Preoperative Isometric Exercise Improves Vein Size and AV Fistula Creation Success before dialysis: Study
According to a new study an 8-week preoperative isometric exercise program significantly increased cephalic vein diameter and improved the rate of radiocephalic arteriovenous fistula (AVF) creation, helping preserve more proximal veins for future vascular access. While short-term AVF maturation rates were not significantly different, the findings support preoperative exercise as a simple strategy to optimize vascular access before dialysis, with larger studies and longer follow-up needed to confirm long-term benefits.
Arteriovenous fistula (AVF) remains the preferred vascular access for hemodialysis, yet maturation failure is common and preoperative strategies to optimize vessel caliber are poorly standardized. This study hypothesizes that isometric exercise, when implemented preoperatively can enhance vascular caliber, thereby improving AVF creation and maturation.
This single-center, prospective randomized controlled trial enrolled 54 patients with CKD stage 4–5 scheduled for vascular access creation at Chulabhorn Hospital, Bangkok. Participants were allocated 1:1 to an 8-week isometric exercise regimen (grip strengthener and pétanque ball; n = 27) or control (n = 27). Vascular caliber was assessed by duplex ultrasound at baseline, 4, and 8 weeks. The primary outcome was change in cephalic vein arm diameter at 8 weeks. Secondary outcomes included changes in other vessel diameters, grip strength, AVF feasibility, AVF type, and 12-week maturation rate. Baseline characteristics were comparable except for higher CAD prevalence (44.4% vs. 18.5%, p = 0.040) and antiplatelet use (40.7% vs. 14.8%, p = 0.033) in the control group.
The exercise group demonstrated a significant increase in cephalic vein arm diameter at 8 weeks (p = 0.045). Radiocephalic AVF creation was significantly more frequent in the exercise group (93.8% vs. 58.3%, p = 0.026). Baseline cephalic vein arm diameter was the strongest independent predictor of AVF feasibility (adjusted OR = 3.63 per mm, 95% CI [1.56, 8.47], p = 0.003). AVF maturation rates did not differ significantly between groups.
An 8-week preoperative isometric exercise protocol significantly improved cephalic vein arm diameter and increased radiocephalic AVF creation rate, a clinically meaningful shift that preserves proximal venous capital for future vascular access procedures. No significant difference in short-term AVF maturation was observed, likely reflecting the premature 12-week follow-up and composition effect of more radiocephalic procedures in the exercise group; adequately powered trials with extended follow-up are warranted.
Reference:
Taengsakul, N., Lertutsahakul, P., Pooloui, P. et al. Effect of preoperative isometric hand exercise on vascular caliber in patients with advanced chronic kidney disease - a randomised controlled trial. BMC Nephrol (2026). https://doi.org/10.1186/s12882-026-05200-9
