Effects of upper limb exercise programs on the arteriovenous fistula in patients on hemodialysis: A systematic review and meta-analysis

Abstract

Background: The arteriovenous fistula (AVF) is a commonly used vascular access for chronic kidney disease (CKD) patients; exercise interventions may boost its maturation and help in its maintenance. A systematic review and meta-analysis of clinical trials on the effects of upper limb exercise programs on the AVF was conducted. Methods: The primary outcomes were draining vein diameter (DVD) and draining vein blood flow rate (DVBFR), and secondary outcomes were handgrip strength (HGS) and brachial artery flow rate (BAFR). Quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Results: Four studies met the inclusion criteria. When compared to usual care groups, the experimental groups did not improve DVD (mean difference [MD] 0.23, confidence interval [CI] −0.20–0.65). There were significant differences in DVBFR (mL/min) according to the fixed-effect model (MD 141.13, CI 36.84–245.42). HGS (kg) was significantly different between groups (MD 2.95, CI 0.55–5.35), but BAFR (mL/min) was not (MD 91.65, CI −94.72–278.01). Conclusions: Although exercise programs did not improve DVD and BAFR, they increased muscle strength and DVBFR. Therefore, experimental exercise programs should be emphasized for AVF maturation and maintenance. Research Registry number: reviewregistry924.

Aerobic Exercise Increases Vascular Diameter of Arteriovenous Fistula in Hemodialysis Patients

“…As we have already documented in our meta-analysis about the effects of upper limb exercise on AVF, the exercise programs significantly increased blood flow rate in the draining vein and the muscle strength from the AVF upper limb, which are 2 important aspects not only for AVF maturation but also for its maintenance [8]. Many of the benefits result from the effect of elevated shear stress on the endothelium due to blood flow increase [9, 10].…”

Effect of exercises on the maturation of newly created arteriovenous fistulas over distal and proximal upper limb: A systematic review and meta-analysis

“…However, there is currently no strong and concrete evidence of its benefits in promoting AVF maturation. 1 Existing systematic reviews suggest that post-operative upper extremity exercise increases muscle strength and draining vein blood flow rate, 6 and facilitated AVF maturation. 7 Whether this beneficial effect applies to all regions of upper limb AVFs remains to be evaluated.…”

“…[2][3][4] Upper limb exercise has been recommended to the patients before and after the AVF creation, but structured exercise programs have not been routinely implemented, possibly due to the lack of solid evidence that exercise promotes the maturation of AVF. 1 Existing systematic reviews focusing on the effects of post-operative exercise either did not include clinical maturation as a result, 5,6 or included studies with a heterogenous population with matured AVF, 6 or included studies comparing two different forms of exercise. 7 Furthermore, fistulas in proximal and distal regions of the upper limb have their own unique characteristics, 8 and the effect of exercise on AVF maturation in different regions has not been well studied.…”

“…Existing systematic reviews focusing on the effects of post-operative exercise either did not include clinical maturation as a result, 5,6 or included studies with a heterogenous population with matured AVF, 6 or included studies comparing two different forms of exercise. 7 Furthermore, fistulas in proximal and distal regions of the upper limb have their own unique characteristics, 8 and the effect of exercise on AVF maturation in different regions has not been well studied.…”

Exercise guide to help on arteriovenous fistula maturation and maintenance

“…Recent systematic reviews have shown that hand and whole arm exercises may be effective in improving draining vein blood flow rate, brachial artery blood flow, upper-limb arm strength, and clinical maturation rate. 5,9 This might indicate that other benefits could be potentially achieved, such as local blood circulation, which increases vasodilation and may help to maintain vessel integrity. 4,10 Previous studies have used dumbbells and elastic bands, progressive manual gripping, structured isometric, and blood flow restriction exercises.…”