Background: Though arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis, some of end-stage renal disease (ESRD) patients inevitably start dialysis via central venous catheter (CVC). We aimed to investigate the relationships between hemodialysis vascular access and all-cause mortality in a large prospective cohort. Methods: A total of 1461 patients who newly initiated hemodialysis and had available data for the first vascular access were prospectively enrolled between August 2008 and September 2014. The initial vascular access type were classified into AVF, arteriovenous graft (AVG), and CVC. The access type which was investigated 3 months or 12 months after dialysis was considered as permanent vascular access for each patient. The primary outcome was all-cause mortality and the secondary outcome was all-cause hospitalization. Results: Among 1461 patients, we identified 314 patients who started hemodialysis via AVF, 76 via AVG, and 1,071 via CVC. Compared among three groups, patients with AVG were older, showed higher rate of diabetic ESRD, higher rate of comorbidities including cerebrovascular disease and peripheral vascular disease. The portion of early referral to nephrologist was higher in the order of AVF>AVG>CVC. In the Kaplan-Meier analysis, patients with AVF or AVG showed significantly better survival compared with patients with CVC (p=0.015). The number of annual hospitalization were not different among the groups. The permanent access data was available in 856 patients which were divided into 703 patients with AVF and 153 with AVG. The survival was better in patients with AVF than patients with AVG (p<0.001). The number of annual hospitalization was higher in the AVG group (0.75 vs. 1.08, p=0.023) which had . Conclusions: AVF and AVG group showed better survival compared to CVC group in a large prospective cohort study in Korea. AVF and AVG should be preferred as an access for hemodialysis, and early referral might facilitate it.