NKF-K/DOQI Clinical Practice Guidelines for Hemodialysis Adequacy
I. Measurement of Hemodialysis Adequacy
- Guideline 1: Regular Measurement of the Delivered Dose of Hemodialysis
- Guideline 2: Method of Measurement of Delivered Dose of Hemodialysis
- Guideline 3: Uniformity of Method of Measurement
II. Hemodialysis Dose
- Guideline 4: Minimum Delivered Dose of Hemodialysis
- Guideline 5: Prescribed Dose of Hemodialysis
- Guideline 6: Frequency of Measurement of Hemodialysis Adequacy
III. Blood Urea Nitrogen (BUN) Sampling
- Guideline 7: Blood Urea Nitrogen (BUN) Sampling
- Guideline 8: Acceptable Methods for BUN Sampling
- Guideline 9: Standardization of BUN Sampling Procedure
IV. Hemodialyzer Reprocessing and Reuse
- Guideline 10: Use of the Association for the Advancement of Medical Instrumentation (AAMI) Standards and Recommended Practices for Hemodialyzer Reprocessing
- Guideline 11: Baseline Measurement of Total Cell Volume
- Guideline 12: Monitoring Total Cell Volume
- Guideline 13: Minimum Required Total Cell Volume
V. Hemodialysis Dose Troubleshooting
VI. Maximizing Patient Adherence to the Hemodialysis Prescription
- Guideline 15: Optimizing Patient Comfort and Adherence
- Guideline 16: Strategies to Minimize Hypotensive Symptoms
VII. References
VIII. Appendices
- A: RPA Guideline Ordering Information
- B: Kinetic Determination of the Urea Distribution Volume
- C: Anthropometric Determination of the Urea Distribution Volume
- D: Contribution of Residual Kidney Function on Clearance With Thrice Weekly Dialysis Therapy
- E: Detailed Error Analysis for Deficiencies in Delivered Kt/V or URR
- F: Performance of Hydraulic Compression Test During Hemodialysis
IX. Biographical Sketches of the NKF-K/DOQI Hemodialysis Adequacy Work Group Members
II. NKF-K/DOQI CLINICAL PRACTICE GUIDELINES FOR PERITONEAL DIALYSIS ADEQUACY: UPDATE 2000
I. Initiation of Dialysis
- Guideline 1: When to Initiate Dialysis Kt/Vurea Criterion
- Guideline 2: Indications for Renal Replacement Therapy
II. Measures of Peritoneal Dialysis Dose
- Guideline 3: Frequency of Delivered PD Dose and Total Solute Clearance Measurement Within Six Months of Initiation
- Guideline 4: Measures of PD Dose and Total Solute Clearance
- Guideline 5: Frequency of Measurement of Kt/Vurea, Total CCr, PNA, and Total Creatinine Appearance
- Guideline 6: Assessing Residual Kidney Function
- Guideline 7: PD Dose Troubleshooting
III. Measurement of Peritoneal Dialysis Dose
- Guideline 8: Reproducibility of Measurement
- Guideline 9: Estimating Total Body Water and Body Surface Area
- Guideline 10: Timing of Measurement
- Guideline 11: Dialysate and Urine Collections
IV. Assessment of Nutritional Status Specifically as It Relates to Peritoneal Dialysis
- Guideline 12: Assessment of Nutritional Status
- Guideline 13: Determining Fat-Free, Edema-Free Body Mass
- Guideline 14: Use of the Modified Borah Equation to Assess Nutritional Status of Pediatric PD Patients
V. Adequate Dose of Peritoneal Dialysis
- Guideline 15: Weekly Dose of CAPD
- Guideline 16: Weekly Dose of NIPD and CCPD
- Guideline 17: PD Dose in Subpopulations
- Guideline 18: Use of Empiric and Computer Modeling of PD Dose
VI. Strategies for Increasing the Likelihood of Achieving the Prescribed Dose of Peritoneal Dialysis
- Guideline 19: Identify and Correct Patient-Related Failure to Achieve Prescribed PD Dose
- Guideline 20: Identify and Correct Staff-Related Failure to Achieve Prescribed PD Dose
VII. Clinical Outcome Goals for Adequate Peritoneal Dialysis
- Guideline 21: Measurement of PD Patient Survival
- Guideline 22: Measurement of PD Technique Survival
- Guideline 23: Measurement of Hospitalizations
- Guideline 24: Measurement of Patient-Based Assessment of Quality of Life
- Guideline 25: Measurement of School Attendance, Growth, and Developmental Progress in Pediatric PD Patients
- Guideline 26: Measurement of Albumin Concentration in PD Patients
- Guideline 27: Measurement of Hemoglobin/Hematocrit in PD Patients
- Guideline 28: Measurement of Normalized PNA in PD Patients
VIII. Suitable Patients for Peritoneal Dialysis
- Guideline 29: Indications for PD
- Guideline 30: Absolute Contraindications for PD
- Guideline 31: Relative Contraindications for PD
- Guideline 32: Indications for Switching from PD to HD
IX. References
X. Appendices
- A: Detailed Rationale for Guideline 1
- B.
