Abstract: Objective  To analyze the risk factors for hemodialysis access-induced distal ischemia (HAIDI) syndrome.  Methods  This study enrolled 70 end-stage renal disease patients undergoing hemodialysis for the first time in Department of Nephrology, Rongxian People's Hospital from May 2025 to May 2022. According to the presence or absence of HAIDI syndrome, they are divided into HAIDI group (n=15) and the non-HAIDI group (n=55). Clinical data were collected and compared between the two groups. Univariate analysis was conducted to find out the potential risk factors for HAIDI syndrome. Binary logistic regression was used to quantify the potential risk factors.  Results  Univariate analysis showed that the ratios of≥60 years of age, female, hypertension history, diabetes, vasculitis, systemic lupus erythematosus, dialysis age more than one year, arteriovenous fistula (AVF) graft, and autologous AVF using brachial artery were higher in HAIDI group than in non-HAIDI group (χ2/t=4.419, 4.272, 4.904, 6.360, 10.972, 7.231, 5.657 and 18.670 respectively; P=0.036, 0.039, 0.027, 0.012, 0.001, 0.007, 0.017 and <0.001 respectively). Binary logistic regression analysis showed that older age, female, hypertension history, diabetes history, vasculitis, systemic lupus erythematosus, longer dialysis age, AVF graft, and AVF of higher position were the risk factors for HAIDI (OR=0.286, 3.353, 0.274, 0.224, 0.051, 0.074, 4.111, 0.055 and 0.049 respectively; 95% CI:0.086～0.954, 1.030～10.920, 0.084～0.895, 0.066～0.755, 0.005～0.500, 0.007～0.775, 1.223～13.818, 0.010～0.303 and 0.007～0.321 respectively; P=0.042, 0.045, 0.032, 0.016, 0.011, 0.030, 0.022, 0.001 and 0.002 respectively).  Conclusion Age, sex, hypertension, diabetes, vasculitis, systemic lupus erythematosus, dialysis age and vascular access type are the risk factors for HAIDI. Prevention and control measures focusing on the patients with these risk  factors will help reduce the occurrence of HAIDI syndrome.

Key words: Hemodialysis, Distal limb ischemia sign, Risk factor, Prevention