The increasing chronic kidney disease (CKD) population is an important public health and social issue. In Taiwan, dialysis costs for end-stage renal disease (ESRD) patients have been fully reimbursed by the National Health Insurance (NHI) since 1995. Over the last two decades, the cases of ESRD requiring dialysis increased progressively, becoming an important issue in medical care [1]. The updated data from United States Renal Data System (USRDS) international report in 2012 indicated that Taiwan ranked first regarding to prevalence of dialysis [2]. Although a nationwide project for CKD prevention in Taiwan has been initiated since 2003, the prevalence and incidence of ESRD still increased steadily in 2005–2012. From subgroup analysis of latest Taiwan Renal Registry Data System (TWRDS), the prevalence of those older than 75 years and diabetes were increasing. Similar to other countries, diabetes mellitus (DM) remains the most common primary disease causing ESRD in Taiwan (47.9 %) [1].

Because of the high availability and easy accessibility of medical service, hemodialysis (HD) continues to be the most commonly utilized renal replacement therapy in Taiwan. Among the 67,665 prevalent ESRD patients, more than 60,000 of patients (89.7 %) undergo in-center HD twice to three times per week [3]. Although currently there is still lacking a national population study to estimate the proportion of vascular access devices in Taiwan, native arteriovenous fistula (AVF) is the most common form of vascular access for HD, owning to its lower risk of infection and thrombosis. According to a multicenter study reported by Chen et al. which enrolled 5161 patients receiving maintenance HD from 25 dialysis facilities in Taiwan since 2008–2012, the AVFs took up approximately 75 % of vascular access for HD, whereas arteriovenous graft (AVG) and tunneled dialysis catheter (TDC) contributed to 20 % and 5 %, respectively. Although there is a slight increase of the proportion of patients using AVG and TDC during the 5-year follow-up, 73.9 % of patients still use native AVF for HD and those with TDC composed only 5.8 % of the total participants in 2012. This increasing trend may be attributed to the increasing poor vascular conditions in aging and DM patients [4]. However, TDCs have significant infectious, thrombotic, and anatomic complication rates comparing to arteriovenous (AV) access for HD. By using claims data from the National Health Insurance Research Database (NHIRD) in Taiwan, Ng et al. reported that in incident patients starting HD with TDCs, the 1- and 3-year mortality and infection rates were lower in conversion to AVF and AVG than in no-conversion group [5]. Since vascular access type is significantly associated with patient survival, it is important for physicians to identify factors for predicting the successful maturation of HD vascular access, as well as therapies for maintaining long-term patency.

Careful evaluation and periodic surveillance of the function of vascular access play fundamental roles in the integrated care for HD patients. Given that patient’s age, gender, race, comorbidity, surgical technique, and vascular conditions could affect the patency and prognosis of AV access, it will be helpful to identify the precipitating factors individually, to avoid multiple interventions in treating AV access malfunctions. On the other hand, with the advantages of genetic analysis, more and more genetic polymorphisms were discovered in association with the patency rate of HD devices. In this paragraph, we will focus on the recent advances in Taiwan investigating the precipitating and prognostic factors in association with AV access patency for HD.