Arteriovenous Fistula
Conditions
Keywords
Arteriovenous Fistula, Pre-operative Exercise, Fistula Maturation
Brief summary
To investigate the effect of pre-operative exercise on 1. Hemodynamics in the fistula artery and vein, pre and post AV fistula formation 2. Suitability of cannulation of AV fistula at 8weeks
Detailed description
Aim: To investigate the effect of pre-operative exercise on hemodynamics in the fistula artery and vein, pre and post AV fistula formation as well as the suitability of cannulation of AV fistula at 8weeks post sugery Methodology: This is a randomised control study with 20 patients each in the exercise arm and the control arm. The subjects will be randomised 1:1 into one of the two groups. Chronic Kidney failure patients with eGFR less than 20mls/min and have chosen Haemodialysis as their modality of renal replacement therapy will be included the study. All the subjects will have an ultrasound doppler vein mapping done prior to entering the study. The exercise protocol for the intervention group will be to squeeze a soft ball 10 times for set and perform 3 sets of 10 squeezes each at an 1 minute interval. Three sets of exercises to be performed twice in the morning and twice in the evening, for a total of six weeks. All patients will have a follow up ultrasound doppler of the AV fistula at 8 weeks and 16 weeks post-surgery, looking at the AV fistula vein diameter, arterial diameter and blood flow rate. All the subjects will also be seen by a single vascular surgeon following the scan, to assess the suitability for AVF cannulation. Significance of the proposed study and benefits: A well functioning arterio-venous fistula is the gold standard vascular access for Hemodialysis patients due to its low rates of complications. The primary failure rate of the AVFs remain high at around 20 -25%, contributed by several factors including the diameter of the vessels. If pre-operative exercise improves the hemodynamics of the AV fistula and aids the maturation rate in our study, it can be incorporated into clinical guidelines to reduce the primary failure rate of AV fistulas.
Interventions
BEHAVIORALHand Exercise
Exercise protocol for the intervention group will be to squeeze a soft ball 10 times for set and perform 3 sets of 10 squeezes each at an 1 minute interval. Three sets of exercises to be performed twice in the morning and twice in the evening, for a total of six weeks.
Sponsors
Changi General Hospital
Study design
Allocation
RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
SINGLE (Caregiver)
Masking description
Care Provider i.e., vascular surgeon are blinded to subject randomisation
Eligibility
Sex/Gender
ALL
Age
21 Years to 90 Years
Healthy volunteers
No
Inclusion criteria
1. Chronic Kidney failure patients with eGFR less than 20mls/min 2. Chosen Hemodailysis as their modality of renal replacement therapy
Exclusion criteria
1. Potential fistula vein diameter less than 3mm (with application of tornique) on initial vein mapping 2. Known left ventricular ejection fraction of less than 20% on Echocardiogram 3. Previous stroke effecting the AV fistula arm 4. Calcified brachial or radial arteries and/or duplex evidence of stenosis of \>50%
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Hemodynamics in the fistula artery and vein, pre and post AV fistula formation | 22 weeks | AV fistula vein diameter, arterial diameter and blood flow rate will be assessed and compared |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Suitability of cannulation of AV fistula | 8 Weeks | Assessment of suitability of AV fistula cannulation by blinded vascular surgeon 8 week post creation |
| Secondary fistula failure | 1 year | Fistula outcomes will be assessed to review the need for angiographic procedures for AVF maturation and also look at secondary fistula failure |
Contacts
Primary ContactSreekanth Koduri
Outcome results
None listed