【Abstract】Objectives This study was aimed to identify early failure of the first native arteriovenous fistula (AVF) in patients on maintenance hemodialysis (HD) and the factors responsible for the failure, for the planning on early intervention strategies. Methods A retrospective study was conducted in 214 patients (aged 4814years, 132 males), who received the first native AVF operation for maintenance HD in West China Hospital from Jan, 2008 to Feb, 2009. Early failure was defined as (a) a blood flow volume ＜200ml/min inadequate to support dialysis therapy with a venous diameter of ≤0.4cm detected by ultrasound, and (b) the AVF failure occurring within the first 3 months of its use. Factors potentially relating to the failure of the first AVF including age, gender, primary disease, surgical procedure, and dwelling duration of central vein catheterization (CVC) before use of the AVF were collected and studied using binary Logistic regression analysis. Results Early failure of the AVF was found in 38 (17.8%) patients, of whom the major risk factors included hypotension status (RR=4.2, P=0.009), diabetes (RR=2.8, P=0.041), low body mass index (BMI) (RR=1.1, P=0.000), and surgical techniques (RR=0.86, P=0.036). Although CVC before the use of AVF showed no correlation with the early failure of AVF (RR=2.6, 95% CI=0.28-25.29, P=0.401), the dwelling duration of CVC was a risk factor (RR=1.1, 95% CI=1.03-6.72, P=0.001). Conclusion Early failure of the first native AVF correlates with hypotension, diabetes, BMI of the patient, surgical techniques, and dwelling duration of CVC. Native AVF should be established before the commencement of maintenance HD, so that the possibility of CVC and its dwelling duration can be reduced, and the patency of AVF can be improved with the decrease of its complications.