Abstract: Hemodialysis vascular access is a vital lifeline for maintenance hemodialysis（MHD） patients. They are frequently hospitalized for infection. Some critically ill patients are hemodynamically unstable and can not receive treatment at a hemodialysis center. Therefore bedside continuous renal replacement therapy（CRRT） is required. For those with arteriovenous fistula（AVF）, puncturing or temporary central venous catheterization provide vascular access for CRRT. Using AVF lowers the risks associated with central venipuncture. However, it may carry the risk of AVF injury or dysfunction. Using a temporary central venous catheter protects AVF and yet elevates the risk of central venous puncture related complications. Therefore this review summarized the relevant mechanism and the clinical selection of vascular access during CRRT in MHD patients with AVF. It may guide clinical practices and clinical researches.