Abstract: Ｏｂｊｅｃｔｉｖｅ：To investigate the effects of different longterm vascular access on prognosis of maintenance hemodialysis (MHD) patients.
Ｍｅｔｈｏｄｏｌｏｇｙ：The study was a retrospective cohort study. The method of stratified sampling by region was used to select MHD patients in Hebei Province from January 1, 2016 to December 31, 2016 from Chinese National Renal Data System (CNRDS). According to the type of longterm vascular access, patients were divided into arteriovenous fistula group and tunnelcuffed catheter group. Survival was estimated by KaplanMeier method. Cox regression model was used to analyze effect of different types longterm vascular access on prognosis of MHD patients.
Ｒｅｓｕｌｔｓ：A total of 4 766 patients were enrolled, including 4 285 patients (899％) in arteriovenous fistula group and 481 patients (101％) in tunnelcuffed catheter group. 982 patients died, and the main cause of death was cardiovascular events (344, 350％). KaplanMeier survival analysis showed that the allcause survival rate (χ2=109334, P<0001) and cardiovascular survival rate (χ2=60362, P<0001) of patients in arteriovenous fistula group were significantly higher than those of tunnelcuffed catheter group. Multivariate COX regression analysis showed that after adjusting for confounding factors, the risk ratio of allcause deaths in tunnelcuffed catheter group was 1598 times that in arteriovenous fistula group (HR=1598, 95％CI 1164～2194,P=0004),and the risk ratio of cardiovascular death was 1894 times that of arteriovenous group (HR=1894, 95％CI 1241～2889, P=0003).
Ｃｏｎｃｌｕｓｉｏｎ：Different longterm vascular access types are closely related to the prognosis of MHD patients. Tunnelcuffed catheter is an independent risk factor for allcause death and cardiovascular death in MHD patients.