The effect of preoperative handgrip exercise on functional performance of arteriovenous fistula in chronic kidney disease patients

Abstract

Background Arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis, but its maturation and long-term function are often suboptimal. Preoperative handgrip exercise (HGE) may improve vascular remodeling and enhance outcomes of AVF. This study aimed to evaluate the effect of preoperative handgrip training on vein diameter (VD) and AVF functional performance in patients with chronic kidney disease (CKD). Patients and methods This was a single-center, prospective pilot study including 40 patients with advanced CKD eligible for AVF creation. Candidates were allocated into an exercise group ( n =20), who performed daily HGEs for 8 weeks prior to surgery, and a control group ( n =20), who received standard care without exercise. VDs at the cubital and wrist levels were measured by Doppler ultrasound at baseline, after 8 weeks, and 6 weeks post-AVF creation. AVF maturation and functional performance were assessed by postoperative blood flow and site distribution. Subgroup analysis was performed in patients with diabetes. Results Baseline demographic and clinical characteristics were comparable between groups. After 8 weeks, the exercise group showed significantly greater increases in VD at both the cubital and wrist sites compared with the control group. Postoperatively, the exercise group maintained larger venous diameters (cubital: 6.96 ± 0.17 vs. 6.00 ± 0.13 mm, P <0.00001; wrist: 7.10 ± 0.46 vs. 6.00 ± 0.07 mm, P <0.0001). AVF blood flow (Qa) was higher in the exercise group (915 ± 117 vs. 635 ± 37 ml/min, P <0.0001), and distal fistulas were more common (75 vs. 20%, P =0.03). Among diabetic patients, exercise was associated with significantly larger postoperative VDs and higher blood flow compared with the control group. Conclusions Preoperative HGE is a simple, low-cost intervention that enhances venous dilatation, improves AVF blood flow, and favors distal AVF creation in patients with CKD. These findings support the incorporation of structured exercise into preoperative care to optimize vascular access outcomes. Larger, multicenter studies are warranted to confirm these results.