Abstract : Hemodialysis (HD) is the major modality of renal replacement therapy in 70% to 90% of patients. Vascular access is a crucial requirement when performing hemodialysis. The three most common types of vascular access used in clinical practice are arteriovenous fistula (AVF), arteriovenous graft (AVG), and central venous catheters (CVC). In this study, we aimed to understand the association of age of patients with a type of vascular access chosen by the vascular surgeon in Gorgan, Iran. In this cross-sectional study, all the new Hemodialysis (HD) patients (Incidence) and prevalent HD patients underwent hemodialysis in 2 academic hospitals (5 Azar and Sayyad Shirazi) from March 2020 to March 2021 were enrolled. In this study, the association between the age of ESRD patients and the type of vascular access was evaluated. According to One Way ANOVA analysis, there was a statistical difference in the mean age of patients in each starting access group of patients (P-value: 0.00). In PostHoc analysis, there was a statistical difference between the mean age of the AVF group, as starting vascular access, and permanent /Temporary catheters respectively (P:0.017& 0.00). Each individual’s decision of vascular access remains challenging. Placement of an AVF therefore may not be justified if the patient’s life expectancy is predicted to be too short to reap the long-term benefits of a native AVF.