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Kidney Week

Abstract: TH-OR138

Preliminary Results of the PHYSICALFAV Trial

Session Information

Category: Dialysis

  • 704 Dialysis: Vascular Access

Authors

  • Aragoncillo, Ines, Hospital Gregorio Marañón, Madrid, Spain
  • Ligero, Jose manuel, Hospital Gregorio Marañón, Madrid, Spain
  • Caldés, Silvia, Hospital Infanta Sofia, Madrid, Spain
  • Hernandez, Yolanda, Hospital Infanta Sofia, Madrid, Spain
  • Amézquita orjuela, Yesika Maria, Hospital Infanta Sofia, Madrid, Spain
  • Vega, Almudena, Hospital Gregorio Marañón, Madrid, Spain
  • Garcia Prieto, Ana M., Hospital Gregorio Marañón, Madrid, Spain
  • Macias, Nicolas, Hospital Gregorio Marañón, Madrid, Spain
  • Abad, Soraya, Hospital Gregorio Marañón, Madrid, Spain
  • Luno, Jose, Hospital Gregorio Marañón, Madrid, Spain
  • Hevia ojanguren, Maria Covadonga, HU Infanta Sofía, S Sebastian de los Reyes.Madird, Spain
Background

Hemodialysis with autologous arteriovenous fistula (AVF) is associated with higher survival, lower costs, and fewer complications. Distal forearm AVF is the best option, but not all patients are good candidates for this approach and the primary failure rate ranges from 20% to 50%. The optimal AVF depends mainly on the anatomical and hemodynamic characteristics of the artery and the vein chosen for the anastomosis. These characteristics can be modified by performing physical exercise.

Methods

The PHYSICALFAV trial (NCT03213756) is an open-label, multicenter, prospective, controlled, randomized trial designed to evaluate the usefulness of preoperative isometric exercise (PIE) in pre-dialysis or prevalent hemodialysis patients who are candidates for a new AVF. Patients are randomized 1:1 to the PIE group (Exercises combining hand grip and elastic band for 8 weeks) or the control group (no exercise).

Results

After 20 months recruitment, 120 patients have been randomized. After 8 weeks of preoperative isometric exercise we have found significant differences on vein diameter (p<0.001), arterial peak systolic velocity and diameter (p 0.041- p 0.001) and maximum strength (p<0.001) on PIE group patients (table 1). We have been able to perform 76% of distal AVF in PIE group compared to 53% in the control group (p 0,043). Global primary failure rate was very low in both groups (6,9% PIE group vs 5,7% control group, pNS) and intervention free rate at 3 months was 82,8% PIE group vs 80% in control group (pNS).

Conclusion

Isometric preoperative exercise can improve vascular calipers and increase the possibility of performing distal AVF. The final results of this trial will be available in September 2019.

Before and after exercise
 Baseline visitAfter 8 weeks of exercisep
Vein diameter (mm)2,88 (1,05)3,55 (0,97)<0.001
Artery diameter (mm)2,57 (0,90)2,76 (0,89)0.001
PSV (cm/sg)66,67 (20,4)72,84 (22,3)0.041
Maximun strength(kg)27,4 (10,3)31,32 (11,9)<0.001

Funding

  • Other NIH Support