Abstract: Objective  To systematically evaluate the risk factors for vascular access thrombosis (VAT) in patients undergoing maintenance hemodialysis, and to provide evidence-based guidance for clinical intervention.  Methods  A comprehensive literature search was conducted in PubMed, Scopus, Ovid, Web of Science, Cochrane Library, CNKI, Wan Fang, VIP, CBM and Duxiu, covering case-control and cohort studies on VAT-related risk factors from database inception to February, 2025. Meta-analysis was performed using Stata version 17.0.  Results  A total of 17 studies were included, all with a quality assessment score of ≥7. Meta-analysis revealed that female (OR=1.481, 95% CI: 1.177～1.862, P＜0.001), graft arteriovenous fistula (OR=2.773, 95% CI: 1.573～4.889, P＜0.001), diabetes mellitus (OR=2.163, 95% CI: 1.451～3.225, P＜0.001), intradialytic hypotension (OR=2.897, 95% CI: 2.146～3.912, P＜0.001), elevated mean platelet volume (OR=1.587, 95% CI: 1.331～1.891, P＜0.001), and increased TNF-α level (OR=1.132, 95% CI: 1.062～1.206, P＜0.001) were associated with an increased risk of VAT. In contrast, higher hemoglobin level (OR=0.867, 95% CI:0.789～0.952, P＜0.050) and antiplatelet therapy (OR=0.669, 95% CI: 0.567～0.790, P＜0.050) were associated with a reduced risk of VAT.  Conclusion   Female, prosthetic graft, diabetes, intradialytic hypotension, increased mean platelet volume, and elevated TNF-α level are the risk factors for VAT, while higher hemoglobin level and antiplatelet therapy are the protective factors for VAT. Given the observed heterogeneity among the included studies, further research is warranted to confirm these findings across different patient groups.

Key words: Maintenance hemodialysis, Vascular access thrombosis, Risk factor