Effect of a Structured Physical Exercise Program on Arteriovenous Fistula Maturation for Hemodialysis in Chronic Kidney Disease Patients

For patients living with Chronic Kidney Disease who are preparing to start hemodialysis, having a well-functioning arteriovenous fistula (AVF) is essential. Although the AVF is considered the best type of vascular access, its maturation process does not always go as expected-studies show that in 28% to 53% of cases, the fistula does not mature properly, making effective dialysis more difficult. There is growing interest in using physical exercise as a way to support AVF maturation. International guidelines even recommend arm exercises for this purpose. However, there is still no clear agreement on what type of exercise, how often, or how intense it should be. This study aims to evaluate whether a structured exercise program focused on the AVF arm can help improve the fistula's development and overall function.

Inclusion Criteria: * Age ≥ 18 years * AVF in the upper limb * No cognitive decline and ability to follow instructions Exclusion Criteria: * History of previous dysfunctional ipsilateral AVF * History of injury/condition causing pain or loss of function in the AVF limb * Musculoskeletal conditions/osteoarticular pathology (e.g., myopathy, rheumatoid arthritis) * Neurological conditions/cardiovascular events (e.g., stroke, peripheral neuropathy