Objective To analyze vascular access methods at the initial hemodialysis (HD) in end stage renal disease (ESRD) patients, so as to provide the bases for continuous quality improvement of management before dialysis and for planning autologous arteriovenous fistula (AVF) pathway in chronic kidney disease (CKD) patients.  Methods  This was a single center retrospective study, involving 204 ESRD patients beginning to have hemodialysis in the Affiliated Hospital of Jiangsu University from January 2019 to December 2021. According to the initial vascular access method, they were divided into autologous arteriovenous fistula (AVF) group (n=42) and central venous catheter (CVC) group (n=162). General demographic data, primary disease and laboratory indexes were compared between the two groups. The influencing factors for the initial use of CVC were analyzed. Based on the primary disease, the patients were further divided into diabetic nephropathy (DN) group (n=82) and non-DN group (n=122); the cause of initiatial hemodialysis, vascular access method and laboratory indexes were compared between the two groups.  Results  Among the initial hemodialysis patients, the utilization rates of AVF and CVC were 20.59% and 79.41% respectively. The proportion of urban residents was significantly higher in AVF group than in CVC group (78.6% vs. 55.6%, c2=7.380, P=0.007). The proportions of workers with medical insurance and patients with better eGFR before dialysis were higher in AVF group than in CVC group (c2=3.999, P=0.046; Z=-2.017, P=0.044). Logistic regression showed that residence area, medical insurance type and DN were the influencing factors for the use of CVC at the beginning of hemodialysis (OR=0.341, 0.488 and 3.076 respectively; 95% CI:0.153～0.758, 0.239～0.994 and 1.525～6.206 respectively; P=0.008, 0.048 and 0.002 respectively). At the initial hemodialysis, the use of AVF was significantly higher in DN group than in non-DN group (c2=10.369, P=0.001). In DN group, plasma albumin level and calcium phosphorus product were lower (Z=-2.274, P=0.023; Z=-1.790, P=0.073), serum creatinine was significantly lower (Z=-3.524, P<0.001), and eGFR was significantly higher (Z=-3.919, P < 0.001), as compared with those in non-DN group.  Conclusion  CVC was the main vascular access method at the beginning of hemodialysis in our hemodialysis center in the recent 3 years. Residence place and primary disease were the main influencing factors for the use of CVC. Management of CKD patients and use of AVF for initial hemodialysis must be emphasized in our future practice.