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Anil Agarwal

The incidence of ESRD is increasing, with a current prevalence of over half a million patients in the United States. Most ESRD patients are treated with hemodialysis (HD) and the number of patients receiving peritoneal dialysis (PD) has steadily declined over the past several decades. According to the U.S. Renal Data System 2011 annual report, approximately 7 percent of patients were being treated with PD at the end of 2009, reflecting gross underuse of this form of therapy (1). Of the incident patients, dialysis was initiated using PD in only 6.1 percent.

The growth in the number of

Anil Agarwal

Until a couple of decades ago, nephrology was extensively dependent for its procedural needs on other specialties, including surgery and radiology. Although nephrologists commonly performed kidney biopsies and nontunneled dialysis catheter placements, the non-nephrologists were mostly creating and maintaining arteriovenous and peritoneal dialysis (PD) accesses. With relatively minimal to modest communication, a multidisciplinary coordinated approach was lacking, leading to a fragmented approach to the care of dialysis access. Further, despite over half a century of tireless efforts to innovate, dialysis access was (and has been) an unrivaled challenge for patients with ESKD. As we long for perfection in achieving a