The early identification of renal patients and their referral andmanagement in a nephrology unit permits: establishing a specific treatment, preserving the maximum renal function

The prevalence of chronic renal insufficiency (CRI) is increasing due to the greater longevity of the population and the ability to treat nephropathies. It has been estimated that 13% of the Spanish population suffer from some degree of renal infection, a certain percentage of which will progress until they require renal replacement therapy (RRT). Every year there is a linear increase in the incidence and prevalence of patients who require this therapy. The age and the time patients remain in the dialysis programme have also increased. An estimated 89% of the patients who start RRT use haemodialysis (HD), compared with 10% who enter a peritoneal dialysis programme and 1% who receive a preventive kidney transplant. Thus, the need to create, maintain and repair vascular accesses (VA) is also increasing, by approximately 10% every year. In many cases, it is possible to foresee the need for haemodialysis and plan a VA in advance for this to mature and even be repaired and reconstructed if necessary, by monitoring patients with CRI. This is an important objective, as it is estimated that currently almost 50% of the patients who start haemodialysis reach the unit late and require a temporary catheter as the VA is not mature. This leads to greater morbidity and mortality, a higher failure rate of VA and the patients’ perception of a lower quality of life. It is important, then, to try to guarantee the availability of a functioning VA in subsidiary HD treatment patients. This requires multidisciplinary management, with close collaboration between primary care physicians, nephrologists, vascular surgeons, radiologists and nursing staff.