Preemptive Vascular Access Placement and Mortality Risk in Hemodialysis Patients: A Real‐World Single‐Center Study

BACKGROUND: The optimal timing for vascular access creation in hemodialysis (HD) patients is critical for improving patient outcomes. This study aimed to investigate the association between preemptive vascular access placement and all-cause mortality in HD patients. METHODS: A retrospective cohort of 489 adult HD patients from 2009 to 2022 was analyzed. Patients were categorized into preemptive and non-preemptive vascular access groups. Inverse probability of treatment weighting (IPTW) was used to balance baseline characteristics, and survival analyses were performed using Kaplan-Meier curves, log-rank tests, and Cox proportional hazards models. RESULTS: Preemptive vascular access was found in 20.7% (101/489) of patients. After IPTW adjustment, the preemptive group had lower mortality (8.9% vs. 18.8%, p < 0.001) and a 65% reduction in all-cause mortality risk (adjusted HR = 0.35, 95% CI 0.15-0.80). Elderly patients (≥ 60 years) showed greater survival benefits (p for interaction < 0.05). CONCLUSIONS: Preemptive vascular access placement significantly improves survival in HD patients, particularly in older adults. However, excessively early placement (> 6 months) offers no additional prognostic advantage.