Vascular access care accounts for a third of ESRD cost and is a leading cause of morbidity in hemodialysis (HD) patients. We designed this study to identify the risk factors for vascular access infection and to determine the cost of related hospitalizations. Methods: All HD patients at DCI Oakland from 1/1/99 to 6/30/02 were prospectively studied for access type, infections (Infx) including bacteremia, exit site, tunnel or cellulitis, and related hospitalizations. Cost data was obtained from the inpatient electronic medical record system. Risk factors for infection were evaluated using Poisson regression analysis, and cost comparison was done using ANOVA. Results: 153 patients were included in the analysis and were grouped by type of access: temporary catheter (TC) n = 84, permanent/tunneled catheter (PC) n = 158, AV graft (AVG) n = 87 and AV fistula (AVF) n = 57. Univariate analysis revealed significant risk factors to be female gender (p = 0.004, RR = 1.85) and type of access. In multivariate analysis, compared to AVF, risk of infection was highest with TC (p < 0.001, RR = 44), followed by PC (p < 0.001, RR = 17) and AVG (p = 0.03, RR = 3). Age, gender, and diabetes were not predictors of infection. The cost per hospitalization in the PC vs. AVG groups was not significantly different. Access type TC PC AVG AVF # Infx/1000 access days 5.0 3.8 0.6 0.1 % Infx requiring hospitalization 12.5 12.2 58.0 60.0 Cost/hosp. admission (mean) $16,896 25,683 9,016 5,650 Conclusions: Catheters are associated with much higher vascular access infection rates when compared to fistulas and grafts. When AVFs or AVGs do become infected, they are more likely to require hospitalization. Infections severe enough to require hospitalization result in similar inpatient cost per admission regardless of access type; however, this may be due to small sample size.