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Effect of a postoperative exercise program on arteriovenous fistula maturation: A randomized controlled trial
Author(s) -
Fontseré Néstor,
Mestres Gaspar,
Yugueros Xavier,
López Teresa,
Yuguero Anna,
Bermudez Patricia,
Gomez Fernando,
Riambau Vicenç,
Maduell Francisco,
Campistol Josep M.
Publication year - 2016
Publication title -
hemodialysis international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 47
eISSN - 1542-4758
pISSN - 1492-7535
DOI - 10.1111/hdi.12376
Subject(s) - medicine , randomized controlled trial , confidence interval , arteriovenous fistula , odds ratio , hemodialysis , ambulatory , dialysis , surgery , clinical trial
Exercises after arteriovenous fistula ( AVF ) creation may help to improve maturation; however, their usefulness has only been examined in indirect, non‐comparative studies or small trials. Between J une 2013 and N ovember 2014, we included all ambulatory patients with stages 5‐5 D chronic kidney disease who were candidates for the creation of a native AVF in our center. After surgery, all patients were randomized to an exercise group or a control group with single‐blind control. At 1 month postoperatively, clinical maturation (expert nurse inspection) and ultrasonographic maturation (flow >500 mL/min, venous diameter >5 mm and depth <6 mm) were assessed in all patients. A total of 72 patients were randomized, 3 were lost to follow‐up, and 69 were finally analyzed. The mean age was 66.8 years (standard deviation 13.8), 70.0% were men, and 65.2% were in pre‐dialysis. After surgery (42.0% had distal AVF ), the patients were randomized (31 controls, 38 exercise group). At 1 month after surgery, global clinical and ultrasonographic maturation was assessed in 88.4% and 78.3% of AVF , respectively (kappa = 0.539). Non‐significant differences in clinical or ultrasonographic maturation were seen between exercise and control group (94.7% vs. 80.6%, P = 0.069; 81.6% vs. 74.2%, P = 0.459). A stepwise logistic regression was performed to control previously analyzed asymmetrically distributed confounding factors ( AVF localization), revealing that the exercise group showed greater clinical, but not ultrasonographic, maturation (odds ratio [ OR ] 5.861, 95% confidence interval: 1.006–34.146 and OR 2.403, 0.66–8.754). A postoperative controlled exercise program after AVF creation seems to increase 1‐month clinical AVF maturation in distal accesses. Furthermore, exercise programs should be taken into account, especially in distal accesses.