Abstract: Objective To analyze the primary disease, the difference in clinical manifestation and the reason for initiating dialysis between diabetic nephropathy (DN) group and non-DN group, and the vascular access in the hemodialysis patients in our center in the recent 20 years. Methods We recruited the patients initiating the maintenance hemodialysis (MHD) during 1994 to 2015. Their primary disease, the direct cause leading to dialysis initiation, vascular access and laboratory tests were recorded. The differences in these parameters in DN and non-DN patients between the first 10-year period and the second 10-year period in 1994-
2015 were compared. Results A total of 289 patients were recruited. The leading primary disease was glomerulonephritis, followed by DN and hypertension. The proportion of DN patients increased significantly (16.000% to 21.296%) in the second 10-year period. At the initiating dialysis in DN patients, serum creatinine
level was relatively low (659.036±350.533 μmol/L vs. 877.452±386.593μmol/L, t=3.789, P＜0.001), anemia was relatively severe (86.839 ± 18.890 g/L vs. 93.092 ± 22.795 g/L, t=2.064, P=0.041), serum phosphorus (1.648±0.481 mmol/L vs. 2.006±0.753 mmol/L, t=3.865, P＜0.001) and iPTH (236.150±203.332 pg/ml vs. 460.647±480.166 pg/ml, t=2.766, P=0.007) were relatively low, and metabolic acidosis was not very heavy (t=-2.483, P=0.014). The direct cause to initiate hemodialysis was mainly heart failure/edema in DN group and uremic symptoms in non-DN group. In the second 10-year period, blood urea nitrogen (30.427±14.519 mmol/L vs. 24.865±7.517 mmol/L, t=-1.312, P=0.036) increased significantly in all patients, but serum potassium (4.676±0.945 mmol/L vs. 5.200±0.745 mmol/L, t=1.880, P=0.037), calcium (2.154±0.369 mmol/L vs. 2.395±0.270 mmol/L, t=2.033, P=0.037), and iPTH (399.920±435.836 pg/ml vs. 968.000±705.377 pg/ml, t= 2.399, P=0.020) were controlled better than those in the first 10year period. Most patients initiated hemodialysis with central venous catheterization as the blood access. The proportion of arteriovenous fistula (AVF) for blood access had no significant change. Conclusions The leading primary disease of MHD was glomerulonephritis in our center, but the proportion of DN as the primary disease increased significantly in recent 10 years. DN patients initiated MHD earlier and often due to the refractory heart failure/edema. Controlling of chronic kidney disease complications became better in the recent 10 years. We should carefully take account of the appropriate time to create and the use of AVF in CKD patients.

Key words: direct cause of the initial dialysis, maintenance hemodialysis, primary diseases, diabetic nephropathy, vascular access