Daily hemodialysis has been associated with favorable surrogate markers of improved survival among hemodialysis patients. These outcomes include improvements in left ventricular mass index, chronic inflammation, nutritional markers and mineral metabolism markers [1–5]. There is currently no study that addresses directly the impact of daily dialysis on vascular access outcomes over long term follow-up. Previous observational and uncontrolled studies of daily hemodialysis have shown mixed results in regards to vascular access outcomes with the majority showing no difference in access outcomes [5–9] and some showing a trend toward improved access outcomes [4, 10–12]. The randomized controlled FHN study of daily, in-center, hemodialysis showed no significant differences in access outcomes, but a trend toward more access procedures with similar patency rates [13]. Importantly, no controlled studies have addressed this issue over a long-term follow-up of greater than one year.