{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T15:58:41Z","timestamp":1790697521009,"version":"4.1.0"},"reference-count":17,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"unspecified","delay-in-days":28,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Taizhou Science and Technology Association Project, China","award":["KT202401064"],"award-info":[{"award-number":["KT202401064"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,9,9]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To describe initial vascular access among incident haemodialysis patients, identify patient-level factors associated with starting haemodialysis with an arteriovenous fistula (AVF) rather than a central venous catheter (CVC), and explore clinical and biochemical status after 3 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Multicentre retrospective observational study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Dialysis centres in six tertiary hospitals in Taizhou, southeastern Zhejiang, China, from 1 January 2019 to 31 December 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Of 1227 database records assessed, 6 were excluded (5 initial arteriovenous graft records and 1 record outside the prespecified study period), leaving 1221 incident haemodialysis patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>The primary outcome was initial AVF rather than CVC use. Secondary exploratory outcomes were mean arterial pressure and biochemical measurements after 3 months; dialysis adequacy, access patency, access infection and mortality were unavailable.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Initial access was an AVF in 446\/1,221 patients (36.5%) and a CVC in 775\/1221 (63.5%); CVCs comprised 413 tunnelled cuffed and 362 non-tunnelled catheters. Initial AVF use varied across hospitals from 18.9% to 49.0%. In a centre-adjusted model using 20 multiply imputed datasets, higher baseline haemoglobin (adjusted OR per 10\u2009g\/L 1.144, 95%\u2009CI 1.060 to 1.234), albumin (per 5\u2009g\/L 1.411, 95%\u2009CI 1.242 to 1.603)\u2009and calcium (per 0.1\u2009mmol\/L 1.112, 95%\u2009CI 1.052 to 1.176) and lower C-reactive protein (per doubling 0.845, 95%\u2009CI 0.797 to 0.896) were associated with initial AVF use. At 3 months, no AVF-CVC difference remained robust after baseline and centre adjustment and false-discovery-rate control.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Initial AVF use was uncommon and was associated with baseline clinical status and centre. These observational findings support timely predialysis assessment and individualised vascular-access planning, but they do not show that access type caused subsequent biochemical differences.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-123710","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T15:01:27Z","timestamp":1790694087000},"page":"e123710","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Initial vascular access type and associated factors among incident haemodialysis patients: a multicentre retrospective observational study"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-4609-0175","authenticated-orcid":false,"given":"Youyou","family":"Lin","sequence":"first","affiliation":[{"name":"Department of Nephrology, Taizhou Hospital of Zhejiang Province, Linhai, Zhejiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lili","family":"Lou","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Taizhou Hospital of Zhejiang Province, Linhai, Zhejiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Gong","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Taizhou Hospital of Zhejiang Province, Linhai, Zhejiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lingling","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Taizhou Hospital of Zhejiang Province, Linhai, Zhejiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8665-503X","authenticated-orcid":false,"given":"Liyun","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Taizhou Hospital of Zhejiang Province, Linhai, Zhejiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"2026092908002797000_16.9.e123710.1","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1001\/jamainternmed.2022.6817","article-title":"Prevalence of Chronic Kidney Disease in China: Results From the Sixth China Chronic Disease and Risk Factor Surveillance","volume":"183","author":"Wang","year":"2023","journal-title":"JAMA Intern Med"},{"key":"2026092908002797000_16.9.e123710.2","doi-asserted-by":"crossref","first-page":"124","DOI":"10.3810\/pgm.2000.07.1152","article-title":"Trends in end-stage renal disease. 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