Background The COVID pandemic has resulted in a major disruption in healthcare that has affected several medical and surgical specialties. European and American Vascular Societies has proposed deferring the creation of an elective vascular access (VA) (autologous or prosthetic arteriovenous fistula (AVF or AVG) in incident patients on hemodialysis (HD) in the era of a COVID pandemic. The aim of this study is to examine the impact of COVID pandemic on VA creation and the CVC-related hospitalizations and complications in HD patients dialyzed in 16 Spanish HD units of 3 different regions. Methods We compared retrospectively two periods of time: the pre-COVID (January 1th 2019-March 11th 2020) and the COVID era (March 12th 2020-June 30th 2021) in all HD patients (prevalent and incident) dialyzed in our 16 HD centers. The variables analyzed were: type of VA (central venous catheter-CVC, AVF and AVG) created, percentage of CVC in incident and prevalent HD, CVC-related hospitalizations and complications (infection, extrusion, disfunction, catheter removal) and percentage of CVC-HD sessions that did not reach the goal of KT(KT> 45) as marker of HD adequacy. Results 1791 VA for HD were created and 905 patients started HD during the study period. Patients who underwent vascular access surgery during COVID period compared to those who did not were significantly younger and a significant decrease of surgical activity to create AVFs and AVGs in older HD patients (> 75 and > 85 years) was observed in COVID period compared to Pre-COVID period. There was a significant increase in CVC placement (from 59.7% to 69.5%) (p<0.001) from the pre-COVID to the COVID time-period. During COVID pandemic a significantly higher number of patients started HD through a CVC (80.3% vs. 69.1%, p<0.001) The percentage of CVC in prevalent HD patients has not decreased 19 months after the start of the pandemic (414 CVC/1058 prevalent patients (39.4%). No significant changes were detected in CVC-related hospitalizations between the pre-COVID and COVID periods. In COVID period a significant increase in catheter replacement and in the percentage of HD session that not reach the HD dose objective (KT> 45) was observed. Conclusions COVID has presented a public health system crisis that has influenced VA for HD with an increase of CVC relative to AVF. A decrease in HD session that not reach the HD dose objective was observed in COVID period compared to preCOVID period.

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