Personalized decision-making for vascular access creation in hemodialysis.

Abstract

Selecting the appropriate kidney replacement therapy (KRT) is crucial in order to secure optimal care for chronic kidney disease (CKD) patients with end-stage renal disease (ESRD). Next to renal transplantation, the choice of dialysis modality directly affects patient well-being, treatment effectiveness, and long-term outcomes. Therefore, clinical decision-making must take into account a range of factors to tailor decisions to each patient's unique needs. Previously, when the dialysis population was less diverse and resources more limited, straight-forward algorithms could be effectively implemented both for selection of KRT as well as for hemodialysis (HD) vascular access (VA). Recently, the growing ESRD population with more elderly being considered for dialysis care together with improved treatment opportunities have resulted in more challenging decision-making where on-size-fits-all strategies are being replaced by more tailored and personalized strategies aimed to ensure "the right dialysis access - to the right patient - at the right time - for the right reason." In this review, recent trends enforcing a more personalized approach in the selection of VA for HD are summarized and discussed, where these concerns have become especially relevant.