnal 1 2 3 RIGHT TIME HD: Home PD Transplant Fistula HD: Graft RIGHT REASONS 2

18-04-16 How?.....P-L-A-N How?.....P-L-A-N ? • • • P atient P atient P atient ? • • • L ife-Plan L ife-Plan L ife-Plan • • • A ccess A ccess A ccess Patient First What is the Patient’s • • • N eeds N eeds N eeds ESKD Life-Plan? How?.....P-L-A-N How?.....P-L-A-N • • A ccess A ccess • • N eeds N eeds What is the Patient’s What is the Patient’s Access Creation Plan Access Contingency Plan What access, where, when, by whom? What are the remedial measures when the access becomes problematic? How?.....P-L-A-N How?.....P-L-A-N • ü A ccess P atient • ü N eeds L ife-Plan ü A ccess What is the Patient’s Access Succession Plan ü N eeds What access is next when the current one fails? 3

18-04-16 Workgroup Members Evidence Review Team • Interventional • Nephrology o Ken Abreo o Michael Allon • Timothy J. Wilt, MD, MPH o Arif Asif o Timmy Lee • Nancy Greer, PhD o Dheeraj Rajan o Charmaine Lok Nephrology • Michelle Brasure, PhD, MSPH o Tushar Vaccharajani o Louise Moist • Areef Ishani, MD, M.C.R. o Alex Yevzlin Allied Health • Allied Health & Epi • Yelena Slinin, MD, M.Sc. o Brad Astor o Janet Graham Workgroup o Cindy Roberts Minnesota Evidence Review Team: Minneapolis VA Health Care System Interventional Surgery University of Minnesota Schools of Medicine • Surgery Epidemiology • Pediatric University of Minnesota School of Public Health & Statistics Nephrology o Marc Glickman o Thomas Huber o Rudy Valentini o Suren Shenoy THANK YOU FOR YOUR ATTENTION 4