Abstract: Objective  To investigate the effects of different vascular access types on survival of maintenance hemodialysis (MHD) patients.  Methods  A prospective cohort study was performed, which included 216 MHD patients treated in Hainan Provincial People's Hospital from January 1, 2017 to December 31, 2017. The patients were followed up for 3 years. According to vascular access type, they were divided into 2 groups: autologous arteriovenous fistula (AVF) group and tunneled cuffed catheter (TCC) group. The observation endpoint was all-cause death in the follow-up period of 3 years.  Results  ①In the 216 MHD patients, 86 patients were in the age of ≥60 years, 60 patients (27.8%) had diabetic nephropathy, 132 (61.1%) were males, 55 patients (25.5%) were in the TCC group.  ②The cause of death was similar between the two groups (χ2=0.676, P=0.879). In AVF group, the first cause of death was cardiovascular events (39.5%), followed by infection (30.2%); in TCC group, the first cause of death was infection (39.3%), followed by cardiovascular events (35.7 %). ③The cumulative survival rate in the 3-year follow-up period was higher in AVF group than in TCC group (χ2=9.618, P=0.002). ④ Univariate regression showed that age (OR=2.854, 95% CI 1.766～4.612, P<0.001), dialysis vintage (OR=0.973, 95% CI 0.963～0.983, P<0.001), primary disease (OR=2.296, 95% CI 1.435～3.673, P=0.001), vascular access (OR=2.091, 95% CI 1.294～3.378, P=0.003), albumin (OR=4.281, 95% CI 2.050～8.938, P<0.001) and chest CT findings (OR=0.409, 95% CI 0.255～0.655, P<0.001) were the important factors affecting all-cause death. ⑤ Multivariate Cox regression after correction for primary disease, age, dialysis vintage, hemoglobin, albumin, chest CT findings showed that vascular access was not the independent risk factor for all-cause death in MHD patients (OR=0.921, 95% CI 0.545～1.557, P=0.759); while dialysis vintage (OR=0.976, 95% CI 0.966～0.986, P<0.001), albumin (OR=2.898, 95% CI 1.327～6.330, P=0.008) and chest CT findings (OR=2.060, 95% CI 1.258～3.376, P=0.004) were the independent risk factors for all-cause death in MHD patients.  Conclusions  AVF and TCC as the vascular access types have no direct effect on survival in MHD patients. Active correction of malnutrition, albumin level, lung inflammation as well as chest CT abnormalities may improve the survival of MHD patients

Key words: Maintenance hemodialysis, Autologous arteriovenous fistula, Catheter, Survival rate