A randomized controlled trial of the effect of postoperative hand exercise training on arteriovenous fistula maturation in patients with chronic kidney disease

Nantakool, Sothida; Srisuwan, Tanop; Reanpang, Termpong; Prasannarong, Mujalin

doi:10.1016/j.jvs.2021.07.124

Cited by 6 publications

(4 citation statements)

References 33 publications

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“…However, the results were obtained through ultrasonography and the vein of interest was a superficial vein 16 . Similar findings are reported by Nantakool and co-researchers who reported an increase in the diameter of cephalic vein after six to eight weeks of isotonic and isometric exercises 19 . In our study venous diameter was not assessed however, luminal area was measured.…”

Section: Resultssupporting

confidence: 90%

Histomorphometric Adaptations of Superior and Inferior Vena Cavae after Moderate Intensity Continuous Exercise - A Preclinical Trial

Hamza,

Nawaid Shah,

Aamir khan

et al. 2024

ashkmdc

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Objective: This study was aimed at evaluation of effects of Moderate Intensity Continuous Training(MICT) on the histomorphometric parameters of superior vena cava (SVC) and inferior vena cava(IVC) in Sprague Dawley rats. Methods: Twenty-four male healthy Sprague Dawley rats were randomly divided into two groups.Group A (n=12) was assigned to the Moderate Intensity Continuous Training whereas Group B (n=12)was the control group with no exercise. The exercise intervention was workout on treadmill at 70%Maximal exercise intensity for 22-24 mins for 5 consecutive days/week for four weeks. The animalswere sacrificed after completion of exercise protocol for histomorphometry of the Inferior Vena Cavaand Superior Vena Cava. H&E stained slides were examined under Nikon Ts2R-FL inverted micro-scope and images were taken. Images were analyzed and morphometry was performed by using Im-age J software. Luminal area, wall thickness and wall to lumen ratio were evaluated. Statisticalanalysis was performed on SPSS version 23. Results: Histomorphometric evaluation of the luminal area, wall thickness and wall to lumen ratio ofboth large veins showed statistically significant difference between control and the exercise groups.The luminal area, wall thickness and wall to lumen ratio of the IVC was significantly increased in theexercise group with p values 0.003, 0.04 and <0.001 respectively. There was statistically significant in-crease in luminal area and wall thickness of SVC in the exercise group (p<0.0001) and (p = 0.0001),whereas wall to lumen ratio was found to be reduced significantly p<0.001. Conclusion: Our study has revealed that moderate intensity continuous exercise of four weeks duration has profound effects on the histomorphometry of superior and inferior vena cava. The findings ofour study highlight that the venous morphological adaptations to meet the heightened demands generated after moderate intensity continuous exercise are as prevalent as cardiac and arterial adapta-tions

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Section: Resultssupporting

confidence: 90%

Histomorphometric Adaptations of Superior and Inferior Vena Cavae after Moderate Intensity Continuous Exercise - A Preclinical Trial

Hamza,

Nawaid Shah,

Aamir khan

et al. 2024

ashkmdc

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“…15,16 The first steps in decreasing cost in AV access care is performing a vast majority of access creation and salvage procedures in an outpatient setting. [17][18][19] Utilizing a ML algorithm could help reduce cost of care by 74% by directing AV access procedures to specialized vascular access outpatient clinics (Balamuthusamy et al Oral presentation at ASDIN 2021). Further improvement in outcomes and reductions in cost be facilitated by utilizing ML analytics that utilizes a variety of attributes that takes clinical, social determinants, behavioral health, health inequity and access related parameters into consideration.…”

Section: Discussionmentioning

confidence: 99%

“…However, flow changes are dependent on numerous factors like changes in MAP and CV status. 19,20 Reacting to flow changes could be burdensome and also not all stenotic lesions need to be addressed as some at the inflow could be protective from downstream adverse cardiovascular events. 21 Hence there is a need for a more comprehensive methodology to identify patients at risk for reinterventions.…”

