Vascular access (VA) dysfunction affects the quality of care in end-stage renal disease (ESRD) patients undergoing hemodialysis. However, comprehensive nationwide data in Japan are limited. Therefore, we estimated VA dysfunction and recurrence and examined their associations with sex, age, and regional variation using the National Database Open Data Japan (NDB Open). We conducted a population-based observational study using the NDB Open for fiscal years 2020-2022. We identified ESRD patients who underwent VA-related procedures based on claims codes. We also calculated annual VA dysfunction rates and 3-month recurrence rates. We used multiple regression models, adjusted for sex, age, and the fiscal year, to examine associations
the regional differences were also evaluated. The average annual VA dysfunction rate was 74.0% (standard error [SE], 1.7%), with a 3-month recurrence rate of 16.9% (SE, 0.5%). Females and older patients showed higher rates. Age correlated positively with the VA dysfunction rate (ρ = 0.827-0.941). VA dysfunction rates varied across prefectures. In Japanese ESRD patients, VA dysfunction showed sex- and age-related differences, along with regional variations. These findings may inform future prevention strategies and research utilizing detailed clinical data.