Upper limb isometric exercise protocolled programme and arteriovenous fistula maturation process

Abstract

Introduction. Arteriovenous fistula (AVF) is the gold standard for vascular access (VA) for end-stage chronic kidney disease (CKD) patients. Post-operative exercises may help to improve maturation. Nevertheless, scarce scientific evidence has been reported about their utility to date. Our objective was to assess the effect of a post-operative isometric exercise programme on native VA maturation in patients with stage 5–5D CKD. Methods. We performed a 24-month prospective study. After surgery, patients were randomized to the isometric exercise group (EG) or control group (CG). An isometric exercise protocolled programme was performed in the EG. The CG received usual care. Demographic data, muscle strength using a hand-grip (HG) dynamometer, main Doppler ultrasound (DUS) measurements, clinical and DUS maturation and VA complications were assessed at 4 and 8 weeks post-operatively. Results. For 60 sixty patients (30 in the EG), demographic data and HG and DUS measurements at baseline were similar. A significant increase in HG was observed only in the EG at the end of the study (20.7 6 8.1 versus 25.1 6 10.3 kg, P ¼ 0.001). The EG obtained the highest clinical maturation at 4 (CG 33.3% versus EG 70%, P ¼ 0.009) and 8 weeks (CG 33.3% versus EG 76.7%, P ¼ 0.002). Similarly, DUS maturation was better in the EG at 4 (CG 40% versus EG 80%, P ¼ 0.003) and 8 weeks (CG 43.3% versus EG 83.3%, P ¼ 0.003) and remained so in the EG for both distal and proximal VA territories for all these periods. Conclusions. The upper limb isometric exercise protocolled programme improved clinical and DUS maturation in our patients in both the distal and proximal VA territories. Further studies are required to support these results.