Patients in maintenance hemodialysis (MHD) need a patent vascular access for optimal treatment. Autologous arteriovenous fistula (AVF) is the optimal vascular access for patients with MHD. However, AVF dysfunction may limit its use. The aim of this article is to explore the factors associated with primary dysfunction of AVF in patients with MHD. This is a retrospective study. A total of 121 patients who underwent anastomosis for AVF in our hospital from January 1st, 2016 through December 31st, 2018 were screened for eligibility. Of these patients, 44 were excluded according to the exclusion criteria. The remaining patients were divided into two groups based on the function of vascular access. The complete blood count and other blood biochemical parameters were compared between two groups. The risk factors associated with AVF dysfunction were analyzed by multivariate Cox proportional hazard regression model for patients with end-stage renal disease (ESRD). There were significant differences in serum phosphorus (P), total cholesterol (TC), low density lipoprotein (LDL) and gender between patency and dysfunction groups of AVFs (P<0.05). Further multivariate COX proportional risk regression showed that hypercholesterolemia and hyperphosphatemia were independent risk factors for AVF dysfunction. Hypercholesterolemia and hyperphosphatemia are independent risk factors for primary AVF dysfunction in patients with MHD.