Ines Aragoncillo Sauco1,2, Covadonga Hevia3, Soledad Manzano Grossi4, Yesika Amezquita3, Nicolas Macias5, Silvia Caldes3, Belen Ramirez Senent4, Yolanda Hernandez Hernandez3, Marian Goicoechea5,6. 1. Nephrology Department, Hospital Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain. inesiglia@hotmail.com. 2. Instituto Carlos III, ISICIII RETIC REDINREN RD016/009 (FEDER funds), Madrid, Spain. inesiglia@hotmail.com. 3. Nephrology Department, Hospital Universitario Infanta Sofía, Madrid, Spain. 4. Vascular Surgery Department, Hospital Universitario Gregorio Marañón, Madrid, Spain. 5. Nephrology Department, Hospital Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain. 6. Instituto Carlos III, ISICIII RETIC REDINREN RD016/009 (FEDER funds), Madrid, Spain.
Abstract
BACKGROUND AND OBJECTIVES:Autologous arteriovenous fistula (AVF) is the best vascular access for hemodialysis. Distal forearm radiocephalic fistula is the best option, although the primary failure rate ranges from 20% to 50%. The main objective of the PHYSICALFAV trial was to evaluate the effect of preoperative isometric exercise on vascular caliber, percentage of distal arteriovenous fistula, and primary failure rate. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: The PHYSICALFAV trial (NCT03213756) is an open-label, multicenter, prospective, randomized, controlled trial (RCT). A total of 138 patients were randomized 1:1 to the exercise group (exercises combining a handgrip device and an elastic band for 8 weeks) or the control group (no exercise) and followed up with periodic Doppler ultrasound (DU) examinations. RESULTS: After 8 weeks of preoperative isometric exercise, in the exercise group, significant increases were detected in venous caliber (2.80 ± 0.95 mm vs 3.52 ± 0.93 mm [p < 0.001]), arterial caliber (2.61 ± 0.82 mm vs 2.74 ± 0.80 mm [p = 0.008]), arterial peak systolic velocity (66.34 ± 19.2 cm/s vs 71.03 ± 21.5 cm/s [p 0.043]), and maximum strength (28.35 ± 9.16 kg vs 32.68 ± 10.8 kg [p < 0.001]). Distal radiocephalic fistulas were performed in 75% of the exercise group patients compared with 50.8% in the control group (p = 0.030). The global primary failure rate was very low in both groups (7% exercise group vs 14% control group [p = 0.373]). CONCLUSION:Isometric preoperative exercise can improve vascular caliber and increase the possibility of performing distal arteriovenous fistula, with no significant differences in primary failure rate.
RCT Entities:
BACKGROUND AND OBJECTIVES: Autologous arteriovenous fistula (AVF) is the best vascular access for hemodialysis. Distal forearm radiocephalic fistula is the best option, although the primary failure rate ranges from 20% to 50%. The main objective of the PHYSICALFAV trial was to evaluate the effect of preoperative isometric exercise on vascular caliber, percentage of distal arteriovenous fistula, and primary failure rate. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: The PHYSICALFAV trial (NCT03213756) is an open-label, multicenter, prospective, randomized, controlled trial (RCT). A total of 138 patients were randomized 1:1 to the exercise group (exercises combining a handgrip device and an elastic band for 8 weeks) or the control group (no exercise) and followed up with periodic Doppler ultrasound (DU) examinations. RESULTS: After 8 weeks of preoperative isometric exercise, in the exercise group, significant increases were detected in venous caliber (2.80 ± 0.95 mm vs 3.52 ± 0.93 mm [p < 0.001]), arterial caliber (2.61 ± 0.82 mm vs 2.74 ± 0.80 mm [p = 0.008]), arterial peak systolic velocity (66.34 ± 19.2 cm/s vs 71.03 ± 21.5 cm/s [p 0.043]), and maximum strength (28.35 ± 9.16 kg vs 32.68 ± 10.8 kg [p < 0.001]). Distal radiocephalic fistulas were performed in 75% of the exercise group patients compared with 50.8% in the control group (p = 0.030). The global primary failure rate was very low in both groups (7% exercise group vs 14% control group [p = 0.373]). CONCLUSION: Isometric preoperative exercise can improve vascular caliber and increase the possibility of performing distal arteriovenous fistula, with no significant differences in primary failure rate.
Authors: José Ibeas; Ramon Roca-Tey; Joaquín Vallespín; Teresa Moreno; Guillermo Moñux; Anna Martí-Monrós; José Luis Del Pozo; Enrique Gruss; Manel Ramírez de Arellano; Néstor Fontseré; María Dolores Arenas; José Luis Merino; José García-Revillo; Pilar Caro; Cristina López-Espada; Antonio Giménez-Gaibar; Milagros Fernández-Lucas; Pablo Valdés; Fidel Fernández-Quesada; Natalia de la Fuente; David Hernán; Patricia Arribas; María Dolores Sánchez de la Nieta; María Teresa Martínez; Ángel Barba Journal: Nefrologia Date: 2017-11 Impact factor: 2.033