Abstract Background and Aims Guidelines to create vascular access for elderly patients is guided by a number of factors i.e. competing risk of death, high rate of arteriovenous fistula (AVF) maturation failure, and poor vascular access outcomes, influencing the outcomes in this population . Does early creation of AVF in elderly patients with advanced CKD influence dialysis outcomes needs evaluation. Method We conducted a retrospective study among elderly (> 65 years ) who chose to create a permanent vascular access before dialysis initiation were identified between Jan 2014-Jan 2017 in Tertiary care hospital, Lucknow and assessed in 43 elderly patients (aged ≥65 years) with CKD undergoing predialysis AVF . Results They were observed for the frequencies of dialysis initiation, death before dialysis initiation, and dialysis-free survival for 2 years after vascular access creation. 45.6 % were diabetic, 78.9% were hypertensive, and 14.2 % had peripheral vascular disease. In all, 67% of patients with predialysis AVF initiated dialysis within 1 years of access placement, but the overall risk of dialysis initiation was modified by patient age. Only one half of patients initiated dialysis with a functioning AVF, 47.9% of AVFs were created <90 days before dialysis initiation. The primary patency rates were 42.7% at one year and 37.8 % at 2 years. Catheter dependence at dialysis initiation was more common in patients receiving predialysis AVF. In conclusion, most elderly patients with advanced CKD who received predialysis vascular access creation initiated dialysis within 1 year. As a consequence of late predialysis placement or maturation failure, almost one half of patients receiving AVFs initiated dialysis with a catheter. Conclusion Insertion of an AVF closer to dialysis initiation may serve as a “catheter-sparing” approach and allow delay of permanent access placement in selected elderly patients with CKD.