One of the biggest misconceptions about dialysis is that an AV fistula is made only after dialysis starts.

It isn’t.

In fact, the best time to create an AV fistula is before dialysis is needed.

Think of it this way. The seat belt is worn before the journey—not after the accident You prepare in advance.

Why should an AV fistula be created early?

An AV fistula is a small surgical connection between an artery and a vein, usually in the arm. Over the next few weeks, the vein becomes larger and stronger, making it the safest and most reliable way to perform dialysis.

But here’s the important part—it takes time to mature.

Most fistulas need 6 to 12 weeks, sometimes even longer, before they can be used. That’s why nephrologists usually recommend creating one 3 to 6 months before dialysis is expected to begin.

If you wait until dialysis becomes an emergency, there may not be enough time. In that situation, patients often need a temporary dialysis catheter. While catheters are lifesaving when urgently required, they are associated with a much higher risk of infection, clotting, and repeated hospital admissions.

What happens if you wait?

Creating a fistula early doesn’t mean you’re starting dialysis tomorrow.

It simply means you’re prepared.

When should you discuss an AV fistula?

If your kidney function is steadily declining, your eGFR is approaching 15 mL/min, or your nephrologist feels dialysis may be needed in the coming months, it’s time to discuss a fistula.

The key message

Remember, an AV fistula is more than a surgical procedure.

It is your lifeline.

Planning ahead means safer dialysis, fewer complications, and a smoother journey when the time comes