A single-center RCT randomized 54 stage 4–5 CKD patients to eight weeks of isometric hand exercise (n=27) or control (n=27). Cephalic-vein diameter improved at week 8 (p=.045) and radiocephalic AVF creation was 93.8% versus 58.3% (p=.026), but 12-week AVF maturation did not differ, so usable-access benefit remains unproven.
Key findings
- Week-8 cephalic-vein diameter improved (p=.045), and radiocephalic creation was 93.8% versus 58.3% (p=.026). Baseline diameter predicted feasibility (adjusted OR 3.63 per mm, 95% CI 1.56–8.47), but maturation was similar. Control patients had more CAD (44.4% vs 18.5%) and antiplatelet use (40.7% vs 14.8%) at baseline.
Why this matters globally
AVF failure is a global problem and preserving proximal venous capital matters. Exercise could be low-cost if confirmed, but the meaningful endpoint is durable usable access, not diameter alone.
Thai researcher contribution
Chulabhorn Hospital and Royal Academy clinicians conducted a registered Thai RCT on a practical preoperative question.
Limitations to consider
The small single-center sample had post-randomization baseline imbalances. The primary p=.045 lacks a reported effect size and CI; blinding and adherence are unclear, AVF type may involve surgeon judgment, and 12 weeks is too short for primary failure, patency, cannulation and harms.