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Effect of preoperative exercise on vascular caliber and maturation of arteriovenous fistula: the physicalfav trial, a randomized controlled study

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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.

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Physicalfav Working Group

1 NEPHROLOGY DEPARTMENT. HOSPITAL UNIVERSITARIO GREGORIO MARAÑÓN. MADRID. SPAIN, 2 NEPHROLOGY DEPARTMENT. HOSPITAL UNIVERSITARIO INFANTA SOFÍA. MADRID. SPAIN, 3 VASCULAR SURGERY DEPARTMENT. HOSPITAL UNIVERSITARIO GREGORIO MARAÑÓN. MADRID. SPAIN, 4 VASCULAR SURGERY DEPARTMENT. HOSPITAL UNIVERSITARIO LA PAZ. MADRID. SPAIN, 5 NEPHROLOGY DEPARTMENT. HOSPITAL UNIVERSITARIO INFANTA LEONOR. MADRID. ESPAÑA, 6 NEPHROLOGY DEPARTMENT. HOSPITAL UNIVERSITARIO DEL SURESTE. ARGANDA DEL REY. MADRID. SPAIN. 7 CENTRO DE DIÁLISIS DIALCENTRO. MADRID. SPAIN, 8 NEPHROLOGY DEPARTMENT. HOSPITAL DEL VINALOPÓ. ALICANTE, 9 PREVENTIVE MEDICINE DEPARTMENT. HOSPITAL UNIVERSITARIO CLÍNICO SAN CARLOS. MADRID. SPAIN.

Funding

This is an investigator-initiated randomized controlled trial that was funded by a grant from the Spanish Society of Nephrology and ISCIII RETIC REDINREN RD016/009 FEDER funds.

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Authors and Affiliations

  1. Nephrology Department, Hospital Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain

    Ines Aragoncillo Sauco, Nicolas Macias & Marian Goicoechea

  2. Nephrology Department, Hospital Universitario Infanta Sofía, Madrid, Spain

    Covadonga Hevia, Yesika Amezquita, Silvia Caldes & Yolanda Hernandez Hernandez

  3. Vascular Surgery Department, Hospital Universitario Gregorio Marañón, Madrid, Spain

    Soledad Manzano Grossi, Belen Ramirez Senent & Diego Ruiz Chiriboga

  4. Instituto Carlos III, ISICIII RETIC REDINREN RD016/009 (FEDER funds), Madrid, Spain

    Ines Aragoncillo Sauco & Marian Goicoechea

Authors
  1. Ines Aragoncillo Sauco
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  2. Covadonga Hevia
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  3. Soledad Manzano Grossi
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  4. Yesika Amezquita
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  5. Nicolas Macias
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  6. Silvia Caldes
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  7. Belen Ramirez Senent
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  8. Yolanda Hernandez Hernandez
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  9. Marian Goicoechea
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Consortia

Physicalfav Working Group

  • Almudena Vega
  • , Soraya Abad
  • , Andres Felipe Delgado
  • , Diego Barbieri
  • , Ana Garcia Prieto
  • , David Arroyo
  • , Antonio Cirugeda
  • , Elena Menendez
  • , Maria Azucena Ayala
  • , Fernando Garcia Boyano
  • , Rosario Garcia Pajares
  • , Angel Luis Morales
  • , Teresa Cervera
  • , Javier Rio
  • , Diego Ruiz Chiriboga
  • , Jose Manuel Ligero
  • , Israel Leblic
  • , Marta Albalate
  • , Maite Jaldo
  • , Patricia de Sequera
  • , Beatriz Gil Casares
  • , Fernando Tornero
  • , Sandra Castellanos
  • , Maite Villaverde
  • , Belen Martin
  • , Alba Santos
  • , Cristina Fernandez
  • , Monica Garcia Garrido
  •  & Beatriz Sanchez Galan

Contributions

All authors contributed to the conception and design of the study. Materials were prepared by Inés Aragoncillo, Covadonga Hevia, Silvia Caldés, and Yésika Amezquita. Data were collected by Inés Aragoncillo, Soledad Manzano, Belen Ramirez, Yolanda Hernandez, Yésika Amezquita, Silvia Caldés, and the PHYSICALFAV working group members. Data were analyzed by Inés Aragoncillo, Marian Goicoechea, and Nicolas Macias. The first draft of the manuscript was written by Inés Aragoncillo, and all of the authors commented on the various versions of the manuscript. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Ines Aragoncillo Sauco.

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Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethics approval

The protocol was approved by the Regional Ethics Committee in May 2017.

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Physicalfav Working Group are listed in the Acknowledgement section.

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Aragoncillo Sauco, I., Hevia, C., Manzano Grossi, S. et al. Effect of preoperative exercise on vascular caliber and maturation of arteriovenous fistula: the physicalfav trial, a randomized controlled study. J Nephrol 34, 763–771 (2021). https://doi.org/10.1007/s40620-020-00907-w

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  • DOI: https://doi.org/10.1007/s40620-020-00907-w

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