FP564
ISOMETRIC EXERCISE AND ARTERIOVENOUS FISTULA FOR HAEMODIALYSIS: THE IMPACT ON MATURATION PROCESS

INTRODUCTION AND AIMS: Arteriovenous fistula (AVF) is the gold standard vascular access (VA) for end-stage chronic kidney disease patients. Postoperative exercises may help to improve maturation. Nevertheless, scarce scientific evidence has been reported about their utility until date.To assess the effect of a postoperative isometric exercises program on native VA maturation in our patients with stages 5-5D chronic kidney disease.

METHODS: A 24 months prospective single-center study. After surgery, all patients were randomized to an isometric exercise group (EG) or a control group (CG). An agreed with Rehabilitation, isometric exercises protocolled program, was performed in EG. CO received usual care. Demographical data, muscle strength using handgrip(HG) dynamometer, main Doppler ultrasound (DUS) measurements (outflow vein (OV) diameter and humeral artery blood flow rate (BFR), clinical and DUS maturation as well as medical (hematoma, stenosis, thrombosis, pseudoaneurysm, aneurysm) or surgical VA complications were assessed at 4 and 8 weeks postoperatively.

RESULTS: 67 patients; 7 drop out. 30 EG, 30 CO. 71,7 % men. Mean age 68,6±13,0 years. 60% Radiocephalic AVF. Demographic data, HG and DUS measurement at baseline were similar. A significant increase in HG was observed only in EG at the end of study (20,7±8,1 vs 25,1±10,3Kg, p=0,001). DUS measurements statistically increased for both groups (OV diameter: EG 3,2 ± 0.8 vs. 6.2 ± 1.5 mm; CG 2.9 ± 0.7 vs. 5.6 ± 6.2 mm; humeral artery BFR: EG 142.7± 35.2 vs. 1536.2 ± 679.2 ml/min; CG 134.6± 36,6 vs. 1170.4 ± 537.1ml/min) at the end of study. EG group obtained highest clinical maturation at 4 (CG 33.3% vs EG 70%; p=0,009) and 8 weeks (CG 33% vs EG 76,7%;p=0,002). Similarly, DUS maturation was better in EG at 4 (CG 40% vs EG 80%; p=0,003) and 8 weeks respectively (CG 43.3%vs EG 83.3%;p=0,003). These results were also observed in EG both distal and proximal territories for all these periods. There were not differences in medical or surgical VA complications during the study.

CONCLUSIONS: The isometric exercises protocolled program improve clinical and DUS maturation in our patients. This effectiveness was observed in both distal and proximal territories. Further studies are required to support the benefits of postoperative isometric exercises in the vascular access maturation process.