A Randomized Control Trial to Determine the Effect of Handball Exercise on Arteriovenous Fistula Maturation
Handball exercise does not significantly impact AVF maturation. AVF can be successfully cannulated at 6 weeks if blood flow ≥ 500 ml/min & diameter ≥ 5 mm. Wall shear stress, blood flow, and fistula body diameter were key predictors of AVF maturation. No significant difference in AVF maturation rates between exercise and control groups. To compare arteriovenous fistula (AVF) maturation in soft handball exercise (Group I) versus no exercise (Group II). Stage 5 chronic kidney disease patients aged 18 to 60 years planned for AVF construction were randomized into soft handball exercise (Group I) versus no exercise (Group II) groups. Side-to-side AVF anastomosis was created after vascular mapping. Doppler parameters such as blood flow and wall shear stress (WSS) were assessed in the 2nd, 4th, 6th, and 12th weeks. Mature AVF was defined with blood flow ≥500 mL, fistula body diameter ≥5 mm, and the ability to use the fistula with 2 needles for 3 consecutive dialysis sessions at 6 weeks. A total of 103 patients were randomized into the handball exercise group (Group I, n = 50) and control group (Group II, n = 53). By 6 weeks, 77 (75%) patients achieved AVF maturation. However, no significant difference was found in maturation rates between the handball group (72%) and the control group (77%; P = 0.628), indicating no added benefit from handball exercise. Blood flow, fistula diameter, and WSS were significantly higher in matured AVFs than nonmatured ones (P < 0.001), but these parameters did not differ between the intervention and control groups. In patients with newly created AVFs, handball exercise does not play any role in AVF maturation. Successful cannulation can be done at 6 weeks with a blood flow ≥500 mL and fistula body diameter ≥5 mm.Highlights
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