What is uremia? When your kidneys cannot afford to remove the metabolites from your body, you have renal insufficiency, the disease will gradually develop, the accumulation of metabolites in the body will affect the function of various organ systems, may cause a variety of symptoms, when it reaches a certain level of severity, is the stage of uremia. You may be afraid of admitting that you have UTI and that using renal replacement therapy means admitting that there is no cure, so you refuse this method; or you may consider the cost and inconvenience of life. But for the sake of the family, the individual and the society, accepting the reality and living happily with the disease may be the most practical solution. Many famous entrepreneurs, doctors and even athletes are UTI patients and are working again through renal replacement therapy, and you can be one of them. If you choose hemodialysis as a form of renal replacement therapy, you will need a good vascular access. Without vascular access, hemodialysis cannot be performed, which is why vascular access has been made the lifeline for patients with end-stage uremia. Establishing and maintaining this lifeline is a shared responsibility of surgeons, physicians, nurses, patients and families. Of the vascular access, the most ideal is to establish a well-functioning arteriovenous endovascular fistula. It is the preferred vascular access (fistula first) because it has the fewest complications, infections and thrombosis of any vascular access. The creation of an endovascular fistula is best done by a specialist with extensive experience, as it is often the first endovascular procedure that has the highest success rate and becomes more difficult as it progresses.