Plasma 25 hydroxycholecaliferol (vit D) has been associated with adverse cardiovascular outcomes in epidemiological studies. CKD is associated with loss of 1-α-hydroxylase and vit D deficiency (vit D def). We hypothesized that vit D def is associated with increased mortality and decreased vascular access patency in patients undergoing permanent vascular access for end stage renal disease. Case series of 129 patients undergoing permanent vascular access surgery who also had concurrent plasma vit D levels. Vit D levels were considered deficient at <20 ng/mL, insufficient at 21-29, and normal >30 ng/mL. Mortality and vascular access patency were evaluated using multivariate logistic regression models. The mean age was 66.6, 96.1% were male and 31.8% African American. 61.2% had diabetes mellitus. In the entire cohort 75.2% were either insufficient or deficient. Mean follow up time was 2.96 years during which there were 41 (31.8%) deaths and 79 (64.75%) vascular access events. Vit D deficient patients tended to be younger (P = .007), have higher total cholesterol (P = .0002), and lower calcium levels (P = .031). Despite their younger age, mortality was significantly higher in this group (P = .008) and AVF patency was worse (P = .015). Age, vit D def, CAD, HTN, albumin and HgbA1C were associated with mortality. In multivariate analysis vit D def (OR, 4.26; CI, 1.37-13.28; P = .012), CAD (OR, 3.56; CI, 1.24-10.24; P = .018), age (OR, 1.08; CI, 1.03-1.15; P = .002), and albumin (OR, .23; CI, 0.07-0.74; P = .014) remained significant. Vit D deficiency (P = .036) and low hematocrit (P = .011) were independently associated with a loss of AVF patency. Vit D deficiency is highly prevalent in patients undergoing vascular access procedures. Patients who are deficient have worse survival and more access related events. Further study is warranted to assess whether vitamin D repletion will improve outcomes in this population.