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.