Many reports have recently highlighted that nephrologists can safely and successfully perform hemodialysis-access-related procedures. Because of their unique clinical perspective on dialysis access and better understanding of the intricacies of renal replacement therapy, nephrologists are ideally suited for this activity. This approach has minimized delays, decreased hospitalizations, and decreased the use of temporary catheters, thereby improving medical care, decreasing costs, and increasing patient convenience. In addition to the procedures, these specialists have focused on the delivery of vascular access education. Invasive interventions commonly employed by nephrologists include vascular access education, vascular mapping, percutaneous balloon angioplasty, thrombectomy, intravascular coil and stent insertion, and tunneled hemodialysis catheter-related procedures. While the performance of these procedures by nephrologists offers many advantages, appropriate training to develop the necessary procedural skills is critical. Recent data have emphasized that a nephrologist can be successfully trained to become a competent interventionalist. In addition to documenting excellent outcome data, multiple reports have demonstrated the safety and success of the interventional nephrology approach. The American Society of Diagnostic and Interventional Nephrology (ASDIN), whose mission includes training, quality assurance, and certification, has published guidelines for training in nephrology-related procedures and has begun certifying physicians in specific procedures related to chronic kidney disease. This chapter will familiarize readers with a variety of dialysis-access-related procedures performed by nephrologists.
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