Background: Arteriovenous fistulas (AVF) have been the main vascular accesses for haemodialysis patients, but the maintenance after maturation poses serious challenges. Arm exercises promote the maturation of AVFs. However, few studies have evaluated the effect of arm exercise on matured AVF and addressed the intervention for late fistula failure. Objectives: The study was conducted to explore the effect of dumbbell exercise on mature AVF. Methods: 86 participants undergoing haemodialysis with AVFs were randomized into the control group and experimental group. The experimental group held 6-pound dumbbells on non-dialysis days for 3 months, while the control group squeezed rubber balls. Results: For blood flow of draining vein (DV; primary outcome), the between-group effects, interaction effect and time effect showed significant differences. A significant increase in blood flow of DV was observed in the dumbbell group at the 3rd month (mean difference, 359.50 [111.90–829.05] mL/min; p = 0.001). The difference in blood flow of AVF proximal artery, blood flow of brachial artery, the diameter of DV and the incidence of adverse events at 3 months (secondary outcomes) between the 2 groups was insignificant. Conclusion: Prolonged training with arm exercises is essential for patients with AVFs though the fistula has matured. The designed dumbbell exercise is an economical, effective intervention to maintain the function of AVF, especially for patients with potential reduction of access blood flow and no percutaneous transluminal angioplasty indication.

Keywords:
Access flow, Arteriovenous fistula, Blood flow, Exercise, Haemodialysis, Randomized controlled trial
1.
Lok CE, Foley R. Vascular access morbidity and mortality: trends of the last decade.
Clin J Am Soc Nephrol
. 2013 Jul;8(7):1213–9.
2.
Brown RS, Patibandla BK, Goldfarb-Rumyantzev AS. The Survival Benefit of “Fistula First, Catheter Last” in Hemodialysis Is Primarily Due to Patient Factors.
J Am Soc Nephrol
. 2017 Feb;28(2):645–52.
3.
Al-Jaishi AA, Liu AR, Lok CE, Zhang JC, Moist LM. Complications of the Arteriovenous Fistula: A Systematic Review.
J Am Soc Nephrol
. 2017 Jun;28(6):1839–50.
4.
Al-Jaishi AA, Oliver MJ, Thomas SM, Lok CE, Zhang JC, Garg AX, et al. Patency rates of the arteriovenous fistula for hemodialysis: a systematic review and meta-analysis.
Am J Kidney Dis
. 2014 Mar;63(3):464–78.
5.
Ng YY, Wu SC, Hung YN, Ko PJ. Effect of demographic characteristics and timing of vascular access maturation on patency in Chinese incident haemodialysis patients.
Nephrol Dial Transplant
. 2009 Nov;24(11):3447–53.
6.
Smith GE, Gohil R, Chetter IC. Factors affecting the patency of arteriovenous fistulas for dialysis access.
J Vasc Surg
. 2012 Mar;55(3):849–55.
7.
Hasuike Y, Kakita N, Aichi M, Masachika S, Kantou M, Ikeda Takahashi S, et al. Imbalance of coagulation and fibrinolysis can predict vascular access failure in patients on hemodialysis after vascular access intervention.
J Vasc Surg
. 2019 Jan;69(1):174–180.e2.
8.
Jeong HY, Ko EJ, Kim SH, Lee MJ, Cho HJ, Yang DH, et al. Administration of a High-Dose Erythropoietin-Stimulating Agent in Hemodialysis Patients is Associated with Late Arteriovenous Fistula Failure.
Yonsei Med J
. 2017 Jul;58(4):793–9.
9.
Wish JB. Vascular access for dialysis in the United States: progress, hurdles, controversies, and the future.
Semin Dial
. 2010 Nov-Dec;23(6):614–8.
10.
Thamer M, Lee TC, Wasse H, Glickman MH, Qian J, Gottlieb D, et al. Medicare Costs Associated With Arteriovenous Fistulas Among US Hemodialysis Patients.
Am J Kidney Dis
. 2018 Jul;72(1):10–8.
11.
Beathard GA. Angioplasty for arteriovenous grafts and fistulae.
Semin Nephrol
. 2002 May;22(3):202–10.
12.
MacRae JM, Dipchand C, Oliver M, Moist L, Lok C, Clark E, et al.; Canadian Society of Nephrology Vascular Access Work Group. Arteriovenous Access Failure, Stenosis, and Thrombosis.
Can J Kidney Health Dis
. 2016 Sep;3:2054358116669126.
13.
Palmer SC, Di Micco L, Razavian M, Craig JC, Ravani P, Perkovic V, et al. Antiplatelet therapy to prevent hemodialysis vascular access failure: systematic review and meta-analysis.
Am J Kidney Dis
. 2013 Jan;61(1):112–22.
14.
