Over 70% of hemodialyis patients start dialysis using a hemodialysis catheter for vascular access despite clear evidence that using hemodialysis catheters, rather than AV fistulas or grafts, result in worsened patient health outcomes, worsened quality of life, and increased health costs. I use non-interventional research methods, such as retrospective cohort analysis, to illuminate approaches toward improving hemodialysis access.