The incidence and population of end stage renal failure patients are expanding in Asia Pacific countries and worldwide. Majority of the renal failure patients rely on a dialysis access to maintain their survival. Thus the dialysis access is the “life-line” of these patients. This created life-line being subject to various challenges day in and day out. A good or bad dialysis access service make huge difference to the survival, quality of life of renal failure patients as well as significant impact to the healthcare system. Dialysis access requires unique and specialized knowledge, clinical decision pathway, surveillance strategy, surgical and intervention skillset. Yet the teaching and training in all these aspects are long being neglected or undermined. Holistic care for dialysis dependent renal failure patients requires knowledge and skillsets beyond the scope of any of the conventional clinical specialties.