Trends in incident hemodialysis access and mortality in China: results from China Renal Data System 2000-2024.
4 affiliations
- 1Department of Nephrology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
- 2Key Laboratory for Molecular Diagnosis of Hubei Province, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
- 3Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Multi-organ Injury Prevention and Treatment, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China.
- 4Department of Geriatrics, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Abstract
Backgrounds
Large‑scale multicenter data on vascular access among Chinese incident hemodialysis (HD) patients are limited. We explored temporal trends of initial vascular access and its relationship with all‑cause mortality.Methods
This retrospective cohort study was conducted using the China Renal Data System, enrolling incident HD patients from January 2000 to April 2024. Vascular access trends and distribution at HD initiation were analyzed.Results
16,717 patients were enrolled (mean age 55.62 ± 10.93 years; 61.54% male; mean follow‑up 64.41 months). At HD initiation, 29.17% of patients used arteriovenous fistula/graft (AVF/AVG), while 70.83% used central venous catheter (CVC), comprising 60.78% with a maturing AVF/AVG and 10.06% with CVC alone. AVF/AVG use increased from 26.24% in 2015 to 35.77% in 2024, while CVC-only use decreased from 16.16% to 8.27%. Mortality rates per 100 person-years were 4.15 (95% confidence interval [CI] 3.93 - 4.38), 7.24 (95% CI 7.00 - 7.49), and 15.08 (95% CI 14.07 - 16.15) in the AVF/AVG, CVC with maturing AVF/AVG, and CVC-only groups, respectively. In the adjusted Cox model, patients using CVC with a maturing AVF/AVG or CVC alone exhibited 36% and 91% higher all-cause mortality risks, respectively, compared with those using AVF/AVG.Conclusions
Over the 25-year period, initial vascular access among Chinese incident HD patients gradually shifted from CVC to AVF/AVG, reflecting ongoing and considerable improvements in vascular access practice in China. CVC use at HD initiation was associated with higher all-cause mortality compared with AVF/AVG. These findings support early AVF/AVG creation in end-stage kidney disease patients to avoid CVC use at HD initiation.
Related
- First human use of an allogeneic tissue-engineered vascular graft for hemodialysis access
- Unraveling the Hemodialysis Patient Network: Results from the Social Network and Renal Education (SNARE) Transplant Intervention Clinical Trial
- Current status of pharmacological interventions for preventing stenosis of arteriovenous hemodialysis access
- Association of hemodialysis vascular access type with dialysis adequacy and access-related outcomes in patients receiving maintenance hemodialysis.
- Ten tips for the management of vascular access in hemodialysis patients.
BibTeX
@article{gan2026trends,
title = {{Trends in incident hemodialysis access and mortality in China: results from China Renal Data System 2000-2024.}},
author = {Wenyuan Gan and Fan Zhu and Xingruo Zeng and Wenli Chen and Huihui Mao and Danni Shao and Licong Su and Peiyan Zhan},
journal = {Renal failure},
year = {2026},
month = oct,
doi = {10.1080/0886022x.2026.2747546},
url = {https://europepmc.org/article/MED/42928039},
note = {CC BY},
}
RIS
TY - JOUR
TI - Trends in incident hemodialysis access and mortality in China: results from China Renal Data System 2000-2024.
AU - Wenyuan Gan
AU - Fan Zhu
AU - Xingruo Zeng
AU - Wenli Chen
AU - Huihui Mao
AU - Danni Shao
AU - Licong Su
AU - Peiyan Zhan
PY - 2026
DA - 2026/10/25
JO - Renal failure
DO - 10.1080/0886022x.2026.2747546
UR - https://europepmc.org/article/MED/42928039
AB - Backgrounds Large‑scale multicenter data on vascular access among Chinese incident hemodialysis (HD) patients are limited. We explored temporal trends of initial vascular access and its relationship with all‑cause mortality.Methods This retrospective cohort study was conducted using the China Renal Data System, enrolling incident HD patients from January 2000 to April 2024. Vascular access trends and distribution at HD initiation were analyzed.Results 16,717 patients were enrolled (mean age 55.62 ± 10.93 years; 61.54% male; mean follow‑up 64.41 months). At HD initiation, 29.17% of patients used arteriovenous fistula/graft (AVF/AVG), while 70.83% used central venous catheter (CVC), comprising 60.78% with a maturing AVF/AVG and 10.06% with CVC alone. AVF/AVG use increased from 26.24% in 2015 to 35.77% in 2024, while CVC-only use decreased from 16.16% to 8.27%. Mortality rates per 100 person-years were 4.15 (95% confidence interval [CI] 3.93 - 4.38), 7.24 (95% CI 7.00 - 7.49), and 15.08 (95% CI 14.07 - 16.15) in the AVF/AVG, CVC with maturing AVF/AVG, and CVC-only groups, respectively. In the adjusted Cox model, patients using CVC with a maturing AVF/AVG or CVC alone exhibited 36% and 91% higher all-cause mortality risks, respectively, compared with those using AVF/AVG.Conclusions Over the 25-year period, initial vascular access among Chinese incident HD patients gradually shifted from CVC to AVF/AVG, reflecting ongoing and considerable improvements in vascular access practice in China. CVC use at HD initiation was associated with higher all-cause mortality compared with AVF/AVG. These findings support early AVF/AVG creation in end-stage kidney disease patients to avoid CVC use at HD initiation.
SN - 0886-022X
SN - 1525-6049
ER -