【Abstract】Objective To investigate whether the use of arteriovenous fistula (AVF) at the beginning of dialysis can improve the 5-year survival rate of patients with end-stage renal disease. Methods The patients undergoing maintenance hemodialysis (MHD) at the Blood Purification Center of Guangdong Provincial People's Hospital from January 1, 2013 to August 31, 2018 were enrolled in this prospective cohort study. According to the type of vascular access at the beginning of dialysis and whether the central venous catheter was changed to AVF/graft, they were divided into three groups: AVF group, central venous catheter to internal fistula group, and long-term/temporary catheterization group. The primary outcome indicator of the three groups

was the 5-year mortality rate. Results A total of 360 patients (197 males; the average age of 61.1±16.0 years) were enrolled; 113 patients (37.2%) had diabetic nephropathy. The first type of blood access was autologous AVF in 129 cases (35.8%), arteriovenous grafts (AVG) in 9 cases (2.5%), long-term catheterization in 16 cases (4.4%), and temporary catheterization in 206 cases (57.2%). The 5-year mortality rate of AVF group, central venous catheter to internal fistula group and long- term/temporary catheterization group were: 10/138 (7.2%), 9/138 (6.5%) and 12/84 (14.3%) respectively (χ2=80.966, P=0.116). In central venous catheter to internal fistula group, the median interval between central venous catheterization and establishment of an AVF was 47 (11-86) days. Survival analysis showed that the use of AVF at the beginning of dialysis could significantly improve the 5-year survival rate (Z=2.625, P=0.008). Multivariate analysis showed a higher mortality rate in patients with long-term/temporal catheterization (HR=4.992, 95% CI=1.224～14.84, P=0.025). Conclusions The use of AVF/graft at the beginning of dialysis can significantly improve the 5-year survival rate of patients with end-stage renal disease.