[Demands on dialysis access from the nephrologists point of view]

Vascular access is the lifeline of hemodialysis patients. The superiority of autogenous arteriovenous fistulas compared to prostethic arteriovenous grafts or a central venous catheter is well established. Fistulas have a far lower risk of failure and a reduced requirement for revision compared to prosthetic grafts. Alternative vascular access can be achieved via a prosthetic graft or permanent central venous catheter but the risk of infection is increased. The most important complications are shunt thrombosis, stenosis, aneurysms or steal syndrome. Signs of these complications should be recognized by the dialysis team and early surgical intervention can avoid major complications. In many cases a complex shunt is necessary if the patient has been on dialysis for a long time. Interaction between the dialysis team, nephrologists, surgeons and interventional radiologists can improve the prognosis of dialysis patient.