Introduction: Arteriovenous fistula (AVF), permanent catheter (PC), and vascular graft are three vascular access types used for hemodialysis (HD) procedure. Due to insufficient reliable information on the comparison between AVF and PC. This study was conducted to compare AVF and PC regarding adequacy of dialysis. Material and Methods: This prospective study was carried out in tertiary care center over 6 months (Jan 2021 to June 2021). In this study, 100 HD pts were enrolled and assigned to two unequal groups of AVF and PC. Before and after the dialysis session, blood samples were taken for laboratory examinations and measurement of urea reduction ratio and Kt/V. The patients were followed up for six months, and then laboratory examinations were repeated. Results: Out Of the 100 HD pts, 40 had AVF and 60 patients on PC. During the 6-month follow-up, 30 patients in PC group but only two patient in AVF group showed infection (P = 0.050), while in each group, thrombosis were seen in 6 patients on PC and 4 patients of AVF (P = 0.50). Catheter dysfunction was seen in 15 patients of PC group and one patients of AVF group (P = 0.0001).There was no difference between the two groups in Kt/V and URR at the beginning of the study; however, after six months, Kt/V and URR were greater in AVF group (P< 0.05). Conclusion: We found better dialysis adequacy in AVF group & there were some advantages of AVF over PC, such as lower rate of infection and thrombosis. We recommend that AVF be created in all of patients with chronic kidney disease who are candidates for HD.