Background: According to KDOQI   guidelines, the lower  limit  of  arteriovenous  fistula  blood  flow  accounting  for  600  ml / min. We  have  observed  that  this  limit  was  not  enough, at  least  for our  patients. The aim of this work was to prove the hypothesis that this limit must be higher for performing adequate dialysis.      Patiemts and methods : Fifty  patients  on  prevalent  hemodialysis   were  included  in this study. They were divided into 3 groups;  group I: 12  patients  formed  low  flow group, group II: 18  patients  formed  moderate  flow group , and group III: 20  patients  formed  high  flow group . Complete  physical  examination including  clinical   fistula  examination  for  patency , were  performed  for  all  patients . Laboratory  tests  performed  for  all patients  included :urea reduction ratio (URR %)  , serum  calcium ,serum  phosphorus ,  calcium – phosphorus  product  ,  serum  albumin  ,  hemoglobin  ,  serum Iron  ,  serum  ferritin  ,TIBC , Transferrin saturation (TSAT %) ,  Kt / V (number used to quantify hemodialysis treatment adequacy), serum  creatinine  , together  with   blood  urea  before  and  after  session . Fistula  blood  flow  and  static  venous  pressure  were  determined  by  Doppler  ultrasound . Fistulogram was performed to confirm the fistula stenosis site , whenever detected by Doppler . Results: Mineral  bone  profile  markers  , Iron  profile  markers  , together  with   malnutrition – inflammation  complex  indicators  ,   were  all   in  favour  of  moderate  and  high  flow  groups  ,  mainly  the  moderate  flow  group II  due  to  the  presence  of  much  less  complications  than  the  other  groups . Conclusion: We  have  to  try  to  perform  arteriovenous  fistulae  for  ESRD  patients  needing  regular  dialysis  ,  in  such  a  way  that  fistula  blood  flow  is  above  800  ml / min  , and it  is  better  to  be  within  the  range  of  801 – 1600  ml / min .