Abstract: Objective: To analyze the influencing factors for Autologous arteriovenous Fistula (AVF) dysfunction in Maintenance Hemodialysis (MHD) patients, and to provide evidence for formulating individualized AVF protection strategies. Methods: A prospective cohort study was adopted, MHD patients with AVF as the vascular access were recruited from 4 hospitals in Beijing from May 2023 and January 2024. We collected data, including patients' demographic characteristics, comorbidities, dialysis-related parameters, laboratory indices, and AVF assessment results from the beginning to October 2025 when the follow-up ended. Univariate analysis and multivariate Cox proportional hazards model were used to identify influencing factors for AVF function. Results: A total of 231 patients were enrolled, with a mean follow-up of 21.05±7.72 months. By October 2025, apart from the 31 patients being lost to follow-up, 40 patients developed AVF dysfunction. Multivariate Cox proportional hazards regression analysis showed that longer dialysis vintage (HR=0.850, P=0.005), use of high-flux dialyzers (HR=0.329, P=0.049), higher total cholesterol level (HR=0.663, P=0.047), and higher palpation score (HR=0.567, P=0.006) were protective factors against AVF dysfunction. As to risk factors, there were not newly created AVF (HR=4.970, P=0.003) and a history of AVF intervention (HR=2.545, P=0.012). Kaplan-Meier survival curves demonstrated a significant negative correlation between the palpation score and AVF patency rate (Log Rank χ2=105.534, P<0.001), with a cut-off value of 3 to effectively distinguish high-risk patients from low-risk patients. Conclusion: Dialysis vintage, type of dialyzers, number of AVF creations, history of AVF intervention, total cholesterol level, and palpation score were factors influencing AVF function in MHD patients. Moreover, the palpation scoring system may serve as a convenient bedside predictive tool, providing evidence for early clinical intervention and individualized management.

Key words: Maintenance Hemodialysis; Autogenous arteriovenous Fistula; dysfunction; influencing factor; cohort study