目的 调查维持性血液透析(MHD)患者首次透析时血管通路使用情况,并分析未使用内瘘的原因。方法 研究对象为2007年10月1日到2012年9月30日于我院行MHD的所有患者,调查首次透析时血管通路使用情况，分为内瘘组和深静脉导管组。比较两组临床各项指标,分析未使用内瘘的原因。结果 研究期内开始MHD治疗的患者共160例，内瘘组32例，深静脉导管组128例。深静脉导管组患者在年龄、首次透析时合并心衰的患者比例、查尔森合并症指数(CCI)、行急诊透析比例、估计的肾小球滤过率(eGFR)、专科随诊以及血色素(Hb)水平不同于内瘘组，差异有统计学意义。首次透析未使用内瘘的主要原因有，在肾脏专科随诊但未及时建立血管通路占30.5%，非专科随诊患者占30.0%；多年前知道有肾脏受损但是一直未复查造成诊治延误占16.4%；在CKD3～4期基础上急性加重占15%。导致CKD3～4期急性加重的原因主要是心衰。结论 绝大部分终末期肾病患者首次透析血管通路位为深静脉导管，未使用内瘘的原因有多种，这些因素大部分为可调节因素。

Objective To investigate vascular access used at the start of hemodialysis of end stage of renal disease（ESRD）patients，arteriovenous ?stula（AVF）or central venous catheters（CVCs）, and analyse the causes of without using AVF. Methods Incident patients with ESRD starting hemodialysis between 1 October 2007 and 30 September 2012 were included in the study. To investigate vascular access used at the start of hemodialysis. The clinical data were collected to analyse the causes of without using AVF. Results A total of 160 patients were included in this study. Hemodialysis started with a AVF in 32 patients and with CVCs in 128 patients. Using CVCs were associated with older age, higher CCI, higher eGFR and lower Hb levels. There were more patients with heart failure and emergency start, less patients with nephrology follow-up in CVCs group. The two main causes of using CVCs were without transfer to the nephrology and delayed planning of vascular access. Conclusions Most ESRD patients started hemodialysis without a AVF. Multiple causes were associated with this fact, many of which are modi?able.