SUBJECT POPULATION. Investigators will enroll fifty subjects aged over 18 years old with stage 4 or 5 CKD scheduled to undergo AVF creation from the clinic at Albany Medical College. AMC has a long history of providing medical care to underrepresented minorities. In investigators' previous studies women composed 45% of the study population, 30% were black, 10% were Hispanic, and 5% other minority races (Asian, Native American, etc.). Investigators anticipate similar rates of inclusion of women and minorities in the current proposal. It has been reported an increased AVF maturation rate failure in women, therefore, they could potentially benefit more from the proposed intervention. Overall, investigators are not aiming at recruiting patients from specific ethnic or racial group in this study.