Dialysis population is currently increasing. In most pediatric units, peritoneal dialysis is the preferred modality of long-term renal replacement therapy. But in the face of co-existing problems, hemodialysis becomes the only available option. There is no specific angioaccess for children, and most vascular access procedures used in adults can be used in the young. We have studied 30 patients on regular HD with variable VA. Thrombotic occlusion was found to be the most common cause of access failure. Infection, primary failure, stenosis, aneurysm and venous edema are others. We conclude that native AVF is the VA of choice in children; however it should be initiated early and monitored regularly. Regular clinical and radiological evaluation; and antiseptic precautions are needed for proper maintenance of the VA function.