Uremia is a major chronic disease, which is jokingly called the “undead cancer”. According to statistics, there are about 800,000 registered uremic patients on regular dialysis in China, including about 720,000 patients on hemodialysis. With this comes an increasing number of various related complications and increasingly prominent vascular access problems. In China, more than 90% of uremic patients rely on maintenance hemodialysis treatment to sustain their lives, usually 2-3 times a week for 4 hours each time, and hemodialysis requires long-term vascular access as a guarantee for hemodialysis, which is their “lifeline” and a guarantee for survival. Currently, the main long-term vascular accesses are autologous arteriovenous endovascular fistula, artificial vascular arteriovenous endovascular fistula, and indwelling catheter with polyester sleeve (commonly known as long-term catheter). With the prolongation of dialysis time, the vascular condition of uremic patients is getting worse and worse, and slowly the vascular resources will be depleted, and it will be difficult to establish hemodialysis vascular access and continue hemodialysis treatment, and then the life will come to an end, such tragedies happen in many hemodialysis centers. Therefore, we propose the concept of “integrated vascular access treatment” for uremic patients, with the aim of minimizing such “tragedies”, protecting vascular resources as much as possible, and prolonging the life of patients with vascular access. The core concept is to have the concept of vascular access planning and to adhere to the principle of “internal fistula first, reduce the number of tubes”. For patients with chronic kidney disease, our medical staff should establish the concept of protecting the patient’s vascular resources from the very first moment of consultation. So what should we do? First, chronic kidney disease patients try to reduce intravenous infusion, when necessary infusion treatment, try to avoid the use of indwelling needles, avoid the use of long time head vein puncture infusion, because indwelling needles or intravenous infusion has damage to the blood vessels, the head vein is the main vascular resources to establish long-term vascular access in the future, to focus on protecting, when necessary, we can choose the vein of the back of the hand or the veins of the lower limbs for puncture infusion use. Second, for patients with chronic kidney disease stage 4 or chronic kidney disease stage 5, who are expected to enter regular hemodialysis within six months, autologous arteriovenous fistula should be established in advance, and the arteriovenous fistula can be directly punctured as long-term vascular access when starting hemodialysis treatment, avoiding temporary dialysis catheters in the internal jugular vein or femoral vein, because each puncture and placement is a vascular injury, and the newly established autologous arteriovenous fistula generally takes 6 to 6 years. This means that temporary dialysis catheters need to be left in place during the transitional period as transitional dialysis access, and some patients have permanent occlusion of thrombus after one temporary placement; Third, for patients who use temporary dialysis catheters for the first time, they should find a nephrologist or hemodialysis center doctor to assess the vascular conditions and establish an autologous arteriovenous fistula as soon as possible, and for patients who cannot establish an autologous arteriovenous fistula because of poor vascular conditions. For patients who cannot establish autologous arteriovenous endovascular fistula due to poor vascular conditions, artificial vascular arteriovenous endovascular fistula can be established as long-term dialysis vascular access; 4. For patients with short life expectancy, poor general condition or very poor cardiac function, an indwelling catheter with polyester sleeve (commonly known as long-term catheter) can be established as long-term dialysis access after comprehensive assessment by a vascular access doctor. V. Regular monitoring of long-term dialysis vascular access, assessment of dialysis blood flow and dialysis venous pressure in the vascular access, early detection and intervention of complications such as stenosis in the vascular access, and reduction of the number of temporary catheter placements and arteriovenous endovascular fistula reconstructions. Sixth, when an endovascular fistula is found to be occluded, contact an experienced vascular access physician at the first opportunity to try to clarify the cause and recanalize the endovascular fistula as soon as possible (through reconstructive surgery or PTA treatment) to best protect vascular resources. The maintenance of vascular access in uremic hemodialysis patients is very important and involves a wide range of expertise and knowledge, so it requires professionals to do professional work with a strong technical team as support.