Objective A cross-sectional analysis of vascular access for hemodialysis in a large hemodialysis center in Tibet.  Methods Patients undergoing maintenance hemodialysis (MHD) in the Blood Purification Center, the People's Hospital of Tibet Autonomous Region from December 2021 to December 2022 were recruited for the analysis. Demographic characteristics, primary disease, dialysis vintage, the first and current vascular access modality were collected.  Results  A total of 194 MHD patients were included in the analysis. Vascular access used temporary central venous catheter, tunnel-cuffed catheter (TCC), arteriovenous graft (AVG) and arteriovenous fistula (AVF) for the first dialysis access were found in 66(34.0%), 88(45.4%), 2(1.0%), and 38(19.6%) patients, respectively. Forty-seven patients (24.2%) completed the AVF construction surgery before dialysis. In the patients with AVF surgery before dialysis, there were more male patients (83% vs. 68%, χ²=3.919, P=0.048), more patients with a college education or above (53.2% vs. 21.1%, χ²=17.875, P<0.001), and more patients using AVF or AVG as the vascular access (97.9% vs. 86.4%, χ²=4.860, P=0.029), as compared with those without AVF surgery before dialysis. AVF, AVG and TCC were used as the vascular access for MHD in 86.6%, 2.6% and 10.8%, respectively, of all MHD patients. Compared with the patients using non-TCC access, TCC as the vascular access was usually found in patients with older age (58.3±15.0 vs. 51.7±13.8, t=2.039, P=0.043) and less likely to have glomerulonephritis as the cause of renal failure (23.8% vs. 47.4%, χ²=4.213, P=0.040). Patients with temporary central venous catheter as the initial vascular access (n=66) were more likely to use TCC for MHD (19.7% vs. 6.3%, χ²=8.157, P=0.007), as compared with the patients using other vascular access (n=128).  Conclusion  AVF as the vascular access for MHD in this center was 86.6%, compliant with the requirement of the guidelines. However, the use of TCC was 10.8%, slightly higher than the requirement of the guidelines. Improvement of technology and pre-dialysis education are warranted to reduce the use of TCC for MHD.