Recurrence of complications related to usual vascular access leads to exhausted vasculature. Several options were described in similar cases like tans-lumbar catheter and intra-atrial tunneled dialysis catheter. We report the case of a 22-year-old- male, with kidney failure, anuria and exhausted vasculature. Emergent kidney transplantation was not suitable to his case. We decided to combine peritoneal dialysis with once-a-week hemodialysis using a tans-lumbar tunneled catheter at first time, then an intra-atrial tunneled dialysis catheter as vascular access of last resort. Development of renal replacement therapy expose nephrologist to new challenges. Working on alternative therapy is inspiring, but rationalizing exploitation of current options meanwhile is imperative.