One of the primary challenges in hemodialysis (HD) has historically been the availability of reliable vascular access. The introduction of the Cimino-Brescia fistula significantly improved outcomes, followed by the use of prosthetic arteriovenous grafts (AVGs) and central venous catheters (CVCs), which expanded the options for dialysis patients. Despite these advancements, the native arteriovenous fistula remains the preferred choice due to the higher infection and thrombosis rates associated with AVGs and CVCs. Enhanced HD techniques and improved comorbidity management have increased patient longevity. Similarly, advances in peritoneal dialysis (PD) have minimized therapy-related complications, making PD a viable long-term treatment for end-stage renal disease (ESRD), with survival rates comparable to in-center HD. However, cardiovascular events remain the leading cause of mortality in both treatment modalities. Recent developments in infection control have reduced the incidence of PD-related peritonitis.