Renal Replacement Therapy (RRT) is an extraordinarily expensive & complicated process – keeping people in ESRF alive & healthy over the long term (years to decades). Dialysis access – Fistulas, Vascaths & PD catheters – are an integral to RRT & responsible for a large part of its costs & hospitalisations. Hence, to achieve optimal patient outcomes cost effectively in planning, creating & maintaining Dialysis Access, sophisticated, well run Dialysis Access Systems are needed. Dialysis Access for a patient in ESRF needs to be individualised to the patient & integrated in sequence & in time. The key components of an effective Dialysis Access System are: 1. A system that bridges care in time (life-long RRT) & in space (at home, at work, in clinic, in hospital) 2. A team 3. Resources to deliver the care: Imaging, Endovascular & Open Surgery, Dialysis Units, Clinics, “Dialysis” Ward & Home Support. Dialysis Access Team: There are many different systems & contexts. However, integral to all are the following players: 1. A Nephrologist with an interest in RRT!!! (Team Leader) 2. An Access Surgeon with an interest in RRT & the following skills: Ultrasound, Open Surgery, Endovascular Surgery, PD skills & Understanding of HD/PD. 3. A Dialysis Access Co-Ordinator. The Critical Position in the Integrated Dialysis Access Team. Responsible for facilitating the individual patients journey thru the RRT system, including PD catheter placement, training & troubleshooting, Fistula planning, creation, Home HD training & troubleshooting. All this in close liaison with the Transplant Team & the Medical Therapy Team. 4. Specialised Dialysis Access Nurses, with skills in PD & HD management. Both at Hospital, Dialysis Unit & Home Care levels.