【Abstract】Objective To investigate the factors affecting the maturation of arteriovenous fistula (AVF) and its complications. Methods A total of 390 cases with end stage renal disease (ESRD) and AVF operation were prospectively studied. Factors relating to the maturation of AVF and its complications, such as primary cause of ESRD, diameter of the artery and vein, and anastomosis size of AVF, were analyzed during the follow-up period of more than four months. Results A total of 413 AVF operations were performed in the 390 patients, of which 370 were the operation for the first time, and 43 were the operation of second time. The operation failed in 43 cases (10.4%), due to immaturation of the AVF in 34 cases and dysfunction of the AVF after use for 6-12 months in 8 cases. Of the 43 cases, ultrasound Doppler examination revealed thrombosis in the AVF in 22 cases. AVF failure correlated with diabetes mellitus, arterial thickening, and anastomosis size of AVF, but unrelated with age, sex, diameter of artery and vein, anastomosis site and postoperative anticoagulation therapy. Diabetes mellitus (OR=2.72, 95% CI=1.18-6.28, P=0.019) and anastomosis size (OR=0.12, 95% CI = 0.02- 0.62, P=0.011) were the independent risk factors for the fistula failure. Conclusion Fistula failure occurred in 10.4% patients. The major cause of fistula failure was thrombosis. Diabetes mellitus and anastomosis size were the independent risk factors for the fistula failure.