Abstract: Objective This study evaluated the impact of vascular access complications on outcomes in maintenance hemodialysis (MHD) patients.  Methods  We retrospectively analyzed the data of a vascular access cohort from Jan 2009 to Oct 2022 in our institution. Demographic, clinical, vascular access, vascular access complication, and survival data were collected. Patients were grouped based on complication status: no complication group (n=324) and complication group (n=176). All-cause mortality was the primary endpoint. Multivariate logistic regression and subgroup analyses were used to assess the relationship between vascular access complications and mortality.  Results  Among 500 MHD patients, 176 (35.5%) developed vascular access complications. During the follow-up period, 82 (16.4%) died. Multivariate logistic regression found that the all-cause mortality risk in complication group increased to 117.8% of the risk in no complication group (HR=2.178, 95% CI: 1.232～3.860, P=0.007). Subgroup analyses demonstrated that age (Z=-1.689, P=0.091), BMI (Z=-1.357, P=0.175), vascular access type (Z=0.863, P=0.172), female (Z=2.834, P=0.005) and non-diabetic were the factors significant influencing the prediction of all-cause mortality by vascular access complications in MHD patients.  Conclusion Vascular access complications may be used to identify the MHD patients at a high risk of mortality that warrants intensive surveillance.

Key words: Vascular access, Maintenance hemodialysis, Complication, All-cause death, Risk factor