Impact of Timing of Vascular Access Creation on Vascular Access Patency in Patients on Hemodialysis: A Nationwide Cohort Study

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Background: The optimal timing for vascular access (VA) creation before hemodialysis (HD) initiation and its impact on access outcomes remain uncertain. Early VA creation may reduce catheter use and improve access patency, but large-scale data are limited. Methods: Using the Korean National Health Insurance Service database, we analyzed patients who initiated HD in 2013. Patients were grouped based on VA creation timing relative to HD initiation: within 1 month (VA0), 1–3 months (VA1), 3–6 months (VA3), 6–9 months (VA6), 9–12 months (VA9), and >12 months prior (VA12). Outcomes included catheter use at HD initiation and primary and secondary VA patency. Multivariate Cox proportional hazards models were used to evaluate associations. Results: Among 24,713 patients (mean age 63.5±12.9 years; 62.9% male), catheter use was markedly higher in VA0 (47.2%) compared to VA6 (5.9%). The primary patency rate was lower in VA0 (33.4%) vs. VA6 (37.6%), and secondary patency was lower (41.9% vs. 74.0%) (both p<0.001). Hazard ratios (HRs) for catheter use were 11.99 (95% CI 10.07–14.28, p<0.001) in VA0 and 1.68 (95% CI 1.40–2.01, p<0.001) in VA1 vs. VA6. HRs for primary patency failure were 2.56 (95% CI 2.40–2.72) in VA0 and 1.18 (95% CI 1.12–1.25) in VA1; for secondary patency failure, 3.94 (95% CI 3.61–4.31) in VA0 and 1.12 (95% CI 1.02–1.22) in VA1 (all p<0.05). Subgroup analysis showed greater catheter use and patency failure rates when AVF was created within 3 months or AVG within 1 month of HD initiation. Conclusion: Vascular access creation within 3 months of HD initiation—particularly AVF within 3 months or AVG within 1 month—was associated with higher catheter use and increased risk of patency failure. Early planning and timely creation of vascular access are critical to optimize outcomes in patients initiating HD.

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