Impact of a 6-Week Preoperative Exercise Program on AVF Outcomes in ESKD: Real World Experience

Background Arteriovenous fistulas (AVFs) are the preferred vascular access for hemodialysis (HD); however, primary failure remains a significant concern. Postoperative exercise is often recommended. Emerging evidence suggests potential benefits of preoperative exercise in improving AVF outcomes. This study aimed to evaluate the impact of a preoperative upper limb exercise regimen on vessel diameters and AVF maturation rates in patients scheduled for radiocephalic AVF creation at a tertiary care center in India. Materials and Methods Thirty patients with ESKD scheduled for radiocephalic AVF creation were prospectively recruited from the Department of Urology, AIIMS Patna. The participants undertook a supervised 6-week self-directed daily upper-limb exercise program. The baseline and post-exercise cephalic vein and radial artery diameters were measured using duplex ultrasonography. Handgrip strength was also assessed. Patients were followed up for 6 months postoperatively to assess the primary AVF failure rates. Results Mean hand grip strength significantly improved from 19.8±5.9 kg to 21.5±6.2 kg (p=0.008) after the exercise. Cephalic vein diameter did not change significantly in all patients (from 2.15±0.65 mm to 2.28±0.70 mm, p=0.09). However, in patients with high adherence (≥ 34 days of exercise, n=18), a statistically significant increase in the mean cephalic vein diameter at the wrist was noted (from 2.18±0.60 mm to 2.40±0.68 mm, p=0.02). The primary AVF failure rate at 6 months was 23.3% (7/30 patients). Conclusion Preoperative upper limb exercise therapy demonstrated a positive trend of increasing venous diameter, particularly in adherent patients, and was associated with improved handgrip strength. These findings suggest a potential role of preoperative exercise in optimizing the conditions for AVF creation.