Should nephrologists be in charge?

Area of Science:

• Nephrology
• Vascular Surgery
• Radiology

Background:

• Historically, nephrologists initiated vascular access (VA) for hemodialysis, but creation shifted to surgeons.
• Interventional procedures like angioplasty are now primarily done by radiologists.
• The year 2005 marked a need to redefine the nephrologist's comprehensive role in VA care.

Purpose of the Study:

• To identify the evolving role of nephrologists in comprehensive vascular access care.
• To emphasize the importance of early referral and nephrologist-led surveillance for hemodialysis access.
• To advocate for interdisciplinary collaboration in vascular access management.

Main Methods:

• Review of historical contributions to vascular access creation.
• Discussion of current practices in vascular access management involving multiple specialties.
• Emphasis on the nephrologist's role in clinical examination and ultrasound Doppler evaluation.
• Highlighting the need for surveillance and monitoring by nephrology teams.

Main Results:

• Early referral to nephrologists and access surgeons is crucial for preserving venous vasculature.
• Nephrologists play a key role in pre-creation assessment, preferring native arteriovenous fistulae.
• Nephrologists are essential for surveillance, early dysfunction diagnosis, and preventing thrombosis.
• Interdisciplinary agreement on strategies and regular assessment of surgical skills are needed.

Conclusions:

• Nephrologists must reclaim responsibility for comprehensive vascular access care, including planning and surveillance.
• Collaboration between nephrology, surgery, and radiology is vital for optimal vascular access outcomes.
• New organizational structures and educational programs are necessary for effective vascular access management.