The Dialysis Journey: Why Comprehensive Care is Crucial for Access

Dialysis access isn’t just about “getting a fistula made.” It’s an ongoing process — and anyone who has lived with chronic kidney disease (CKD) or cared for someone on dialysis knows exactly what I mean.

The reality is: dialysis access is a journey, and like any journey, it needs long-term planning, regular upkeep, and a guide who knows what lies ahead.

Let me share a recent example. A middle-aged gentleman with CKD came to me with a fistula that wasn’t working well. The vein was irregular and showing signs of narrowing. A balloon angioplasty could possibly fix it — but the problem was deeper. This was not his first fistula, and his arm veins were already partially exhausted. If the angioplasty didn’t work, he’d need a new access, possibly using a deeper vein or even another limb.

That’s when it hit me again — how important it is to have a comprehensive access strategy from day one.

What exactly is “comprehensive dialysis access care”?

It means thinking beyond just one procedure. It means having someone who can:

- Do the initial mapping and fistula creation

- Handle balloon angioplasty or stenting if needed

- Salvage or reconstruct a failing access

- Place a dialysis catheter (perm-cath) when required

- Plan the next best step when the current access isn’t viable

But here’s what often happens instead: Patients get shuffled from one specialist to another — one doctor creates the fistula, another only does angioplasty, someone else is called in for complex or redo surgeries, and a completely different team handles catheter insertions. Each person may be good at their part, but the patient is left coordinating it all, often without a clear roadmap.

This approach can be confusing, expensive, and honestly, overwhelming for most families.

This is where a vascular surgeon comes in.

Vascular surgeons are trained in both open and endovascular techniques, which means they can offer a full range of solutions. Whether it’s a first-time fistula, a salvage procedure, or a catheter placement — they handle it in a single framework, often under one roof.

Why does this matter?

1. simpler for the patient. You don’t have to run pillar to post. You get a unified plan, and one team following through.

2. cost-effective. Multiple referrals, repeat tests, and coordination delays add up — financially and emotionally. A comprehensive approach saves resources in the long run.

3. better outcomes. When one specialist is overseeing the whole access journey, things are more streamlined. Failures are anticipated early, and salvage is done timely.

Dialysis is tough enough on the body. Your access care shouldn’t be another battle.

If you or your loved one is on dialysis, consider consulting a vascular surgeon early — not just when things go wrong, but to plan ahead. The right access, maintained the right way, can make all the difference in quality of life.

Because in dialysis, access is life — and it deserves nothing less than complete care.

The Vascular Society of India is currently running a Vascular Awareness Campaign to help people recognize the importance of reaching the right specialist in time. Initiatives like these aim to reduce delays in care and promote better outcomes for patients across the country.

Dr. Ashutosh Kumar Pandey

M.S, M.Ch

Chief consultant and Head of Vascular and Endovascular sciences

TENDER PALM HOSPITAL LUCKNOW