The Effect of Arm Exercise on Arteriovenous Fistula Maturation in Chronic Kidney Disease Patients

Abstract

Arteriovenous fistula (AVF) failure has been recognized as a critical problem in chronic kidney disease patients (CKD) with hemodialysis. Arm exercise training before and after surgery is recommended to reduce the AVF failure and promote AVF maturity. However, there has been inconclusive evidence on benefits of such arm exercise programs. The first part of this study aimed to investigate effectiveness of post-operative isometric hand exercise training on AVF maturation in CKD patients. The CKD patients were randomly allocated into isometric-hand exercise training (ISM) or isotonic-hand exercise training (IST) (25 per group). Each patient performed daily exercise at 30% of maximum voluntary contraction (MVC) for 10 weeks. Outcomes included vein and artery diameters, vein and artery blood flows, ultrasound and clinical maturations, and ultrasound and clinical maturation times. The outcomes were assessed at week 0 (the day of surgery), week 2, 6, and 10 of exercise, The results illustrated that the ISM group had significantly greater in the vein diameter and vein blood flow at week 6 and 10, and significantly higher number of AVF maturation since week 2 than the IST group. The second part of this study aimed to systematically reviewed and quantified the effectiveness of arm exercise training prior to and after AVF operation on AVF maturation in CKD patients. Scopus, CINAHL, PubMed, Science Direct, and Cochrane Library were searched, using keywords involving CKD, AVF maturation, vascular function, and exercise. The results found that arm exercise training increased vessel diameters and grip strength before surgery. According to meta-analysis of effectiveness of post-operative exercise training, the results demonstrated a higher clinical and ultrasound (US) maturation rates, arterial blood flow, and grip strength than controls. Subgroup analysis showed that isometric exercise training promoted clinical and US maturations, while isotonic exercise training only promoted clinical maturation. In conclusion, this study provides scientific evidence that isometric-hand exercise training at 30% MVC is feasible, safe, and effective to facilitate greater AVF maturation than isotonic-hand exercise training. In addition, the findings of this dissertation reveal that pre- and post-operative arm exercise training especially isometric exercise promote AVF maturation measured via clinical and US methods. Therefore, the isometric exercise type may be a suitable option to promote a usable AVF before and after operation in CKD patients.