We recommend optimizing the placement of autogenous accesses using the following operative strategies:

1. AV accesses are placed as far distally in the upper extremity as possible to preserve proximal sites for future accesses (Grade 1, Level C).
2. When possible, autogenous AV accesses should be considered before prosthetic arteriovenous accesses are placed. These autogenous access configurations should include, in order of preference, the use of direct AV anastomosis, venous transpositions, and translocations (Grade 1, Level C).
3. Upper extremity access sites are used first, with the non-dominant arm given preference over the dominant arm only when access opportunities are equal in both extremities (Grade 1, Level C).
4. Lower extremity and body wall access sites are used only after all upper extremity access sites have been exhausted (Grade 1, Level C).