Abstract: Objective To systematically review the influence of the first cannulation time for newly established arteriovenous fistula (AVF) on vascular access failure. Methods Databases including PubMed, Medline, the Cochrane Library (Issue 6, 2017) and CNKI were searched up to June 2017 to collect cohort studies about the influence of first cannulation time for newly established arteriovenous fistula on vascular access failure. According to the inclusion and exclusion criteria, the related cohort studies were screened, data were extracted and cross-checked, and quality of included studies was independently evaluated by two reviewers. Meta-analysis was then conducted using Stata 12.0 software. Results A total of 9 studies involving 5,045 AVFs were included to the systematic review, showing that the first cannulation time for newly established arteriovenous fistula is associated with fistula failure. Four studies involving 2,450 AVFs were finally included in our meta- analysis. When the primary patency rates were compared between patients with the first cannulation time within 14 days and those more than 14 days, the differences were statistically significant after 3 months(RR=2.124, P=0.030), after 12 months (RR=2.172, P＜0.001), after 18 months (RR=2.276, P=0.003), and after 24 months (RR=2.087, P=0.008), but without significance after 36 months (RR=2.093, P=0.337). When the primary patency rates were compared between patients with the first cannulation time within 30 days and those more than 30 days, the differences were statistically significant after 24 months (RR=2.952, P＜0.001) and after 36 months (RR=2.336, P＜0.001), but without significance at other time points of follow-up. When the primary patency rates were compared between patients with the first cannulation time within 14 days and those within 15～30 days, the difference was statistically significant after 24 months (RR=1.146, P=0.442), but without significance at other time points of follow-up. When the primary patency rates were compared between patients with the first cannulation time within 15～30 days and those more than 30 days, the differences were statistically significant after 3 months (RR=2.893, P=0.030), 24 months (RR=2.834, P＜0.001) and 36 months (RR=2.232, P＜0.001), but without significance at other time points of follow-up. Conclusions The first cannulation time of the newly established AVF was an important risk factor for long-term patency. Cannulation of AVF within 14 days should be avoided. Cannulation between 2 and 4 weeks was performed only at emergency condition, and the maturation degree of the fistula must be evaluated by physical and ultrasound examinations before cannulation. Maturation of AVF was completed after 30 days.

Key words: Arteriovenous fistula, First cannulation, Primary patency, Systematic review, Meta-analysis