Background: To evaluate the role of color Doppler ultrasound in pre-operative vascular mapping in hemodialysis arteriovenous fistula assesses the process of AVF maturation and comprehensive evaluation of possible shunt complications in ESRD patients on hemodialysis. Prospective analysis of vascular access related data were obtained from 30 patients (14 male, 16 female and age range 10-67 years) referred from Cairo University Hospital for CDUS examination in upper limbs. All patients were examined pre-operative mapping, post-operative AVF for identify the different types of fistula with their maturity assessment and during hemodialysis for shunt complication with Doppler indices (PSV, EDV and RI) were measured at the site of anastomosis, draining veins and afferent arteries. Volume of blood flow was also measured at the site of anastomosis. The majority of patients who underwent CDUS in our center were female (53.3%) and male (46.7%) with normal vessels diameter. Nine patients had a BB fistula (30%), 14 patients had a RC fistula (46.7%) and 7 patients had a BC fistula (23.3%). The study showed a mean age of AVF maturation occurrence 2.17 ± 0.379 weeks after 1st creation. 17 patient had uncomplicated 56.66% and 13 patients had shunt complication 43.33% (venous thrombosis 16.7% (5 patients) followed by stenosis 10.0% (3 patients) and pseudoaneurysmal formation 10.0% (3 patients), and finally venous hypertension 6.7% (2 patients). The study concluded that CDUS is a noninvasive technique that allows the assessment of both anatomy and haemodynamics of an AVF. This technique is free of any known risk, cheap and can be used at the bedside. CDUS outlines the AVF lumen and allows definition of lumen dimensions and detection of luminal encroachment. The technique also provides important information to the surgeon, thereby potentially increasing the number of AVF reconstruction rather than new shunts.