Background: Australia historically has been recognized for its high fistula use. Study Design: Observational study using registry data. Setting Participants: Adult patients registered in the Australia and New Zealand Dialysis and Transplant Association Registry on hemodialysis in Australia. Predictor: Cohort year. Outcomes Measurement: Hemodialysis access trends were examined from 2000 to 2005 for incident patients (within 60 days of hemodialysis therapy start), patients on hemodialysis therapy for 6 to 8 months, and prevalent hemodialysis patients. Multivariate analyses were performed to examine the relationship between access type and cohort year for each group, with adjustment for age, sex, race, body mass index, late referral, smoking status, cause of end-stage renal disease, comorbidities, and dialysis vintage.