In Germany approximately 70,000 patients with a renal insufficiency are treated by hemodialysis. The most frequent reasons for the need for dialysis are currently diabetic nephropathy and nephrosclerosis. Due to the increasing average age and the resulting multimorbidity of dialysis patients, the difficulties of medical care have also increased. Therefore, an interdisciplinary treatment of these patients is of great importance. An important point in the treatment is the choice of vascular access. This depends on the patient's concomitant diseases and on the urgency of hemodialysis. Vascular access is a prerequisite for dialysis and thus for the survival of the patient. A well-functioning dialysis access not only ensures the patient's survival but it is also important for the quality of life. The surgeon's task is therefore to create the optimal vascular access at the right time together with the treating nephrologist.