Organizational structures of dialysis access care and the role of interventional nephrology: a Germany-wide survey

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. Between April and July 2024, 160 German inpatient nephrology departments were invited to participate in an anonymous online survey. Data were analysed descriptively. A total of 64 hospitals responded (response rate: 40%). Of these, 23% (n = 15) were university hospitals, 45% (n = 29) were tertiary care providers, and 32% (n = 20) were primary (n = 1) or secondary care hospitals (n = 19). 19% (n = 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. 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.