Effect of a postoperative exercise program on arteriovenous fistula maturation: A randomized controlled trial.
Exercises after arteriovenous fistula (AVF) creation may help to improve maturation; however, their usefulness has only been examined in indirect, non-comparative studies or small trials. Between June 2013 and November 2014, we included all ambulatory patients with stages 5-5D chronic kidney disease who were candidates for the creation of a native AVF in our center. After surgery, all patients were randomized to an exercise group or a control group with single-blind control. At 1 month postoperatively, clinical maturation (expert nurse inspection) and ultrasonographic maturation (flow >500 mL/min, venous diameter >5 mm and depth <6 mm) were assessed in all patients. A total of 72 patients were randomized, 3 were lost to follow-up, and 69 were finally analyzed. The mean age was 66.8 years (standard deviation 13.8), 70.0% were men, and 65.2% were in pre-dialysis. After surgery (42.0% had distal AVF), the patients were randomized (31 controls, 38 exercise group). At 1 month after surgery, global clinical and ultrasonographic maturation was assessed in 88.4% and 78.3% of AVF, respectively (kappa = 0.539). Non-significant differences in clinical or ultrasonographic maturation were seen between exercise and control group (94.7% vs. 80.6%, P = 0.069; 81.6% vs. 74.2%, P = 0.459). A stepwise logistic regression was performed to control previously analyzed asymmetrically distributed confounding factors (AVF localization), revealing that the exercise group showed greater clinical, but not ultrasonographic, maturation (odds ratio [OR] 5.861, 95% confidence interval: 1.006-34.146 and OR 2.403, 0.66-8.754). A postoperative controlled exercise program after AVF creation seems to increase 1-month clinical AVF maturation in distal accesses. Furthermore, exercise programs should be taken into account, especially in distal accesses.
Department of Nephrology, Vascular Access Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain.
Néstor
N
Fontseré
Department of Vascular Surgery, Vascular Access Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain.
Gaspar
G
Mestres
Department of Vascular Surgery, Vascular Access Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain.
Xavier
X
Yugueros
Department of Nephrology, Vascular Access Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain.
Teresa
T
López
Department of Nephrology, Vascular Access Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain.
Anna
A
Yuguero
Department of Interventional Radiology, Vascular Access Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain.
Patricia
P
Bermudez
Department of Interventional Radiology, Vascular Access Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain.
Fernando
F
Gomez
Department of Vascular Surgery, Vascular Access Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain.
Vicenç
V
Riambau
Department of Nephrology, Vascular Access Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain.
Francisco
F
Maduell
Department of Nephrology, Vascular Access Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain.
Josep M
JM
Campistol
D000328:Adult; D001164:Arteriovenous Fistula / Q000534:rehabilitation*; D001166:Arteriovenous Shunt, Surgical / Q000534:rehabilitation*; D015444:Exercise / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D006435:Renal Dialysis / Q000009:adverse effects*; D051436:Renal Insufficiency, Chronic
Chronic kidney disease; arteriovenous fistula (AVF); clinical parameters; exercise; maturation; ultrasonographic parameters