Arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis in patients with end-stage renal disease (ESRD) due to its long-term patency and lower complication rates. However, AVF placement may lead to complications affecting the ipsilateral upper limb, including muscle weakness, hand grip reduction, and functional limitations. This study aimed to compare hand grip strength before and three months after AVF placement in ESRD patients. A quasi-experimental study was conducted at the Department of Nephrology, Mayo Hospital Lahore, enrolling 60 patients aged 20–60 years undergoing AVF placement. Hand grip strength was measured using a manual dynamometer with standardized positioning, and the mean of three readings was recorded in kilogram-force (kg-f). Measurements were taken before AVF placement and repeated three months postoperatively. The mean pre-AVF hand grip strength was 37.0 ± 10.0 kg, while post-AVF it decreased to 24.0 ± 11.0 kg, demonstrating a statistically significant reduction (p < 0.001). Subgroup analysis revealed a greater reduction in brachiocephalic AVFs compared to radiocephalic AVFs (14.5 ± 3.2 kg vs 11.2 ± 2.9 kg, p = 0.02). These findings indicate that AVF placement is associated with a significant decline in ipsilateral hand grip strength within three months. Awareness of this functional impairment is important for patient counseling and may inform physiotherapy or exercise interventions to preserve muscle function. Further longitudinal studies are warranted to assess long-term recovery and functional outcomes