: Our altered order of preference enabled us to create all the first-time fistula in the distal forearm, providing all the advantages of distal fistula like RC-AVF and avoiding proximal fistula, improved patient convenience and short-term benefit. In an inference that may be used for references and needs support from a larger sample and longer duration study from other centers, UB-AVF may be considered as the second option after RC-AVF depending on the clinical scenario.