Impact of Presurgical Exercise on Hemodialysis Fistula Outcomes

The Impact of Exercise on Vascular Remodeling, Arteriovenous Fistula Creation and Use in Patients With Chronic Kidney Disease: A Randomized Controlled Trial

The purpose of this research study is to determine whether two different types of forearm exercise, performed before fistula creation surgery, can improve surgery success and fistula maturation.

This is a randomized, double blinded controlled trial to study the impact of handgrip exercise prior to surgical creation of hemodialysis fistula on vascular remodelling and fistula maturation in chronic kidney disease patients.

Inclusion Criteria:

1. Adult (age>18 years old) with chronic kidney disease
2. Hemodialysis is their renal replacement therapy (RRT) modality
3. Deemed eligible for an arteriovenous fistula
4. Anticipated RRT start < 3 months (from the time of vascular surgery assessment) if predialysis
5. Scheduled surgical creation of fistula aniticpated >= 8 weeks
6. Able to follow instructions for an exercise intervention
7. Able to provide informed written consent

Exclusion Criteria:

1. Life expectancy < 6 months

2. Need for urgent vascular access (i.e. <4 weeks)

3. Pre-existing fistula distal to site of newly scheduled fistula

4. Ipsilateral central stenosis or occlusions not amenable to correction

5. Contraindications or unable to perform handgrip exercise

   • Unable to withstand transiently raised systolic blood pressure (SBP) by 35 mmHg, and diastolic (DBP) by 25 mmHg
   • severe upper extremity arthritis or other pain

6. Contraindications to general exercise

   • Poorly controlled blood pressure - SBP>180, DBP>90; SBP<110, DBP<50
   • NYHC IV heart failure