Patient with chronic kidney disease will need to receive hemodialysis as the renal function deteriorated. According to KDOQI 2006, a patient in Chronic kidney disease stage IV (eGFR 15-30ml/min/1.73m2) is expected to initiate hemodialysis treatment within 6 months. However, some patients receive AVF creation but did not receive hemodialysis 6 months to 1 year after then. Sometimes, they suffered from congestive heart failure after surgery of AVF creation. To seek the best timing for vascular access creation, there are more consideration need to be made.