Beyond the Technical: Determining Real Indications for Vascular Access and Hemodialysis Initiation in End-Stage Renal Disease.

Determining valid indications for vascular access creation and hemodialysis initiation in end-stage renal disease requires utilization of verified prognostication tools and recognition of triggers to initiate serious conversations, and implementation of concurrent palliative care and/or hospice care is recommended. Establishment of a multi-disciplinary team that includes consideration of interventionalists in the pre-dialysis medical situation is important. A "catheter best" approach may be the most appropriate for some patients to meet goals of care.