Trends in incident hemodialysis access and mortality in China: results from China Renal Data System 2000–2024

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.