Background <p>Ongoing changes in healthcare are expected to significantly reshape the hospital landscape in the coming years. Within this context and in order to respond appropriately, an up-to-date assessment of the structural and process quality of dialysis access care is essential.</p> Methods <p>Between April and July 2024, 160 German inpatient nephrology departments were invited to participate in an anonymous online survey. Data were analysed descriptively.</p> Results <p>A total of 64 hospitals responded (response rate: 40%). Of these, 23% (<i>n</i> = 15) were university hospitals, 45% (<i>n</i> = 29) were tertiary care providers, and 32% (<i>n</i> = 20) were primary (<i>n</i> = 1) or secondary care hospitals (<i>n</i> = 19). 19% (<i>n</i> = 12) were certified as a dialysis access centre. Availability of dialysis access surgery like arteriovenous fistulas (AVF), tunnelled-haemodialysis catheters (tHDC), and peritoneal dialysis (PD) catheters procedures was generally rated as good, with 80% performed in an inpatient setting. Satisfaction with access to AVF interventions trends to decrease with increasing hospital size. Overall, 58% of respondents favoured greater nephrology involvement, particularly in tHDC placement (92%), PD catheter placement (36%), and AVF procedures (44%). Nevertheless, only 25% reported planning to expand nephrological interventions. Key barriers included limited hands-on experience, lack of structured training curricula, inadequate infrastructure, and interdepartmental competition. Economic pressure and the shift toward outpatient care were cited as additional challenges.</p> Conclusions <p>Most hospital nephrologists are satisfied with the service and timely availability of dialysis access surgery or interventions. While there is a strong desire to increase nephrological involvement, only a few hospitals plan to expand these services. Standardized training programs are needed to strengthen the field of interventional nephrology.</p>