During the course of providing adequate access for hemodialysis, the majority of patients with end-stage renal disease will encounter episodes of catheter dependency. Although catheter-based dialysis is inferior to that obtained through native or synthetic arteriovenous conduits, it is often the only way to provide durable venous access into the central venous circulation system for large volume exchanges. Traditional sites for venous access such as internal/external, subclavian, and common femoral veins will eventually occlude. When alternative percutaneous access sites such as translumbar, transhepatic, and transazygous fail or become less desirable, other approaches become necessary. The authors report a successful case of transrenal access into the renal vein with consequent insertion of a tunneled catheter for hemodialysis in a patient with limited options.