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Preemptive Vascular Access Placement and Mortality Risk in Hemodialysis Patients: A Real-World Single-Center Study
Wei Wang1, Buyuan Tian2,3, Xumao Deng2,3
1Department of Nephrology, Pengzhou First People's Hospital, Pengzhou, Sichuan Province, China.
Hemodialysis International. International Symposium on Home Hemodialysis
|May 13, 2026
Summary
Preemptive vascular access placement significantly improves survival for hemodialysis (HD) patients, especially older adults. However, placing it more than six months before dialysis offers no extra benefit.
Area of Science:
- Nephrology
- Vascular Surgery
- Public Health
Background:
- Optimal timing for vascular access creation is crucial for hemodialysis (HD) patient outcomes.
- This study examines the link between preemptive vascular access and mortality in HD patients.
Purpose of the Study:
- To investigate the association between preemptive vascular access placement and all-cause mortality in hemodialysis patients.
- To determine if early vascular access placement impacts survival rates.
Main Methods:
- Retrospective cohort analysis of 489 adult HD patients (2009-2022).
- Patients grouped into preemptive and non-preemptive vascular access categories.
- Inverse probability of treatment weighting (IPTW) and survival analyses (Kaplan-Meier, Cox models) were employed.
Main Results:
- Preemptive vascular access was present in 20.7% of patients.
- IPTW-adjusted analysis showed significantly lower mortality in the preemptive group (8.9% vs. 18.8%, p < 0.001).
- Preemptive access was associated with a 65% reduction in all-cause mortality risk (aHR=0.35). Elderly patients (≥60 years) demonstrated greater survival benefits.
Conclusions:
- Preemptive vascular access placement significantly enhances survival for HD patients.
- The survival benefits are particularly pronounced in elderly HD patients.
- Placement exceeding six months before dialysis initiation does not provide additional prognostic advantages.
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