A substantial proportion (28%–53%) of Arteriovenous Fistula never matures adequately. However, if there is any doubt about maturation, the fistula should be evaluated by ultrasound. With US showing evidence of stenosis or multiple draining venous branches and thrombosis, will help to undergo early intervention. Ultrasound minimum venous diameter and blood flow volume measured at 1–2 months with cut–off of flow volume of 500–600 ml/min, calibre up to 4–5mm, can be used to accurately assess the likelihood of maturation. If findings indicate the fistula is unlikely to mature, a new permanent access can be placed, thus reducing the waiting time.