Background: Optimal timing of arteriovenous fistula (AVF) surgery in chronic kidney disease (CKD) is uncertain. Methods: A single-centre retrospective study of pre-dialysis CKD patients having first AVF surgery. Results: The median estimated glomerular filtration rate (eGFR) at the time of AVF surgery in 100 patients was 15 ml/min/1.73 m2, with patients classified as having an early AVF if eGFR was >15 ml/min/1.73 m2 (n = 46) or a late AVF if eGFR was ≤15 ml/min/1.73 m2 (n = 54). In the eGFR ≤15 group, 81% of patients started haemodialysis (HD), compared with 63% of the eGFR >15 patients (p = 0.04). The median time to starting HD was 30.3 months in the eGFR >15 group compared to 10.7 months for the eGFR ≤15 group (log rank p = 0.018). There were no differences in the requirements for a dialysis catheter (eGFR >15 24% vs. eGFR ≤15 11%, p = 0.20) or additional access procedures between the two groups. Conclusions: AVF surgery with an eGFR >15 ml/min/1.73 m2 was associated with a higher risk of AVF non-use and a more prolonged time to the need for HD.