The Comprehensive Dialysis Access Center

In most freestanding practices and in virtually all academic and large urban settings, creation of dialysis access is lumped in with the team’s general practice, usually vascular surgery or transplantation. In neither field is access creation considered “sexy.” It us usually relegated to junior staff and late operating room times, and in addition to poor patient care the trainees pick up this attitude, creating what Ingemar Davidson has called the “cycle of shame” in dialysis access training. We put forth the concept that provision and maintenance of dialysis access is perhaps the perfect arena in which truly multidisciplinary care is best for the patient (and providers). We have called this concept the Comprehensive Dialysis Access Center, or CDAC, and feel this is the ideal situation to provide truly longitudinal care with high efficiency. We propose five factors that, in general, are critical for such a center: In addition, we suggest that participation in clinical trials, educational activity, community outreach, scholarship, and teaching (including nationally on this topic itself) are important things to consider to fully embrace this concept. This concept works well in an HOPD environment, as well as in an ASC or OBL with appropriate surgical partners. Creation of a CDAC in an academic or large tertiary care hospital is more problematic, but can be successful, we feel, if the element of short-term internal competition can be solved.