Efeitos de um programa de exercícios na reabilitação das fístulas arteriovenosas em pacientes que realizam hemodiálise

Abstract

Introduction: Chronic kidney disease (CKD) is a significant public health issue. Vascular access complications have been the leading cause of hospitalizations in patients with CKD on dialysis, with a high mortality rate. Patients undergoing HD via AVF experience an 81% reduction in mortality risk, and there is substantial evidence that exercise aids in increasing the diameter of vessels around the fistula and improving blood flow. Objective: To evaluate the effects of implementing an exercise program (EP) for patients with CKD undergoing HD with dysfunctional AVFs. Methodology: Patients were divided into three groups: Control Group (CG), Manual Handgrip Intervention Group (MHIG), and Instrumentalized Handgrip Intervention Group (IHIG). All groups participated in an exercise protocol for AVF rehabilitation. All groups were assessed before and after the study period, using the following parameters: manual grip dynamometry, oxidative stress, forearm perimetry, and AVF ultrasound to measure vessel diameter, blood flow velocity, and volume. Results: Increased Kt/V in the MHIG when comparing baseline and post-protocol, with a trend towards increased values compared to the CG. Increased blood flow in the AVF both in the MHIG when comparing baseline and post-protocol, and in the IHIG when compared to the other two groups. Increased catalase levels in the IHIG compared to the other groups, and reduced glutathione levels; several trends towards increased values in other variables. Conclusion: Despite low patient adherence, the proposed protocol proved to be effective, as improvements in blood flow, Kt/V, and workload were observed.