Abstract: Objective To investigate the clinical efficacy, safety, and economic benefits of two vascular
accesses: autologous arteriovenous fistula (AVF) and temporary central venous catheter (CVC), in prolonged
intermittent renal replacement therapy (PIRRT) for critically ill maintenance hemodialysis (MHD) patients.
Methods Sixty critically ill MHD patients requiring PIRRT and admitted to the Fifth People's Hospital of
Chengdu between January and May 2025 were enrolled in this study. Using a random number table, they were
randomly assigned to AVF group (undergoing plastic trocar puncture, n=30) or CVC group (n=30). The two
groups were compared in terms of dialysis adequacy (Kt/V value), incidence of access- related complications
(infection, thrombosis and bleeding), length of hospital stay, total treatment expenses, and prognosis. Results
The average Kt/V value in the AVF group was higher than that in the CVC group (1.39±0.17 vs. 1.29±0.17, t=
2.146, P=0.036). The incidence of access-related complications was significantly lower in the AVF group than
in the CVC group (3.33% vs. 36.67%, χ² =8.440, P＜0.001). In particular, the incidence of catheter- related
complications (catheter-related infection, central venous thrombosis, and bleeding) was as high as 36.67% in
the CVC group. The length of hospital stay in the AVF group was shorter than that in the CVC group (10.83±
3.84 vs. 12.93±3.56 days, t=-2.308, P=0.025), and the total treatment expenses in the AVF group was lower
than that in the CVC group (24 394.48±11 953.48 yuan vs. 32 339.92±17 950.68 yuan, t=-2.018, P=0.048).
There was no significant difference in the 28-day survival rate between the two groups (93.33% vs. 90.00%,
χ²=0.209, P=0.648). Conclusion For critically ill MHD patients undergoing PIRRT, selecting AVF as the vascular access can improve treatment efficacy, reduce access- related complications (e.g., infection) and lower
medical expenses, being worthy of further clinical application and exploration.

Key words: Maintenance hemodialysis, Vascular access, Prolonged intermittent renal replacement therapy, Critically ill patient