Objective To analyze the changes of blood pressure rhythm and blood pressure variability in maintenance hemodialysis patients with early failure after arteriovenous fistula, and to explore the risk factors affecting early failure after arteriovenous fistula in hemodialysis patients, to provide reference for early clinical intervention. Methods A total of 122 patients undergoing maintenance hemodialysis who were admitted to Jieyang People's Hospital from July 2020 to November 2020 were selected as the research subjects, carried out prospective study. All patients underwent arteriovenous fistula surgery for the first time, and who were followed up regularly for 1 year after surgery, clinical indicators and ambulatory blood pressure were monitored, and patients were divided into the primary patency group (102 cases) and the early failure group (20 cases) according to whether early failure after arteriovenous fistula occurred, the general conditions, clinical indicators, preoperative color doppler ultrasound parameters of internal fistula, and ambulatory blood pressure monitoring parameters of patients were compared between the two groups; K-M method was used to draw the survival curve of fistula patency rate within 1 year after surgery, and log-rank test was used for comparison, multivariate Cox regression was used to analyze the risk factors of early failure after arteriovenous fistula. Results? Among the 122 patients with maintenance hemodialysis who underwent arteriovenous fistula surgery, there were 20 cases of early failure (16.39%) and 102 cases of primary patency (83.61%); the age, proportion of diabetic patients, platelet count, C-reactive protein, total cholesterol, serum phosphorus, and full-parathyroid hormone levels of patients in the early failure group were significantly higher than those in the primary patency group, cephalic vein diameter, cephalic vein diameter, head venous blood flow, posterior cephalic vein diameter and posterior head venous blood flow were lower than those in the primary patency group; compared with the primary patency group, the 24 h mean systolic blood pressure (24 h SBP), standard deviation of 24 h systolic blood pressure (24 h SBP SD),variation coefficient of 24 h diastolic blood pressure (24 h DBP CV), the proportion of patients with non-dipper blood pressure significantly increased, while the rate of decline in SBP and DBP at night significantly decreased; the patency rate within 1 year in the primary patency group was significantly higher than that in the early failure group; multivariate Cox regression analysis showed that, the level of C-reactive protein level increasing, the preoperative cephalic vein diameter decreasing, non-dipper blood pressure, 24 h SBP SD increasing were the risk factors for early failure of arteriovenous fistula (RR =2.245, 3.334, 3.567, 3.412, all P<0.05). Conclusion C-reactive protein level increasing, the preoperative cephalic vein diameter decreasing, non-dipper blood pressure, 24 h SBP SD increasing are risk factors for early failure of arteriovenous fistula, improving the inflammatory state of maintenance hemodialysis patients and reducing the 24 h SBP SD can reduce the risk of early failure of arteriovenous fistula, at the same time, the preoperative cephalic vein diameter should be closely observed clinically to predict the maturity of internal fistula.