Arteriovenous Fistula, Chronic Kidney Failure, End-Stage Renal Disease
Conditions
Keywords
Arteriovenous fistula maturation, Arteriovenous fistula patency, Hemodialysis vascular access, Chronic kidney disease, End-stage renal disease, Hand-grip exercise, Isometric muscle exercise, Dynamometer training
Brief summary
Patients with chronic kidney failure who require hemodialysis depend on a surgically created connection between an artery and a vein in the arm, known as an arteriovenous fistula. This connection allows blood to flow at a high enough rate for effective hemodialysis treatment. However, many arteriovenous fistulas do not enlarge or strengthen adequately after surgery, a process known as maturation. When maturation fails, the fistula may not provide enough blood flow, leading to delays in hemodialysis, repeated procedures, or the need for temporary catheters. Improving the maturation of arteriovenous fistulas is therefore essential for patient safety, comfort, and the long-term success of hemodialysis. Isometric hand-grip exercises, such as repeatedly squeezing a hand-held dynamometer, may help increase blood flow to the arm and stimulate the blood vessels that are part of the fistula. These exercises require the muscles to contract without changing length, which can encourage enlargement of the vein and the development of new small blood vessels in the forearm. Previous research suggests that improving hand-grip strength may support better vein remodeling and improved blood flow, both of which are important for fistula maturation. This study is designed to evaluate whether performing a structured program of isometric hand-grip exercises using a dynamometer can enhance the maturation and long-term openness (patency) of arteriovenous fistulas in adults receiving hemodialysis. Participants are randomly assigned to one of two groups: a control group that receives routine postoperative care, and an exercise group that performs hand-grip exercises for six weeks. All participants undergo ultrasound imaging of the fistula before starting the study and again after six weeks. The ultrasound measurements include fistula size, vein diameter, blood flow, and blood flow velocity. The goal of this study is to determine whether a simple, low-cost exercise intervention can help arteriovenous fistulas mature more successfully and reduce the need for additional procedures.
Interventions
BEHAVIORALIsometric Hand-Grip Exercise Training Using a Hand Dynamometer
Participants perform a structured isometric hand-grip exercise program using a hand-held dynamometer for six weeks after creation of an arteriovenous fistula for hemodialysis. The grip handle is adjusted to the size of the hand, the elbow is flexed to a ninety-degree angle, and the participant performs repeated maximal voluntary hand-grip contractions according to a standardized schedule. Training is added to usual postoperative care and is monitored during follow-up visits.
Sponsors
Mansoura University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Two-arm parallel randomized controlled study comparing standard postoperative care versus a structured isometric hand-grip exercise program using a dynamometer in adult hemodialysis patients with a surgically created arteriovenous fistula.
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* Adults aged 18 to 75 years * End-stage renal disease requiring hemodialysis * Patients undergoing hemodialysis through a surgically created arteriovenous fistula * Ability to provide written informed consent
Exclusion criteria
* Failure or refusal to provide written informed consent * Amputation of the arm or fingers * Significant osteoarthritis of the hand or wrist * Severe physical disability preventing exercise performance * Active infection or ongoing hospitalization * Known underlying malignancy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in arteriovenous fistula blood flow volume measured by Doppler ultrasound | Baseline and six weeks after starting the hand-grip exercise program or standard care | Blood flow volume through the arteriovenous fistula (milliliters per minute) will be measured using duplex Doppler ultrasound at the outflow vein. The primary metric is the change in blood flow volume from baseline (before starting the hand-grip exercise program or standard care) to six weeks. Change will be calculated as the value at six weeks minus the baseline value for each participant. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in arteriovenous fistula vein diameter measured by Doppler ultrasound | Baseline and six weeks after starting the hand-grip exercise program or standard care | Vein diameter of the arteriovenous fistula (millimeters) will be measured using duplex Doppler ultrasound at the inflow and outflow segments. The metric is the change in vein diameter from baseline to six weeks. |
| Change in hand-grip muscle strength of the dominant hand | Baseline and six weeks after starting the hand-grip exercise program or standard care | Maximum isometric hand-grip strength (kilograms or newtons) will be assessed using a calibrated hand-held dynamometer. Each participant performs three maximal voluntary contractions with the dominant hand, and the mean of the three values is recorded. The metric is the change in hand-grip strength from baseline to six weeks. |
| Clinical usability of the arteriovenous fistula for hemodialysis | Assessed at six weeks after starting the hand-grip exercise program or standard care | Proportion of participants whose arteriovenous fistula can be used successfully for routine hemodialysis, defined as achieving two-needle cannulation with the prescribed blood flow rate during at least three consecutive hemodialysis sessions without access failure or thrombosis. |
Countries
Egypt
Outcome results
None listed