The Access is written, drawn, and kept by one author — John Cruz.
John Cruz is a registered nurse with 15 years of experience across acute and outpatient hemodialysis, peritoneal dialysis, clinical management, medical device sales, and healthcare quality and safety. He publishes The Access, an independent atlas of the U.S. dialysis system, drawn for the people who work inside it.
Most people in dialysis are experts in one seat. I was moved through all of them — not by design, by accumulation. The floor, the unit, the bedside. Then I crossed to the other side of the curtain, into the industry, and for the first time saw the whole country at once — what worked, what didn’t, and how much of the confusion was baked into the system itself. The country was settled in layers, in the order its problems arrived. So was I. That is the whole reason I can draw this map: I did not study the territory from above. I accreted through it, then stepped back far enough to see it whole.
Every plate carries its sources and the date it was last verified. When this atlas and a primary source disagree, the primary source wins. Always.