Neuromuscular electrostimulation: a new therapeutic option to improve radio-cephalic arteriovenous fistula maturation in end-stage chronic kidney disease patients

  • Lucia Martinez
  • Vicent Esteve
  • Montserrat Yeste
  • Vicent Artigas
  • Secundino Llagostera
Nephrology – Original Paper

DOI: 10.1007/s11255-017-1601-3

Cite this article as:
Martinez, L., Esteve, V., Yeste, M. et al. Int Urol Nephrol (2017). doi:10.1007/s11255-017-1601-3
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Abstract

Background

Radio-cephalic arteriovenous fistula (RCAVF) is the gold standard vascular access for end-stage chronic kidney disease patients. Exercises after arteriovenous fistula (AVF) creation improve maturation. No articles are published regarding neuromuscular electrostimulation (NMES) in AVF maturation.

Objectives

To assess the usefulness of a NMES programme on RCAVF maturation process.

Methods

An 8-week single-centre prospective study. Two groups were established: control group (CG): underwent usual RCAVF forearm exercises and electrostimulation group (ESG): underwent RCAVF NMES programme. Handgrip (HG) measurement, preoperative Doppler ultrasonography (DUS) parameters, clinical and DUS maturation as well as surgical complications were assessed.

Results

Thirty-six patients (54% men). Mean age 67.9 ± 14.3 years; 12 ESG and 24 CG. Demographic data, comorbidities, medical treatment, HG and DUS measurement at baseline were similar. HG increased in both groups at the end of the study (CG 24.5 ± 9.5 vs. 26.1 ± 10.1 kg, p 0.048; ESG 25.8 ± 10.3 vs. 26.3 ± 11.6 kg, p 0.644). RCAVF forearm vein diameter (CG 3.1 ± 0.7 vs. 5.7 ± 1.1 mm; ESG 2.9 ± 0.8 vs. 6.1 ± 1.7 mm) and humeral artery blood flow rate (CG 110.5 ± 20.7 vs. 1053.4 ± 510.7 ml/min; ESG 118.2 ± 31.6 vs. 954.1 ± 542.2 ml/min) statistically increased for both groups. A significant increase in clinical maturation in ESG (62.5 vs. 91.7%, p 0.046) at 8 weeks was observed. Four patients in each group developed juxta-anastomotic stenosis and were surgically repaired. No adverse NMES effects were registered.

Conclusions

NMES of forearm muscles is a safe and effective technique to improve RCAVF maturation and constitutes a novel alternative to forearm isometrics exercises. Nevertheless, further studies are required to confirm the potential effect of NMES in the vascular access maturation process.

Keywords

Chronic kidney disease Radio-cephalic arteriovenous fistula Maturation Neuromuscular electrostimulation 

Copyright information

© Springer Science+Business Media Dordrecht 2017

Authors and Affiliations

  • Lucia Martinez
    • 1
    • 2
  • Vicent Esteve
    • 3
  • Montserrat Yeste
    • 1
  • Vicent Artigas
    • 4
  • Secundino Llagostera
    • 5
  1. 1.Vascular Surgery DepartmentHospital of Terrassa, Consorci Sanitari de Terrassa (CST)BarcelonaSpain
  2. 2.Surgery DepartmentUniversitat Autònoma de Barcelona (UAB)BarcelonaSpain
  3. 3.Nephrology DepartmentHospital of Terrassa, Consorci Sanitari de Terrassa (CST)BarcelonaSpain
  4. 4.General Surgery DepartmentHospital de la Santa Creu i Sant PauBarcelonaSpain
  5. 5.Head of Vascular SurgeryHospital Germans Trias i PujolBarcelonaSpain

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