Is exercise progression necessary to increase cephalic vein diameter and distensibility in patients with chronic kidney disease? A case series

INTRODUCTION: Exercise is used for maturing arteriovenous fistula (AVF) in patients with chronic kidney disease (CKD) to improve endothelial function and vessel adjustments for hemodialysis. OBJECTIVE: To evaluate the effects of a progressive exercise protocol to increase the diameter and distensibility of the cephalic vein prior to AVF creation. METHOD: This is a case series study developed with nine patients with CKD (stages 4 and 5) aged between 35-75 years who participated in the training protocol distributed in two groups [non-progression group (NPG) and exercise progression group (EPG)], trained five days a week for four weeks. Patients were evaluated for diameter and distensibility of the cephalic vein (ultrasonography) at 2, 10 and 20 cm of the non-dominant limb and handgrip strength (HGS) before and after the protocol. RESULTS: Th patients who participated in the study all showed an increase in the diameter and distensibility of the cephalic vein. Younger and older patients showed better performance in terms of diameter and distensibility of the cephalic vein in the 2 cm (1.3 to 4.2 mm) and 20 cm segments (1.6 to 5.2 mm), respectively. All patients increased their HGS after applying the exercise protocol with a range of 30-68 kilogram-force (kgf) and 35 to 68 kgf for the NPG and EPG groups, respectively. CONCLUSION: Exercises with and without load progression may indicate the onset of an increase in the diameter and distensibility of the cephalic vein in patients with CKD, notably in the group which performed the protocol without load adjustment.