Hemodialysis access in 2026: What the vascular medicine provider should know

Hemodialysis is the primary renal replacement therapy in the US for patients with end-stage kidney disease (ESKD). Functioning vascular access, in the form of an arteriovenous fistula (AVF) or graft (AVG), is fundamental to the outcomes for these patients. Over the last decade, changes have occurred in the field of vascular access. Evolving guidelines have placed unprecedented emphasis on individualized access, and rapid innovation—particularly in endovascular technologies—has expanded the toolkit for access creation and maintenance. This narrative review offers vascular medicine providers an in-depth evaluation of contemporary practice relating to hemodialysis access, including a comprehensive review of emerging technologies expected to shape the future of hemodialysis care.