Lin CC, Chang CF, Lai MY, Chen TW, Lee PC, Yang WC. Far-infrared therapy: a novel treatment to improve access blood flow and unassisted patency of arteriovenous fistula in hemodialysis patients.
J Am Soc Nephrol
. 2007 Mar;18(3):985–92.
15.
Rus R, Ponikvar R, Kenda RB, Buturović-Ponikvar J. Effects of handgrip training and intermittent compression of upper arm veins on forearm vessels in patients with end-stage renal failure.
Ther Apher Dial
. 2005 Jun;9(3):241–4.
16.
Fontseré N, Mestres G, Yugueros X, López T, Yuguero A, Bermudez P, et al. Effect of a postoperative exercise program on arteriovenous fistula maturation: A randomized controlled trial.
Hemodial Int
. 2016 Apr;20(2):306–14.
17.
Kumar S, Seward J, Wilcox A, Torella F. Influence of muscle training on resting blood flow and forearm vessel diameter in patients with chronic renal failure.
Br J Surg
. 2010 Jun;97(6):835–8.
18.
Salimi F, Majd Nassiri G, Moradi M, Keshavarzian A, Farajzadegan Z, Saleki M, et al. Assessment of effects of upper extremity exercise with arm tourniquet on maturity of arteriovenous fistula in hemodialysis patients.
J Vasc Access
. 2013 Jul-Sep;14(3):239–44.
19.
Hsiao YH, Shin ML, Huang CP, Chen SJ, Huang TY: [Using Interdisciplinary Cooperation to Improve the Rate of Proper Performance of a Hand Exercise Among Hemodialysis Patients With Arteriovenous Fistula Construction]. Hu Li Za Zhi. 2017 Jun;64(3):74–81.
20.
Jin G, Liu Y, Wang J, Zhang Y. The effect of griping exercise on limb palmar swelling after percutaneous coronary intervention.
Chin J Prac Nurs
. 2016;32:889–92.
21.
Kong S, Lee KS, Kim J, Jang SH. The effect of two different hand exercises on grip strength, forearm circumference, and vascular maturation in patients who underwent arteriovenous fistula surgery.
Ann Rehabil Med
. 2014 Oct;38(5):648–57.
22.
Sullivan B, Desai S, Singh TM, Mitra A. Early application of an intermittent pneumatic compression device assists dilation of radiocephalic fistulas.
J Vasc Access
. 2019 Mar;20(2):146–52.
23.
Schmidli J, Widmer MK, Basile C, de Donato G, Gallieni M, Gibbons CP, et al.; Esvs Guidelines Committee; Esvs Guidelines Reviewers. Editor’s Choice - Vascular Access: 2018 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS).
Eur J Vasc Endovasc Surg
. 2018 Jun;55(6):757–818.
24.
Tang WJ, Adnan AS, Md Salleh MS, Mat Saad AZ. Microcalcification in the arterial wall and its relationship to the ultrasound criteria of maturation of the arteriovenous fistula.
J Vasc Access
. 2019 Jan;20(1):46–51.
25.
American College of Radiology (ACR)Society of Radiologists in Ultrasound (SRU)American Institute of Ultrasound in Medicine (AIUM). AIUM practice guideline for the performance of a vascular ultrasound examination for postoperative assessment of dialysis access.
J Ultrasound Med
. 2014 Jul;33(7):1321–32.
26.
Access V; Vascular Access 2006 Work Group. Clinical practice guidelines for vascular access.
Am J Kidney Dis
. 2006 Jul;48(suppl 1):S176–247.
27.
Guo Y, Pandis N. Sample-size calculation for repeated-measures and longitudinal studies.
Am J Orthod Dentofacial Orthop
. 2015 Jan;147(1):146–9.
28.
Basile C, Lomonte C, Vernaglione L, Casucci F, Antonelli M, Losurdo N. The relationship between the flow of arteriovenous fistula and cardiac output in haemodialysis patients.
Nephrol Dial Transplant
. 2008 Jan;23(1):282–7.
29.
Leaf DA, MacRae HS, Grant E, Kraut J. Isometric exercise increases the size of forearm veins in patients with chronic renal failure.
Am J Med Sci
. 2003 Mar;325(3):115–9.
30.
Rus RR, Ponikvar R, Kenda RB, Buturović-Ponikvar J. Effect of local physical training on the forearm arteries and veins in patients with end-stage renal disease.
Blood Purif
. 2003;21(6):389–94.
31.
Ji S.
The Technology of Therapeutic Exercises
. 2nd ed, revised. China: Huaxia; 2004.
32.
Neyra NR, Ikizler TA, May RE, Himmelfarb J, Schulman G, Shyr Y, et al. Change in access blood flow over time predicts vascular access thrombosis.
Kidney Int
. 1998 Nov;54(5):1714–9.
© 2019 S. Karger AG, Basel
2019
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.