Initial vascular access type and associated factors among incident haemodialysis patients: a multicentre...

To describe initial vascular access among incident haemodialysis patients, identify patient-level factors associated with starting haemodialysis with an arteriovenous fistula (AVF) rather than a central venous catheter (CVC), and explore clinical and biochemical status after 3 months.

Multicentre retrospective observational study.

Dialysis centres in six tertiary hospitals in Taizhou, southeastern Zhejiang, China, from 1 January 2019 to 31 December 2023.

Of 1227 database records assessed, 6 were excluded (5 initial arteriovenous graft records and 1 record outside the prespecified study period), leaving 1221 incident haemodialysis patients.

The primary outcome was initial AVF rather than CVC use. Secondary exploratory outcomes were mean arterial pressure and biochemical measurements after 3 months; dialysis adequacy, access patency, access infection and mortality were unavailable.

Initial access was an AVF in 446/1,221 patients (36.5%) and a CVC in 775/1221 (63.5%); CVCs comprised 413 tunnelled cuffed and 362 non-tunnelled catheters. Initial AVF use varied across hospitals from 18.9% to 49.0%. In a centre-adjusted model using 20 multiply imputed datasets, higher baseline haemoglobin (adjusted OR per 10 g/L 1.144, 95% CI 1.060 to 1.234), albumin (per 5 g/L 1.411, 95% CI 1.242 to 1.603) and calcium (per 0.1 mmol/L 1.112, 95% CI 1.052 to 1.176) and lower C-reactive protein (per doubling 0.845, 95% CI 0.797 to 0.896) were associated with initial AVF use. At 3 months, no AVF-CVC difference remained robust after baseline and centre adjustment and false-discovery-rate control.

Initial AVF use was uncommon and was associated with baseline clinical status and centre. These observational findings support timely predialysis assessment and individualised vascular-access planning, but they do not show that access type caused subsequent biochemical differences.