Principles of renal access surgery

The treatment of end stage renal failure is renal replacement therapy. This may be by dialysis (blood or peritoneal) or by kidney transplantation. The outlook for those who have a successful renal transplant has improved massively over the past 20 years with graft survival of a mean of 14 years from non-heart beating donation and 18 years for live donated transplant.Unfortunately the number of renal transplants fails to meet the demand from patients on the transplant waiting list. The shortfall has to be managed by dialysis. The life expectancy of a patient on haemodialysis is a fifth to a quarter of that of age-matched healthy population, but doubles following successful transplantation.To provide blood or peritoneal dialysis, patients require a portal of access to the circulation or the peritoneum. This patient group requires timely and well-planned renal access surgery. Their access is their lifeline and failure of access coupled with the need for emergency admission is a major cause of morbidity and mortality.