Effect of a Postoperative Upper Limb Exercise Regimen on Arteriovenous Fistula (AVF) Outcomes: A Randomized Controlled Trial

Background: AVF non-maturation rates vary from 10% to 40%. Post-operative exercises may increase blood flow to the limb and help improve AVF maturation; however, supporting evidence is lacking. We aimed to assess the effect of a postoperative upper limb exercise regimen on AVF maturation, compared to standard soft ball handgrip exercises. Methods: Adults with chronic kidney disease admitted for AVF creation were screened for eligibility. Those with previous failed access in the same limb, immediate vascular access failure and those unable to perform upper limb exercises were excluded. After consent, participants were randomized 1:1 to either an upper limb exercise regimen using a flex band or standard care. Both groups received standard postoperative care and advice on AVF care including handgrip exercises using a soft ball. The primary outcome was AVF maturation at 8 weeks (initially intended to be assessed at 4 weeks but modified prior to unblinding due to low follow-up rates at 4 weeks). AVF maturation (defined as an easily palpable vein with straight segment of ≥ 6cm length and a good thrill, with diameter of ≥ 6mm, skin-vein distance ≤6 mm AND blood flow ≥ 600ml/min on doppler ultrasound) was assessed by a nephrologist blinded to the group assignment. Results: A total of 162 patients were recruited in the study. Baseline characteristics of the study population are tabulated in Table 1. There was no significant difference in the AVF maturation rates at 8 weeks in the two groups (85.5% vs. 85.9%, P= 0.943). Median time to successful AVF cannulation was also similar in both groups (P=0.716). There was also no significant differences in vein diameter and AVF blood flow. Conclusion: Post-operative upper limb flex band exercises did not improve AVF maturation, compared to standard handgrip exercises. Funding: Private Foundation Support