Vascular access-related procedures commonly performed by nephrologists include percutaneous balloon angioplasty, intravascular coil and stent insertion, thrombectomy, vascular mapping and tunneled hemodialysis catheter-related procedures. In addition, using vein obliteration and percutaneous balloon angioplasty techniques, nephrologists have recently documented successful salvage of arteriovenous fistulas that had failed to mature, whereas traditionally these fistulas have frequently been abandoned. While the performance of these procedures by nephrologists offers many advantages, appropriate training in order to develop the necessary procedural skills is critical. Recent data have emphasized that a nephrologist can be successfully trained to become a competent interventionalist. In addition to documenting excellent outcome data, multiple reports have demonstrated the safety and success of interventional nephrology. This report focuses on hemodialysis access-related procedures performed by nephrologists and calls for a proactive approach in optimizing this aspect of patient care.