Background: The inability of a newly created arteriovenous fistula to support hemodialysis due to non-maturation results in increased complications secondary to catheter dependence. Methods: In view of the highly variable approaches by providers with heterogenous backgrounds (general surgery, vascular surgery, interventional radiology and interventional nephrology, urology, transplant surgery, etc.) we sought to describe a collection of algorithms that have functioned well in our hands to manage this challenging clinical problem and guide trainees and practicing clinicians alike. Results: Physical examination along with selective duplex ultrasound and fistulogram can identify most pathologies underlying non-maturation. Conclusion: Both endovascular and open techniques can be employed to optimize maturation rates in this complex population. © The Author(s) 2022.