Foreword

Healthcare management is inherently complex[1]. End Stage Renal Disease (ESRD) is no exception. ESRD being more contained lends itself to be studied due to the smaller number of affected individuals receiving dialysis. In addition, dialysis patients are seen frequently by healthcare professionals—typically three times per week for hemodialysis in specialized units, allowing closer monitoring and data collection[2-5]. The practice patterns are continuously changing, most dramatically shown in the turned around in the DOOQI guidelines[3-6]. ESRD can be studied and documented in greater depth.

The United States Renal Data System (USRDS) publishes comprehensive global data on ESRD management and outcomes reporting major variation across regions and countries regarding the selection and application of Renal Replacement Therapy (RRT) including renal transplantation[6]. This publication uses Structured Analytic Techniques to define Intelligent ESRD RRT options[7]. These tools facilitate systematic evaluation of the many factors contributing to the diverse approaches observed in clinical practice. While cognitive intuition is often effective, it is also a source of bias and errors stemming from faulty assumptions.

Throughout the text, we highlight regional variations frequently influenced by personal, institutional, or cultural preferences which can be broadly termed as "intuition." This thinking is fast, efficient, often unconscious, and shaped by personal experience and local context. In contrast, a more effective decision-making process involves deliberate, analytical thinking[7]. This slower, more methodical approach relies on collaborative reasoning, source validation, evidence-based tools, and forward-looking planning grounded in expert generated data[8].

For example, intuitively protecting the non-dominant limb or arm for future fistula formation is an erroneous strategy as this may protect the limb that does not contain vessels suitable for an AVF creation or graft placement. Throughout the chapters we will revisit these concepts particularly as they relate to ESRD analysis and therapeutic choices as innovation is driving progress. This publication was developed with no external influence or directives. Each chapter has been reviewed by the contributors and has undergone extensive editing.

Through linking, we aim to make this work a dynamic, accessible resource for all healthcare professionals involved in ESRD care. It will be updated with extended materials as they become available. A recent development defined as minimal Invasive dialysis access was recently reviewed[9-13].(13)

The Editor
Ingemar Davidson, MD, PhD, FACS Dallas, Texas www.KidneyAcademy.com

These references have been selected in the attempt to be non-biased, an impossible task. To compensate, we have added an expanded list of 512 references covering all aspects of native vein AVF (Document 4). (Courtesy of Dr. G Beathard).

  1. Slakey D. The Process Manifesto. Improving Healthcare in a Complex World.2023, ISBN 979-8-9892576-1-
  2. Davidson I, Gallieni M, Saxena R et al. Patient-Centered Decision-Making Dialysis Access Algorithm. J Vasc Access, 2007; 8: 59-68. (Document 8)
  3. Lok CH, Davidson. Optimal choice of dialysis access for chronic kidney disease patients: developing a life plan for dialysis access. Semin Nephrol. 2012;32(6):530-537.
  4. Lok CH, Huber KDOQI Clinical Practice Guideline for Vascular Access: 2019. IM J Kidney Dis. 2020;75(4),1-164.
  5. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: Evaluation, classification and stratification. Kidney disease outcome quality initiative. Am J Kidney Dis 2002; 39; S1-246.
  6. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: Evaluation, classification and stratification. Kidney disease outcome quality initiative. Am J Kidney Ds 2002; 39 S1-246.
  7. United States Renal Data System. 2024 USRDS Annual Data Report: Epidemiology of kidney disease. National Institutes of Health.
  8. Pherson RH, Heuer JR. RJ. Structured Analytic Techniques for Intelligent Analysis. 2016. ISBN:978-1-5063-16888.
  9. Swinnen JJ, Baker L, Burgess D, et al. Changing the peritoneal dialysis access algorithm with a precise technique of percutaneous Seldinger PD catheter placement. J Vasc Access. 2022;23(4):615–622.
  10. Swinnen J, Davidson I, Baker L, et al. Modified Seldinger peritoneal dialysis catheter insertion: a game changer in renal replacement therapy. Endovascular Today. 2022; 21:54.
  11. Liew NC, Chew S, Swinnen J et al. Minimally Invasive Dialysis Access. 2025, JVA. In press (Document 13).

Contributors to Chapter 1 on Arteriovenous Fistulae (AVF)

NC Liew. MD. University Putra Malaysia, Serdang, Selangor, Malaysia
J Swinnen. Prince of Wales Hospital, Sydney, NSW, Australia
T Litchfield. President of Access Solutions. Milwaukee, WS
M Gallieni, MD Professor. Editor, the Journal of Vascular Access, Milan, Italy
N Inston, MD, PhD. Surgeon, Birmingham, UK
M Ali Sheta, MD, FASN, FASDIN. Houston Kidney Specialists. Houston TX
G Beathard, MD. Clinical Professor, University of Texas, Galveston, TX
D Slakey, MD, PhD. Belmont University Frist College of Medicine, Nashville, TN
J Ross, MD, Dialysis Surgeon, South Carolina
A Kramer, MD, Dialysis Surgeon, South Carolina
T Wykoff, BS, MS, Founder Ren Consulting, Boulder, CO
U Hahn-Lundstrom, MD, PhD. Professor Int. Medicine, Karolinska Institute, Stockholm Sweden
U Hedin, MD, PhD. Professor of Surgery, Karolinska Institute, Stockholm Sweden
T Davis, General Glyphics, Inc. Dallas TX
S White, ScreenPlay Productions, Dallas TX

Learning Objectives. Currently we are not offering CME.  The content and quality meet or exceed CME criteria. After reading this AVF chapter you will be able to:

  • Identify patient and vascular criteria selection for a native vein AV fistula 
  • Appreciate atraumatic surgical technique
  • Name the three principal types of arteriovenous fistulae
  • Discuss the time duration for arteriovenous fistula maturation.
  • Appreciate the importance of ultrasound vascular mapping
  • Understand pathology and treatment of early fistula failure
  • Describe late AVF fistula failure and treatment options
  • List the common AVF complications and managements
  • The implications of “secondary fistula” for vascular access planning

One hundred pre-study multiple choice test questions are linked (PRE and POST study testing)  (Document 5 and Document 6).  

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