Basis for Proposed KDOQI Guidelines Recommendation on Physical Examination
The 2019 proposed National Kidney Foundation’s (NKF) Kidney Disease Outcomes Quality Initiative (KDOQI) recommends a regular physical examination by a knowledgeable and experienced health practitioner to detect flow dysfunction. The proposed Guidelines cite five references to support their position.1-5 Asif’s 2005 reference “Accuracy of physical examination in the detection of arteriovenous fistula stenosis” from the Miller School of Medicine at the University of Miami was referenced several times. Two other studies3-4 also originated at that same institution. All four studies1-4 cited the use of interventionalists, interventionalist fellows, or physicians trained in vascular access physical examinations to monitor for and detect AV-access flow dysfunction.
None of the references evaluated the physical examination skills of Nephrology Patient Care Technicians (PCTs), the persons who, in the US, are most frequently charged with cannulation of the access and care of the patients. The guidelines recommendation came from the experience and physical examination skills of highly trained physicians rather than those at the forefront of hemodialysis process of care, who see and care for their dialysis patients on a daily and weekly basis.
Can this recommendation, therefore, be feasible for PCTs, nephrology trainees, and nurses, who, in practice, would be the ones conducting the physical exam?