目的  了解血液透析(hemodialysis，HD)患者首次透析血管通路使用情况及通路手术负担。 方法  纳入2018年3月—2024年2月在北京协和医院透析通路中心线上预约血管通路诊疗的终末期肾病(end stage renal disease,ESRD)患者。回顾性收集患者基本情况、ESRD病因、合并症、肾脏替代治疗史、通路史等资料并进行统计分析。 结果  共纳入420例患者，男性占56.9%，平均年龄(54.7±14.8)岁，中位透析龄(dialysis vintage，DV)17.0(2.5，58.0)个月。首次透析使用非隧道式中心静脉导管、隧道式中心静脉导管、动静脉通路及血管直接穿刺的比例分别为66.0%、10.7%、22.6%及0.7%。合并心力衰竭(OR=0.337，95% CI：0.137～0.825，P=0.017)、原发病诊断至首次透析间隔时间(OR=1.003，95% CI：1.000～1.007，P=0.032)以及肾功能不全至首次透析间隔时间(OR=1.006，95% CI：1.000～1.012,  P=0.037)影响首次透析血管通路类型。首次建立动静脉通路时机：4.2%在首次透析前1年以上，22.5%在首次透析前12月至透析前2月，50.0%在首次透析前2月内至透析后1月，23.3%在透析后1月后。年均通路手术次数随DV延长逐渐下降：3个月≤DV＜12个月为3.0次/人年，12个月≤DV＜24个月为1.5次/人年，24个月≤DV＜60个月为0.7次/人年，DV≥60个月为0.4次/人年。首次透析使用动静脉通路患者与首次透析使用非动静脉通路患者年均手术次数比较：3个月≤DV＜12个月为2.0次/人年比3.3次/人年  (Z=2.491，P=0.013)，12个月≤DV＜24个月为0.7次/人年比1.8次/人年(Z=3.248，P=0.001)，24个月≤DV＜60个月为0.3次/人年比0.8次/人年(Z=3.478，P＜0.001)，DV≥60个月为0.3次/人年比0.4次/人年(Z=1.432，P=0.152)。 结论  多数HD患者动静脉内瘘建立时机偏晚。血管通路手术负担在透析早期更高。提前建立有功能的动静脉通路有助于减少患者的通路手术负担。

Objective  To investigate the types of vascular access used at the start of dialysis and the procedural burden in hemodialysis patients.  Methods This study included end-stage renal disease (ESRD) patients on dialysis who scheduled appointments online at the vascular access center of Peking Union Medical College Hospital from March 2018 to February 2024. Demographic data, cause of ESRD, dialysis history, and vascular access history were collected retrospectively through questionnaires. Data were analyzed using SPSS software.  Results  Of the 420 patients, there were 239 males (56.9%), with an average age of 54.7±14.8 years and median dialysis vintage (DV) of 17.0 (2.5, 58.0) months. The initial dialysis access types were non-cuffed catheters (66.0%), tunnel-cuffed catheters (10.7%), arteriovenous fistula/graft (22.6%), and straight percutaneous access (0.7%). The presence of congestive heart failure (OR=0.337, 95% CI: 0.137～0.825, P=0.017), the time interval between diagnosis of kidney disease and initial dialysis (OR=1.003, 95% CI: 1.000～1.007, P=0.032), and the time interval between discovery of renal insufficiency and initial dialysis (OR=1.006, 95% CI: 1.000～1.012, P=0.037) were found to affect initial dialysis access type. The first time of arteriovenous access placement was as follows: 4.2 % at least 12 months before dialysis, 22.5% within 2～12 months before dialysis initiation, 50.0% within 2 months before and one month after dialysis initiation, and 23.3% after one month of dialysis initiation. The procedural burden for maintenance dialysis patients decreased gradually with the prolongation of DV: 3.0/person-year for DV ≥3 months to ＜12 months, 1.5/person-year for DV ≥12 months to ＜24 months, 0.7/person-year for DV ≥24 months to ＜60 months, and 0.4/person-year for DV≥60 months. The procedural burden for maintenance dialysis patients according to arteriovenous access group vs. non-arteriovenous access group was as follows: 2.0/person-year vs. 3.3/person-year (Z=2.491, P=0.013) for DV ≥3 months to ＜12 months; 0.7/person-year vs. 1.8/person-year (Z=3.248, P=0.001) for DV ≥12 months to ＜24 months; 0.3/person-year vs. 0.8/person-year (Z=3.478, P＜0.001) for DV ≥24 months to ＜60 months; and 0.3 procedures/person-year vs. 0.4 procedures/person-year (Z=1.432, P=0.152) for DV ≥60 months.  Conclusion  The placement of arteriovenous access in most hemodialysis patients is often delayed. The procedural burden of dialysis access is highest at the early stages of dialysis initiation. Timely establishing functional arteriovenous access before dialysis can help reduce the risk of central venous catheter placement and subsequent procedural burden in hemodialysis patients.