Effect of Forearm Exercise on Flow Mediated Vasodilation prior to Arteriovenous Fistula Placement for Hemodialysis

Purpose:  
To determine whether six weeks of preoperative arm exercise can improve overall maturation of native fistulas created for hemodialysis.

Design:  
The study will be a randomized controlled trial testing the effect of 6 weeks of preoperative arm exercise on the primary outcome of flow-mediated dilation (FMD) of the brachial artery in subjects with chronic kidney disease with a calculated GFR (MDRD equation) of less than or equal to 20 ml/min and who are eligible for a new arteriovenous fistula (see figure). A total of 20 subjects will be enrolled and randomized 3:1 into the exercise arm of the study. (15 exercise and 5 control, non-exercise).

Outcome:  
The primary outcome measure is measurement of flow-mediated dilation of the brachial artery in patients with end-stage renal disease (ESRD) scheduled for an arteriovenous fistula.  Secondary outcome measures will include the effect of exercise on artery and vein size, the correlation between FMD, vessel size and the fistula flow rate at 2 weeks and access survival at 6 weeks and finally the correlation between asymmetric dimethylarginine (ADMA) and FMD before and after exercise. 

Risk:  
Arm exercise can raise blood pressure and pulse rate.  Sublingual Nitroglycerine may cause transient dizziness and headache.  Risk of blood loss from lab tests performed.

Sample size:    
20 Subjects.

Duration:   
2 Years.

Start date:  
Enrollment started November 2004.

Stop date:  
Enrollment expected to stop November 2006.

Investigator(s):   
Bradley Dixon, MD

Coordinator(s):   
Bradley Franzwa

Funding:  
National Kidney Foundation, Iowa Affiliate Amgen, Inc.

For more Information, please contact:    

Brad Franzwa, Vascular Access Study Coordinator
W339A GH, Internal Medicine
University of Iowa Hospitals and Clinics
Iowa City, IA  52242
Phone: 319-353-6689
Fax: 319-353-7327
Pager: 1-888-354-9807 (Toll-Free in Iowa)