Background: Arteriovenous fistula (AVF) is the vascular access of choice for End-Stage Renal Disease (ESRD) patients on maintenance hemodialysis. Arteriovenous fistula is the vascular access of choice for adequate hemodialysis.AVF dysfunction is one of the most important causes of morbidity and mortality in these patients. Aim: To access the frequency of dysfunctional AFVs using clinical examination among end-stage renal disease patients on thrice-weekly maintenance hemodialysis. Study design: Cross-sectional study Place and duration of study: Dialysis Unit, Nephrology Department, Sir Ganga Ram Hospital, Lahore from 21st January 2019, to 21st July 2019. Methodology: 177 patients who had end-stage renal disease and were on maintenance hemodialysis were enrolled. Fistulas were examined clinically. The presence and types of dysfunctional AVF were recorded. Results: Fifty three (29.9%) were females and 124 (70.1%) were females with mean age was 48±13.29 years. There were 44.1% diabetic, 91.0% hypertensive, and 44.1% both diabetic and hypertensive. The frequency of dysfunctional arteriovenous fistula was 30.5%. 123 (69.5%) patients had normal fistula, 13 (7.3%) had signs of outflow obstruction, 23 (13.0%) had aneurysm, 5 (2.8%) had signs of inflow obstruction, and 13 (7.3%) had a weak or absent thrill/bruit however no infection or steal syndrome was present. Conclusion: The frequency of dysfunctional arteriovenous fistula among patients on thrice-weekly maintenance hemodialysis is 30.5% on physical examination. Periodic physical assessment of AVF can reduce fistula failure rates. Key words: End-stage renal disease, Haemodialysis, Arteriovenous fistula