Adherence to KDOQI vessel preservation guidelines in chronic kidney disease: A 5-year retrospective single-institution review of device and vein selection.

Preservation of upper extremity vasculature in patients with chronic kidney disease (CKD) and end-stage kidney disease (ESKD) is essential to maintain future arteriovenous fistula (AVF) creation options. Despite Kidney Disease Outcomes Quality Initiative (KDOQI) recommendations, inappropriate device and vein selection persists. This study evaluated adherence to KDOQI vessel preservation guidelines over a 5-year period at a single academic institution. A total of 3505 patients underwent placement of peripherally inserted central catheters (PICCs), centrally inserted central catheters (CICCs), femorally inserted central catheters (FICCs), acute dialysis catheters with venous ports (ADCwVPs), or centrally inserted tunneled catheters (CITCs) between January 2020 and January 2025, including 1433 PICCs, 1574 CICC/FICC/ADCwVP devices, and 498 CITCs. Nephrology consultation was obtained in 1464 patients (41.8%), of whom 647 (44.2%) had CKD stage 3b-ESKD. KDOQI compliance was achieved in 585 patients (90.4%); 62 patients (9.6%) were non-compliant, including 33 PICCs, 9 CICC/FICC/ADCwVPs, and 20 CITCs. Sensitivity analysis identified 22.6% (14/62) of non-compliant cases as clinically unavoidable, yielding an adjusted avoidable non-compliance rate of 7.4%. Axillary and femoral vein utilization differed significantly between renal cohorts (p < 0.001). Twenty-five CRBSIs were identified: 13 in patients without nephrology consultation and 12 within the consultation subgroup (6 CICC/FICC/ADCwVP, 5 CITC, 1 PICC); patients with renal impairment accounted for 48% of all CRBSIs. Two-year follow-up of 33 PICC recipients with CKD stage 3b-ESKD showed progression to hemodialysis in four patients, mortality in 13, and one case of upper extremity DVT managed with anticoagulation, with removal of the PICC and placement of a CITC. A multidisciplinary bedside vascular access model achieved high adherence to KDOQI vessel preservation recommendations while maintaining low complication rates. Strategic device and vein selection may support safe vascular access management in patients with advanced kidney disease, though downstream outcomes such as AVF creation and central venous stenosis were not directly assessed.