Upper limb isometric exercise protocolled programme and arteriovenous fistula maturation process
Tapia González, Irati (Universitat Autònoma de Barcelona. Departament de Medicina)
Esteve Simó, Vicent (Consorci Sanitari Terrassa)
Ibáñez Pallarès, Sara (Consorci Sanitari Terrassa)
Moreno Guzman, Fátima (Consorci Sanitari Terrassa)
Fulquet Nicolás, Miquel (Consorci Sanitari Terrassa)
Duarte Gallego, Verónica (Consorci Sanitari Terrassa)
Saurina Solé, Anna (Consorci Sanitari Terrassa)
Pou Potau, Mónica (Consorci Sanitari Terrassa)
Yeste Campos, Montserrat (Consorci Sanitari Terrassa)
Ramírez de Arellano Serna, Manel (Consorci Sanitari Terrassa)

Data:	2020
Resum:	Arteriovenous fistula (AVF) is the gold standard for vascular access (VA) for end-stage chronic kidney disease (CKD) patients. Post-operative exercises may help to improve maturation. Nevertheless, scarce scientific evidence has been reported about their utility to date. Our objective was to assess the effect of a post-operative isometric exercise programme on native VA maturation in patients with stage 5-5D CKD. We performed a 24-month prospective study. After surgery, patients were randomized to the isometric exercise group (EG) or control group (CG). An isometric exercise protocolled programme was performed in the EG. The CG received usual care. Demographic data, muscle strength using a hand-grip (HG) dynamometer, main Doppler ultrasound (DUS) measurements, clinical and DUS maturation and VA complications were assessed at 4 and 8 weeks post-operatively. For 60 sixty patients (30 in the EG), demographic data and HG and DUS measurements at baseline were similar. A significant increase in HG was observed only in the EG at the end of the study (20. 7 ± 8. 1 versus 25. 1 ± 10. 3 kg, P = 0. 001). The EG obtained the highest clinical maturation at 4 (CG 33. 3% versus EG 70%, P = 0. 009) and 8 weeks (CG 33. 3% versus EG 76. 7%, P = 0. 002). Similarly, DUS maturation was better in the EG at 4 (CG 40% versus EG 80%, P = 0. 003) and 8 weeks (CG 43. 3% versus EG 83. 3%, P = 0. 003) and remained so in the EG for both distal and proximal VA territories for all these periods. The upper limb isometric exercise protocolled programme improved clinical and DUS maturation in our patients in both the distal and proximal VA territories. Further studies are required to support these results.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Chronic kidney disease ; Isometric exercise ; Maturation ; Vascular access
Publicat a:	Clinical Kidney Journal, Vol. 14 Núm. 2 (February 2021) , p. 688-695, ISSN 2048-8513

DOI: 10.1093/ckj/sfz194
PMID: 33623693

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