Abstract: 【Abstract】Objective To analyze the major risk events and the influencing factors of maintenance hemodialysis patients(MHD)in the Lanzhou University Second Hospital hemodialysis center. Methods MHD patients were included in the hemodialysis center of Lanzhou university second hospital from July 2014 to July 2019. Results 168 patients were enrolled, including 63.10% males. The most common major risk events occurred in MHD patients were cardiovascular and cerebrovascular events (17.04%), vascular access problems (17.04%), followed by pulmonary infection (14.38%). Patients in the cardio-cerebrovascular event group were
older (Z=-2.489, P=0.013),with hogher proportion of catheter with cuff (CVC)(c2=5.080,P=0.024), and with lower hemoglobin (Hb) (t=2.465,P=0.015), blood urea nitrogen (BUN) (t=2.736,P=0.007), serum creatinine (Scr) (Z=- 3.067,P=0.002), and total cholesterol(TC) (t=2.291,P=0.023). Patients in the lung infection group were older (Z=-2.272,P=0.023), with higher proportion of CVC (c2=10.510, P=0.001),and with lower Hb (Z=-2.418,P=0.016) and serum albumin(ALB) (Z=-2.087,P=0.037). In the vascular access event group, the proportion of females was higher (c2=11.191,P=0.001) ,the proportion of CVC was higher (c2=38.768,P＜0.001), and Hb (t=2.551,P=0.012),BUN (t=2.210,P=0.028),Scr (Z=-2.408,P=0.016) levels were lower. In the severe anemia group, the proportion of females was higher (c2=12.196, P＜0.001),the proportion of CVC was higher (c2=11.419,P=0.001), and the levels of Hb (t=5.048, P＜0.001), Scr (Z=-3.643, P＜0.001), ALB (Z=-2.324, P=0.020) and serum phosphate (P) (t=2.821, P= 0.005) were lower. Multivariate Logistic regression analysis indicated that in MHD patients, TC (OR=0.685,95% CI:0.481～0.977, P=0.037) was an independent risk factor for cardio-cerebrovascular diseases. CVC was an independent risk of pulmonary infection (OR=2.948,95% CI:1.248～6.961,P=0.014) and vascular access problems (OR=11.164, 95% CI:4.125～30.219, P＜0.001) in
MHD patients. High intact parathyroid hormone (iPTH) level was a risk factor for severe anemia in MHD patients (OR=1.001,95% CI:1.000～1.002, P=0.013). Conclusion We need pay more attention to the cardiocerebrovascular and pulmonary health problems in MHD patients. It is recommended that if there are no special issues, the arteriovenous fistulas should be the first choice for MHD patients. In addition, we need to pay more attention to the choice of vascular access and the monitoring of anemia in female patients.

Key words: hemodialysis, vascular access, arteriovenous fistula, semi-permanent catheter, long-term survival