A Randomized Trial of Postoperative Handgrip Exercises for Fistula Maturation in Patients With Newly Created Wrist Radiocephalic Arteriovenous Fistulas

Jeng-Wei Chen; Hsun-Yi Fu; Ing-Heng Hii; Hsien-Wei Tseng; Po-Ya Chang; Chin-Hao Chang; Yih-Sharng Chen; Ron-Bin Hsu; I-Hui Wu; Yung-Ming Chen; Tzong-Shinn Chu; Kuan-Yu Hung; Shuei-Liong Lin; Kwan-Dun Wu; Chih-Yang Chan

doi:10.1016/j.ekir.2022.12.019

A Randomized Trial of Postoperative Handgrip Exercises for Fistula Maturation in Patients With Newly Created Wrist Radiocephalic Arteriovenous Fistulas

Kidney Int Rep. 2022 Dec 24;8(3):566-574. doi: 10.1016/j.ekir.2022.12.019. eCollection 2023 Mar.

Authors

Affiliations

¹ Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
² Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan.
³ Division of Cardiovascular Surgery, Department of Surgery, Dalin Tzu Chi General Hospital, Chiayi, Taiwan.
⁴ Department of Surgery, Taitung MacKay Memorial Hospital, Taitung, Taiwan.
⁵ Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
⁶ Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan.
⁷ Renal Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.

Abstract

Introduction: We aimed to substantiate the benefit of postoperative handgrip exercises (HGEs) in enhancing the maturation of an arteriovenous wrist fistula.

Methods: We randomly assigned 119 patients aged 20 to 80 years who had wrist arteriovenous fistulas (AVFs) to undergo either a basic HGE program (group A), an advanced program (group B), or an advanced-plus upper arm banding program (group C). Outcomes were assessed by ultrasonographic evaluation of the diameter and flow at each follow-up. The attending nephrologist decided the clinical use of the fistula.

Results: We identified no significant differences among the HGE groups in the mean diameter and blood flow 14, 30, 60, and 90 days after the creation of the wrist AVF (P = 0.55, 0.88, 0.21, and 0.19 for the diameter; 0.94, 0.81, 0.49, and 0.56 for the flow, respectively). The intent-to-treat analysis also found no difference in the clinical use of fistulas for hemodialysis (HD) (P = 0.997).

Conclusion: In patients with a newly created wrist AVF, advancing frequency, with or without adding intensity using an upper arm tourniquet, of postoperative HGEs did not enhance the growth of the fistula or increase the rate of clinical use over 3 months. (ClinicalTrials.gov ID: NCT03077815).

Keywords: exercise; hemodialysis; surgical arteriovenous shunt.

Associated data

ClinicalTrials.gov/NCT03077815