Section: Discussionmentioning

confidence: 99%

Utility of a ML analytics on real time risk stratification and re-intervention risk prediction on AV access outcomes and cost

et al. 2023

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Background: Vascular access is the lifeline for patients on hemodialysis. The average survival rates of dialysis dependent patients have been improving over the last 5 years and hence their dialysis access needs longevity for uninterrupted optimal dialysis. With the lack of genomic vascular access failure predictors, there is an unmet need for predicting an event and the appropriate approach to mitigate recurrence of the event that could have cost and outcome implications. Methods: We performed a single center experience that extracted relevant clinical (access flow, laboratory data and CKD details), access intervention (prior interventions, type & location of lesion, type of balloon used, use of stents etc.) and demographic (age, vintage on dialysis, sex, social determinants, other medical conditions) data in real time and feeds it into validated ML algorithms to predict risk of reintervention. (Plexus EMR LLC). Results: About 200 prevalent hemodialysis patients with a AV graft or AV fistula were included for this analysis. Need for re-intervention and use of stent/ flow reduction/new access creation were the outcomes analyzed. Plexus EMR is a licensed Azure based platform. R software was used to develop the ML algorithms. Regression factors were developed to assess and test the validity of individual attributes across all the data attributes. Each patient had a real time risk calculator available to the interventionalist on risk of reintervention/ year. Of the 200 patients, 148 had a AV fistula and the remaining 52 had a AV graft. Mean interventions in the year prior to analysis was 1.8 in patients with AV fistulas and 3.4 in AV grafts which decreased to 1.1 in AV fistulas and to 2.4 in AV grafts ( p < 0.01) post tool deployment. There were 62 AV graft thrombectomies done in the observation year and 62% of those were repeat thrombectomies. Stent utilization increased to 37 (22 in AV grafts and 15 in AV fistulas) and 2 patients had AV access flow reduction surgery. The cumulative cost (predicted) preintervention was $712,609 and decreased to $512,172 post intervention. Stent utilization increased by 68% in the evaluation year and 89% of the stents used were PTFE coated stents. Conclusion: Utilizing AI with ML based algorithms that includes clinical, demographic and patency maintenance variables could become new standards of care to optimally manage AV accesses and lower cost of care.

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“…The arteriovenous fistula (AVF) is the choice procedure for vascular access in patients subjected to hemodialysis for chronic kidney disease (CKD), whose incidence is increasing worldwide and represents a risk factor for cardiovascular disease (CVD) [1]. Despite the higher patency rate and the lower risk of complications in comparison to the other vascular access options, AVF carries a high percentage of failure because of inadequate maturation or degeneration, resulting in increased morbidity and further surgical operations [2][3][4][5]. AVF degeneration is commonly caused by neointimal hyperplasia (IH), a complex process characterized by progressive intimal thickening and consequent stenosis with lumen occlusion [3,6].…”

Section: Introductionmentioning

confidence: 99%

The PPAR-γ Agonist Pioglitazone Modulates Proliferation and Migration in HUVEC, HAOSMC and Human Arteriovenous Fistula-Derived Cells

Ciavarella

Motta

Vasuri

et al. 2023

IJMS

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The failure of arteriovenous fistulas (AVFs) following intimal hyperplasia (IH) increases morbidity and mortality rates in patients undergoing hemodialysis for chronic kidney disease. The peroxisome-proliferator associated receptor (PPAR-γ) may be a therapeutic target in IH regulation. In the present study, we investigated PPAR-γ expression and tested the effect of pioglitazone, a PPAR-γ agonist, in different cell types involved in IH. As cell models, we used Human Endothelial Umbilical Vein Cells (HUVEC), Human Aortic Smooth Muscle Cells (HAOSMC), and AVF cells (AVFCs) isolated from (i) normal veins collected at the first AVF establishment (T0), and (ii) failed AVF with IH (T1). PPAR-γ was downregulated in AVF T1 tissues and cells, in comparison to T0 group. HUVEC, HAOSMC, and AVFC (T0 and T1) proliferation and migration were analyzed after pioglitazone administration, alone or in combination with the PPAR-γ inhibitor, GW9662. Pioglitazone negatively regulated HUVEC and HAOSMC proliferation and migration. The effect was antagonized by GW9662. These data were confirmed in AVFCs T1, where pioglitazone induced PPAR-γ expression and downregulated the invasive genes SLUG, MMP-9, and VIMENTIN. In summary, PPAR-γ modulation may represent a promising strategy to reduce the AVF failure risk by modulating cell proliferation and migration.

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A randomized controlled trial of the effect of postoperative hand exercise training on arteriovenous fistula maturation in patients with chronic kidney disease

Cited by 6 publications

References 33 publications

Histomorphometric Adaptations of Superior and Inferior Vena Cavae after Moderate Intensity Continuous Exercise - A Preclinical Trial

Histomorphometric Adaptations of Superior and Inferior Vena Cavae after Moderate Intensity Continuous Exercise - A Preclinical Trial

Utility of a ML analytics on real time risk stratification and re-intervention risk prediction on AV access outcomes and cost

The PPAR-γ Agonist Pioglitazone Modulates Proliferation and Migration in HUVEC, HAOSMC and Human Arteriovenous Fistula-Derived Cells

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