 Factors that influence vessel remodelling following fistula formation have been under investigated in this important aspect in the management of kidney disease. Arterial stiffness refers to the distensability, compliance and elastic modulus of the arterial vascular system. It is found to increase with age, diabetes mellitus, atherosclerosis and end stage renal disease. Aortic pulse wave velocity is considered the gold standard for assessing arterial stiffness and the pulse wave VicorderSkidmore Medical is a non-invasive, easy to learn and reproducible method of assessing stiffness. Increased aortic pulse wave velocity has been independently associated with adverse cardiovascular outcome in large prospective studies including specifically patients with end stage renal failure. Advanced glycation end products AGEs have also been implicated in the development of vascular pathology resulting in AVF failure. The measurement of advanced glycation end products, using the AGE readerDiagnoptics Technologies, offers a new avenue to establish the association between AGE levels and AVF outcomes. Furthermore, potential therapeutic options exist for improving the AGE-related vascular biology of AVFs with evidence that aminoguanine, ALT-946, ALT-711, statins, pyrodoxamine and dietary modifications can reduce AGE levels. Endothelial function is another aspect of arterial health that has been under reported in vascular access research. The INVOS spectra machine uses near infrared spectroscopy to measure the mixed arteriovenous saturations of deep tissues as a reflection of perfusion. Manipulation of this environment using a vascular occlusion test can provide invaluable information regarding endothelial responsiveness. Patient reported symptoms of vascular health may also provide important information in the search for novel predictors of AVF outcomes. Many vascular diseases have associated symptoms that reflect severity and direct questioning of patients regarding the vascular health of their upper limbs may offer further guidance in the placement of AVF. 