#4046 Advanced Chronic Kidney Disease, Preoperative Isometric Exercise and Vascular Access: Let´s Clear the Doubts

Abstract

Background and Aims Arteriovenous fistula (AVF) is the best vascular access for hemodialysis. However, the role of preoperative isometric exercises in patients with advanced cronic kidney disease (CKD) who are candidates for AVF is unclear and not well reported in the literature. The main objetive of this study was to evaluate the effect of preoperative isometric exercise on vascular territory in advanced CKD prior to AVF creation. Method An 8 months prospective single-center study. We performed an isometric preoperative exercise program for 4 weeks on the non dominant arm (exercise arm) and was compared with the dominant arm (control arm) performing usual activity in our advanced CKD patients. Demographic data, upper limb muscle strength (ULMS), Doppler ultrasound (DUS) measurements (foream and distal cefalic vein (FCV, DCV) diameter, basilic vein (BV) diameter and depth, peak systolic velocities (PSVs) and diameters in the radial artery (RA) and braquial artery (BA), as well as percentage of patients candidates to AVF in both arm (exercise and control arm) according to Spanish Clinical Guidelines of Vascular Access (VA) and possible medical complications were analyzed. Results 27 patients. 67,7%men. Mean age 70,3±10,4years. Main cardiovascular risk factors: HBP (93,5%) and DM (64,5%). Exercise arm was left side in 87,1%. A significant increase was observed in ULMS only in exercise arm at the end of study (23,8±8,7Kg vs 27, 6±9,5Kg, p = 0,001). Related to DUS measurements, there were not diffences between groups on vein caliber. However, a significant increase was observed in RA PSV (57,7±15,3 vs 62,6±17,4cm/seg, p = 0,044), BA diameter (4,6±0,6 vs 4,9±0,9mm, p = 0,029) and percentage of patients who could be candidates to AVF (70,4 vs 92,6%, p = 0,034) in exercise arm at the end of the study. We did not observe any related complications (pain, hypotension or muscle injury). Conclusion Preoperative isometric exercises would increase the percentage of performing a native AVF in those advanced CKD patients candidates for HD. Similarly, our results suggest that preoperative isometric exercise could be a useful tool to improve the vascular territory, mainly arterial, in our patients. However, more studies are required to confirm our results.