Abstract: 【Abstract】Objective To compare the clinical characteristics and all-cause mortality of maintenance hemodialysis (MHD) patients with different vascular access types. Methods A retrospective collection of 310 MHD patients started receiving MHD in affiliated Zhongshan Hospital of Dalian University from May 31, 2010 to December 31, 2016. The follow-up deadline was July 31, 2020. The endpoint events were all-cause death, complications of vascular access, and cardiovascular and cerebrovascular events. The differences in clinical data, laboratory indexes, cardiac ultrasound parameters, and all-cause mortality rate of patients in the
autogenous arteriovenous fistula (AVF) group and the tunnel- cuffed catheter (TCC) group were compared. Results A total of 310 MHD patients were enrolled, with 184 males (59.4%), and the mean age was 65.69±13.11 years old. The age of starting dialysis and the primary cause of end-stage renal disease were different between groups (t=- 3.134, P=0.002;χ2=11.792, P=0.007). Compare with the AVF group, patients in the TCC group with a higher rate of anemia (χ2=5.120，P=0.024) and a lower rate of pulmonary hypertension (χ2=4.696, P=0.030). The incidence of pathway complications and cardiovascular death was not statistically significant (P>0.05). After 50.00 (25.00, 73.25) months of follow-up, 219 patients died. The independent risk factors of
all-cause death including male gender (HR=1.384, 95% CI:1.042～1.839, P=0.025), the age of starting dialysis (HR=1.036, 95% CI: 1.023～1.049, P=0.001), the history of cardiovascular disease (HR=1.698, 95% CI: 1.244～2.318, P=0.001), use catheter (HR= 2.264, 95% CI:1.703～3.009, P=0.001), diabetic nephropathy (HR=1.734, 95% CI:1.322～2.275, P=0.001). Conclusion Patients in the TCC group with a higher rate of anemia and a lower rate of pulmonary hypertension. Use catheter, the age of starting dialysis, history of cardiovascular disease, and diabetic nephropathy were independent risk factors of all-cause death in our MHD patients.

Key words: Maintenance hemodialysis, Vascular access, Pulmonary hypertension, All-cause death