A systematic review with meta‐analysis of the effects of arm exercise training programs on arteriovenous fistula maturation among people with chronic kidney disease

Abstract

This study systematically reviewed the evidence and quantified the effectiveness of arm exercise training programs, before and after arteriovenous fistula (AVF) operation on AVF maturation, among people with chronic kidney disease. Scopus, CINAHL, PubMed, Science Direct, Cochrane Library, and reference lists were searched. Experimental studies that investigated the effect of arm exercise before and post-operation on AVF maturations were included. Screened and extracted data were administered by two independent reviewers. Seven studies with preoperative exercise were included in a systematic review, while five studies were analyzed in a meta-analysis. Preoperative exercise significantly increased vessel diameters and grip strength after training. Postoperative exercise had higher clinical and ultrasonographic (US) maturation rates and arterial blood flow than controls (risk ratio [

Surgical creation of upper extremity arteriovenous fistula and grafts: a narrative review

“…Post-operative assessment within the first month of access creation is important. Hand/arm exercises have been shown to assist with fistula maturation/usability and given no significant risk, should be recommended routinely ( 20 , 21 ). Many accesses however, will need maturation procedures, evidenced by an unassisted AVF maturation failure rate of roughly 60% in the DAC trial ( 22 ).…”

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

“…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. In addition, despite a narrative review of the evidence, 7 there has been no meta-analysis of the efficacy of pre-operative limb exercise on the maturation process of AVFs.…”

“…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. In addition, despite a narrative review of the evidence, 7 there has been no meta-analysis of the efficacy of pre-operative limb exercise on the maturation process of AVFs. Increase in venous diameter could result in the increase in access flow rate 9 as presence of AVF is not an independent predictor of time-adjusted velocity.…”

Exercise guide to help on arteriovenous fistula maturation and maintenance

“…1,2 The upper-limb physical stimulus may help the new AVF in its maturation process, and whole arm exercise programs for the AVF limb might avoid complications during this process. [3][4][5] Arteriovenous fistula access is generally evaluated by a vascular surgeon after 2 weeks of its surgery, 2 however, exercise programs may begin earlier for improving outcomes. 6,7 Maturation failure may reduce the quality of life and treatment efficiency, so exercise interventions may become important.…”

“…6,[11][12][13] These studies investigated whether exercises would improve AVF maturation and despite it seems they do, which was confirmed by previous systematic reviews, the evidence is not well-established yet. 5,14 Based on the available evidence, we have chosen some exercises that may potentially help AVF maturation and maintenance. They are clinical routine in our dialysis center in Brasília, Brazil.…”