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Clinical Trial Details — Status: Recruiting

Administrative data

NCT number NCT03886116
Other study ID # 2016/2573
Secondary ID
Status Recruiting
Phase N/A
First received
Last updated
Start date November 28, 2018
Est. completion date December 2021

Study information

Verified date September 2021
Source Singapore General Hospital
Contact Tang Tjun Yip
Phone 65767986
Email tang.tjun.yip@singhealth.com.sg
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

This study will investigate the effect of pre-operative exercise on hemodynamics in the fistula artery and vein, Pre and Post Arteriovenous Fistula Formation as well as the suitability of Cannulation of Arteriovenous Fistula at 12 weeks Post Surgery. This is a randomised control study with 20 patients each in the Control arm (Group A) or the Exercise arm (Group B). The subjects will be randomised into 1:1 into one of the two groups. The patients will have an ultrasound doppler vein mapping done prior surgery and the necessary follow up visits.


Description:

The incident and prevalent population on renal replacement therapy for End Stage Renal Disease (ESRD) is steadily increasing in Singapore as well as other countries worldwide. Around 85 - 90% of the prevalent dialysis population is on Hemodialysis and Arteriovenous Fistula (AVF). AVF is considered the Gold standard for safe and effective vascular access for hemodialysis treatment due to its low rates of complication. However, Primary Failure rate of AVFs remain high at around 20 - 25% depending on the site of the surgery, contributed by several factors including the diameter of the artery and the vein used for AVF formation. If Pre-operative exercise improves the hemodynamics of the AVF and aids the maturation rate in our study, it can be incorporated into clinical guidelines to reduce the primary failure rate of AVF. Even though, there is sufficient evidence to support the beneficial role of the forearm exercises on fistula blood flow and maturation, there are no studies looking at the effects of Pre-Operative Exercise on AVF maturation. Our Study is aiming to fulfil this gap in knowledge.


Recruitment information / eligibility

Status Recruiting
Enrollment 40
Est. completion date December 2021
Est. primary completion date December 2021
Accepts healthy volunteers No
Gender All
Age group 21 Years to 90 Years
Eligibility Inclusion Criteria: - Age >=21 to <= 90. - Chronic Kidney Failure patients with Estimated Glomerular Filtration Rate (eGFR) less than 20mls/min. - Haemodialysis is chosen as their modality of renal replacement therapy. Exclusion Criteria: - Potential fistula vein diameter <= 3mm (with application of tornique) on initial vein mapping. - Known Left ventricular ejection fraction of less than 20% on Echo diagram. - Previous stroke effecting the AVF arm. - Calcified brachial or radial arteries and/or duplex evidence of stenosis of >= 50%

Study Design


Intervention

Other:
Exercise
3 sets of 10 forearm exercises performed twice in the Morning and Evening for 6 weeks.

Locations

Country Name City State
Singapore Tang Tjun Yip Singapore

Sponsors (1)

Lead Sponsor Collaborator
Singapore General Hospital

Country where clinical trial is conducted

Singapore, 

References & Publications (4)

Kong S, Lee KS, Kim J, Jang SH. The effect of two different hand exercises on grip strength, forearm circumference, and vascular maturation in patients who underwent arteriovenous fistula surgery. Ann Rehabil Med. 2014 Oct;38(5):648-57. doi: 10.5535/arm.2014.38.5.648. Epub 2014 Oct 30. — View Citation

Rus RR, Ponikvar R, Kenda RB, Buturovic-Ponikvar J. Effect of local physical training on the forearm arteries and veins in patients with end-stage renal disease. Blood Purif. 2003;21(6):389-94. — View Citation

Salimi F, Majd Nassiri G, Moradi M, Keshavarzian A, Farajzadegan Z, Saleki M, Nikpoor A, Ghane M. Assessment of effects of upper extremity exercise with arm tourniquet on maturity of arteriovenous fistula in hemodialysis patients. J Vasc Access. 2013 Jul-Sep;14(3):239-44. doi: 10.5301/jva.5000123. Epub 2013 Jan 3. — View Citation

Uy AL, Jindal RM, Herndon TW, Yuan CM, Abbott KC, Hurst FP. Impact of isometric handgrip exercises on cephalic vein diameter in non-AVF candidates, a pilot study. J Vasc Access. 2013 Apr-Jun;14(2):157-63. doi: 10.5301/jva.5000116. Epub 2012 Dec 12. — View Citation

Outcome

Type Measure Description Time frame Safety issue
Primary Change of Diameter of the vein at 5cm, 10cm & 15cm from wrist joint/elbow joint Measure with the use of an Ultrasound Doppler Baseline, 1 Week Pre-Op, 6 Weeks Post-Op
Primary Diameter of the Artery - Brachial & Radial Measure with the use of an Ultrasound Doppler Baseline
Primary Diameter of the Artery used for AVF Measure with the use of an Ultrasound Doppler 1 Week Pre-Op
Primary Change of Blood Flow Rate in the Artery Measure with the use of an Ultrasound Doppler Baseline, 1 Week Pre-Op, 6 Weeks Post-Op
Primary Diameter of the fistula vein at 5cm, 10cm & 15cm from anastomosis Measure with the use of an Ultrasound Doppler 6 Weeks Post-Op
Primary Diameter of the artery 2cm above anastomosis Measure with the use of an Ultrasound Doppler 6 Weeks Post-Op
Primary Suitability for Cannulation Measure with the use of an Ultrasound Doppler 6 Weeks Post-Op
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