- C: Detailed Rationale for Guideline 6
- D: Detailed Rationale for Guideline 8
- E: Detailed Rationale for Guideline 9
- F: Detailed Rationale for Guideline 12
- G: Detailed Rationale for Guideline 15
- H: Detailed Rationale for Guideline 19
XI. Biographical Sketches of the NKF-K/DOQI Peritoneal Dialysis Adequacy Work Group Members
III. NKF-K/DOQI CLINICAL PRACTICE GUIDELINES FOR VASCULAR ACCESS: UPDATE 2000
I. Patient Evaluation Prior to Access Placement
- Guideline 1: Patient History and Physical Examination Prior to Permanent Access Selection
- Guideline 2: Diagnostic Evaluation Prior to Permanent Access Selection
- Guideline 3: Selection of Permanent Vascular Access and Order of Preference for Placement of AV Fistulae
- Guideline 4: Type and Location of Dialysis AV Graft Placement
- Guideline 5: Type and Location of Tunneled Cuffed Catheter Placement
- Guideline 6: Acute Hemodialysis Vascular Access—Noncuffed Catheters
- Guideline 7: Preservation of Veins for AV Access
- Guideline 8: Timing of Access Placement
- Guideline 9: Access Maturation
II. Monitoring, Surveillance, and Diagnostic Testing
- Guideline 10: Definition of Terms
- Guideline 11: Monitoring Primary AV Fistulae for Stenosis
- Guideline 12: Recirculation Methodology, Limits, Evaluation, and Follow-Up
III. Prevention of Complications: Infection
- Guideline 13: Infection Control Measures
- Guideline 14: Skin Preparation Technique for Permanent AV Accesses
- Guideline 15: Catheter Care and Accessing the Patients Circulation
IV. Management of Complications: When to Intervene
- Guideline 16: Managing Potential Ischemia in a Limb Bearing an AV Access
- Guideline 17: When to Intervene—Dialysis AV Grafts for Venous Stenosis, Infection, Graft Degeneration, and Pseudoaneurysm Formation
- Guideline 18: When to Intervene—Primary AV Fistulae
V. Management of Complications: Optimal Approaches for Treating Complications
- Guideline 19: Treatment of Stenosis Without Thrombosis in Dialysis AV Grafts and Primary AV Fistulae
- Guideline 20: Treatment of Central Vein Stenosis
- Guideline 21: Treatment of Thrombosis and Associated Stenosis in Dialysis AV Grafts
- Guideline 22: Treatment of Thrombosis in Primary AV Fistulae
- Guideline 23: Treatment of Tunneled Cuffed Catheter Dysfunction
- Guideline 24: Treatment of Infection of Dialysis AV Grafts
- Guideline 25: Treatment of Infection of Primary AV Fistulae
- Guideline 26: Treatment of Infection of Tunneled Cuffed Catheters
- Guideline 27: Treatment of Pseudoaneurysm of Dialysis AV Grafts
- Guideline 28: Aneurysm of Primary AV Fistulae
VI. Potential Quality of Care Standards
- Guideline 29: Goals of Access Placement—Maximizing Primary AV Fistulae
- Guideline 30: Goals of Access Placement—Use of Catheters for Chronic Dialysis
- Guideline 31: Center-Specific Thrombosis Rate
- Guideline 32: Infection Rate
- Guideline 33: Primary Access Failure Rate—AV Grafts
- Guideline 34: Primary Access Failure Rate—Tunneled Cuffed Catheters
- Guideline 35: Primary Access Failure—Native AV Fistulae
- Guideline 36: Cumulative Patency Rate of Dialysis AV Grafts
- Guideline 37: Cumulative Patency Rate of Tunneled Cuffed Catheters
- Guideline 38: Cumulative Patency Rate of Primary AV Fistulae
VIII. Biographical Sketches of the NKF-K/DOQI Vascular Access Work Group Members
IV. NKF-K/DOQI CLINICAL PRACTICE GUIDELINES FOR ANEMIA OF CHRONIC KIDNEY DISEASE: UPDATE 2000
I. Anemia Work-Up
- Guideline 1: When to Initiate the Work-Up of Anemia
- Guideline 2: Anemia Evaluation
- Guideline 3: Erythropoietin Deficiency
II. Target Hemoglobin/Hematocrit
III. Iron Support
- Guideline 5: Assessment of Iron Status
- Guideline 6: Target Iron Level
- Guideline 7: Monitoring Iron Status
- Guideline 8: Administration of Supplemental Iron
- Guideline 9: Administration of a Test Dose of IV Iron
- Guideline 10: Oral Iron Therapy
IV. Administration of Epoetin
- Guideline 11: Route of Administration of Epoetin
- Guideline 12: Initial Epoetin Administration
- Guideline 13: Switching From Intravenous to Subcutaneous Epoetin
- Guideline 14: Strategies for Initiating and Converting to Subcutaneous Epoetin Administration
- Guideline 15: Monitoring of Hemoglobin/Hematocrit During Epoetin Therapy
- Guideline 16: Titration of Epoetin Dosage
- Guideline 17: Inability to Tolerate Subcutaneous Epoetin; IV Epoetin Dose
- Guideline 18: Intraperitoneal Epoetin Administration
- Guideline 19: Epoetin Dosage Perioperatively or During Intercurrent Illness
V. Inadequate Epoetin Response
- Guideline 20: Causes for Inadequate Response to Epoetin
- Guideline 21: When to Obtain a Hematology Consultation
- Guideline 22: Epoetin-Resistant Patients
VI. Role of Red Blood Cell Transfusions
VII. Possible Adverse Effects Related to Epoetin Therapy
- Guideline 24: Possible Adverse Effects Related to Epoetin Therapy: Hypertension
- Guideline 25: Possible Adverse Effects Related to Epoetin Therapy: Seizures
- Guideline 26: Possible Adverse Effects Related to Epoetin Therapy: Increased Clotting Tendency
- Guideline 27: Possible Adverse Effects Related to Epoetin Therapy: Hyperkalemia
X. Biographical Sketches of the NKF-K/DOQI Anemia Work Group Members