In the early 1990, several studies suggested improved outcome with the use of algorithms for treating various disease processes. This standardization, driven in part by managed care organizations, outcome analyses, and cost-cutting efforts, prompted further analysis of the care provided to patients with end-stage renal disease. In 1994, the National Kidney Foundation began a massive program designed to improve Dialysis Outcome Quality Initiative Clinical Practice Guidelines for Vascular Access.The outcome in patients with end-stage renal disease. The process culminated in 1997 with the publication of the practice recommendations known as the DOQI Guidelines. The objectives of the consensus statement were to improve patient survival, increase the efficiency of care, reduce morbidity, and improve quality of life for dialysis patients. An update of the DOQI Guidelines was published in 2000. The DOQI Vascular Access Work group (DOQI Work Group) that authored the guidelines was composed of a multidisciplinary team that formally reviewed nearly 3,500 vascular access-related auricles. The team evaluated the credibility of these publications and used the best available evidence in the literature to develop the clinical practice guidelines. Where evidence was not available, the guidelines were based on the opinion of the Work Group. For each guideline, there was a clear indication of whether the guideline was based on evidence, opinion, or both.