A randomized controlled trial of the effect of post-operative hand exercise training on arteriovenous fistula maturation in patients with chronic kidney disease

ABSTRACT Objective Immature arteriovenous fistula (AVF) is a critical problem in chronic kidney disease (CKD) patients after creation. Exercise with 30% maximum voluntary contraction (MVC) encourages vascular functions in other populations. It is unknown which exercise type is superior on maturation in CKD population. We compare effects of isometric- (ISM) and isotonic-hand exercise training (IST), both at 30% MVC, on AVF maturation and grip strength in CKD patients. Methods Fifty CKD patients were randomized into ISM program or IST program (25 per group). Each group performed exercise program at intensity of 30% MVC every day for 10 weeks. Cephalic vein (CV) and brachial artery diameters and brachial blood flows, and grip strength were measured at weeks 0, 2, 6, and 10 of program. The number of patients meeting clinical and ultrasound (US) maturation were evaluated at weeks 2, 6, and 10. Results At weeks 6 and 10 of the programs, ISM group had greater CV diameters (week 6, 7.1±1.2 versus 6.2±1.0 mm; week 10, 7.1±1.0 versus 6.2±1.1 mm) than the IST group. Compared to the IST, the ISM had a higher number of patients meeting US maturation at weeks 2 (IST/ISM=8/2), 6 (16/8), and 10 (21/12), and clinical maturation at week 10 (25/18). No adverse events were observed throughout the study. Conclusions At 30% MVC, ISM is more effective at promoting increases in cephalic vein diameter and maturation than IST. Both exercise types are feasible and safe for CKD patients after AVF creation.