To undergo Hemodialysis (HD), it is essential for the patient to have Vascular Access
(VA) for HD, with priority given to the creation of an Arteriovenous Fistula (AVF). The
AVF is considered the ideal VA for HD due to its advantages over other types of access.
However, to become functional, the AVF must go through a maturation process. Initial AVF
maturation is a complex process of vascular adaptation and remodeling, driven by a
significant increase in arterial blood flow into the vein. This requires dilation and
structural changes in the blood vessel walls.
One of the main issues related to AVFs is primary maturation failure. It is estimated
that between 28% and 53% of AVFs experience compromised maturation, which can hinder or
even prevent effective long-term cannulation for hemodialysis treatment.
It is well recognized that physical exercise promotes vascular remodeling, as shown by
increased capillarity in active muscles, the development of adjacent blood vessels,
increased muscle strength, and greater diameter and prominence of veins. Due to its
positive influence on vascular remodeling, exercise involving the AVF limb is frequently
recommended by international best practice guidelines, and it has the potential to
improve the AVF maturation process. However, current scientific evidence does not yet
offer a consensus on the most effective type, duration, or intensity of exercise.
Nevertheless, intentional, repetitive, and sustained physical exercise has been shown to
lead to vascular remodeling, which may positively impact the functional maturation of an
AVF. In this context, the aim is to conduct a quantitative, experimental, and randomized
study to evaluate the effect of implementing a Physical Exercise Program for the AVF limb
(PEFAV), designed by a rehabilitation nursing specialist, on the AVF maturation process.
As part of the development of the research project titled "Effect of a Structured
Physical Exercise Program on Arteriovenous Fistula Maturation", the research team intends
to conduct a quantitative, experimental, and randomized study with an expected duration
of twenty-four months. The main objective is to evaluate the effect of implementing a
Physical Exercise Program for the AVF limb (PEFAV) on the maturation process of the AVF
in individuals with stage 5 Chronic Kidney Disease (CKD) who have an upper limb AVF.
Participant recruitment will take place during the specialized nursing clinics for
individuals with AV for HD at CHUC - HUC Campus, using a non-probability convenience
sampling method. To ensure anonymity and data confidentiality, participants will be
randomly assigned to either the Exercise Group (EG) or the Control Group (CG) through a
computer-generated randomization sequence using the RedCap software, with a 1:1
allocation ratio.
Two in-person appointments with the participants will be required, both taking place at
the specialized nursing clinics for CKD patients with AV for HD at CHUC - HUC Campus.
During the first visit, participants will be provided with information about the study's
objectives and procedures, and informed consent will be obtained. Following consent, data
collection instruments and procedures will be applied. Participants in the EG will
receive training and instruction on how to carry out the PEFAV, while those in the CG
will receive only the usual recommendations regarding AVF care.
Each participant in the EG will receive a "PEFAV Follow-up Booklet," which will include
illustrations and descriptions of the exercises, the number of sets and repetitions, and
a section called the "Exercise Log," where participants will be asked to record, after
each session, any sensations, perceived changes, or complications related to the AVF, as
well as any difficulties performing the exercises.
At the second in-person visit (eight weeks after the first), data collection instruments
and procedures will be applied again, and the EG's adherence to the PEFAV will be
assessed.
Data collection will include: a questionnaire; grip strength testing and measurements of
forearm and arm circumference; and data from the specialized nursing consultation report
(physical examination and ultrasound criteria) at CHUC - HUC Campus.
All data collection procedures will follow formal and ethical research standards,
ensuring that all informed participants voluntarily, anonymously, consent to take part in
the study, with confidentiality maintained and no costs or harm to participants.
The ultimate goal is to increase the number of functional and clinically viable AVFs
while reducing associated complications.