Preoperative cephalic vein diameter and diabetes do not limit the choice of wrist radio-cephalic arteriovenous fistula.

Small cephalic vein diameter (<2 mm) and diabetes were independent risk factors for failed wrist radio-cephalic arteriovenous fistulas, but this risk could be overcome by aggressive ipsilateral mid-forearm radio-cephalic arteriovenous fistula to address a failed first attempt. Cephalic vein diameter is more important during the maturation stage, and once maturation has occurred, diabetes has an additive role in determining the patency of wrist radio-cephalic arteriovenous fistula. The "wrist RCAVF first, ipsilateral mid-forearm RCAVF second" strategy is the most clinically significant message of our study.