Handgrip Exercise for Arteriovenous Fistula Maturation

Study Overview
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Brief Summary
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The purpose of this study is to investigate whether post operative progressive forearm exercise is effective in improving arteriovenous fistula maturation in chronic kidney disease patients.

Detailed Description
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The arteriovenous fistula is considered to be the gold standard form of access for haemodialysis patients, however only 37% of haemodialysis patients have this form of access. A possible explanation for this could be the high fistula failure rate due to the lack of maturation. Therefore interventions aimed at enhancing fistula maturation are warranted. One such intervention could be forearm exercise, however this recommendation is not evidence based. Therefore, the purpose of this study is to investigate whether a program of post operative progressive hand grip exercise can improve fistula maturation.

Official Title
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The Effects of Progressive Handgrip Exercise Training on Arteriovenous Fistula Maturation in Chronic Kidney Disease

Conditions
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Chronic Kidney Disease

Intervention / Treatment
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* Other: Post operative progressive handgrip exercise
* Other: Treatment as usual


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Stage 4-5 chronic kidney disease, attending for arteriovenous fistula creation in forearm Exclusion Criteria: Are under the age of 18years; Not able to exercise forearm safely (as decided by the patients consultant) Have any other uncontrolled medical condition Unable to withstand transiently raised systolic blood pressure by 35 mmHg and diastolic by 25 mmHg Or are unable to give consent

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Basic Science
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Handgrip exercise<br>Handgrip exercise - patients allocated to this intervention will carry out an eight week post operative progressive handgrip exercise training program | Other: Post operative progressive handgrip exercise<br>* As soon as possible post operation the patient will commence an eight week progressive handgrip training intervention<br>|
| Active Comparator: Treatment as usual<br> | Other: Treatment as usual<br>* Continue routine care, with removal of exercise information given to patients(if anye.g. do not give out squeeze balls)<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Venous Diameter. | Measurements were made using duplex ultrasonagraphy. Measurements were made at predetermined distances 5 to 10 cm proximal to the anastomosis (dependent on wound dressings and turbulent flow around the anastomosis). The scanning position for each patient was traced using transparent sheets which allowed analogous measurement positions for all scans. Cross sectional vascular diameter measurements were made using conventional grey scale B Mode imaging. Diameters were measured from the inner edges of the vascular wall (Wiese & Nonnast-Daniel, 2004). | 3 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Maximum Handgrip Strength |  | 3 months | 
| Handgrip Endurance |  | 3 months | 
| Forearm Muscle Cross Sectional Area |  | 3 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Exercise; arteriovenous fistula; chronic kidney disease