The Effect of Post-Operative Handgrip Exercise on the Maturation of Arteriovenous Fistula: a Randomized Controlled Trial

Hand exercise is advised for newly placed arteriovenous fistulae for hemodialysis because of its effects on vein diameter and fistula maturation, however with controversy and inconsistent results. The objective of this study is to evaluate the effect of post-operative handgrip exercise on the maturation of arteriovenous fistula (AVF). A single institution, single surgeon, in-hospital, two arm, open-labeled randomized control trial, comparing exercise group and control group, was conducted between 2017 and 2018. Clinical maturation was defined as the use of AVF for repetitive hemodialysis. Duplex ultrasound (DUS) maturation was defined as the cross-sectional luminal diameter of draining vein > 4 mm and intra-access flow rate > 500 ml/min. Out of 200 patients recruited, 98 were randomized to exercise group and 96 to control and 6 were excluded as they were lost to follow-up. Mean age was 40 ± 13 years, with 71.6% males. Radiocephalic AVF was created in 130/194 (67%) patients. In RCAVF, 104/130 (80%) achieved clinical maturation, 59/104 (56.7%) in exercise group, and 45/104 (43.26%) in control group (p = 0.043). Duplex ultrasound (DUS) maturation was seen in 86/130 (66.2%) cases, 48/86 (55.8%) in exercise group and 38/86 (44.2%) in control group (p = 0.263). In brachiocephalic AVF, clinical maturation was seen in 57/64 (89.1%) cases, 27/57 (47.4%) and 30/57 (52.6%) in exercise and control group respectively (p = 0.821). Duplex ultrasound (DUS) maturation in BCAVF was seen in 57/64 (89.1%) cases, 27/57 (47.4%) in exercise and 30/57 (52.6%) in control group (p value = 0.821). Post-operative handgrip exercise improves clinical maturation in radiocephalic arteriovenous fistula. Registration number: CTRI/2017/04/008283, Registered on 03.04.2017