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Nicholas Inston (consultant vascular access and renal transplant surgeon, Birmingham, UK) discusses the crucial care interventional radiologists provide for renal patients with Ian Mcafferty (consultant interventional radiologist, Birmingham, UK, and immediate past president of the British Society of Interventional Radiology [BSIR]). Mcafferty asserts that there has been “an evolution” that has seen interventional radiologists poised on the brink of “a primary care role” to deliver therapies such as renal ablation, tumour embolization, and prostatic artery embolization. This shift might provoke the need for a specialised renal or broader, genitourinary interventionalist. “[These minimally invasive procedures are being] driven by the patients wanting them, rather than traditional surgery, Mcafferty insists. Dialysis interventions come in for particular scrutiny with interventional radiologists adding percutaneous arteriovenous fistula creation (EndoAVF) to an armamentarium that has, in the main, provided maturation, maintenance and salvage interventions. The sweeping advances in technology will see interventional radiologists, who tend to be early adopters, really push the field forward, “and this will benefit renal patients”, says Inston, who is also on the executive board of the Charing Cross (CX) Vascular Access Masterclass and editor-in-chief of Renal Interventions. This interview was filmed at the BSIR Annual Scientific Meeting 2021 (8–10 December, Glasgow, UK).