Does blood flow restriction training increase the diameter of forearm vessels in chronic kidney disease patients? A randomized clinical trial

Abstract

Introduction:

Blood flow restriction training can be used as an alternative to conventional exercise in chronic kidney disease patients with indication of arteriovenous fistula.

Objective:

Evaluating the efficacy of blood flow restriction training in the diameter and distensibility change of the cephalic vein and the diameter and flow of the radial artery, muscle strength and forearm circumference in chronic kidney disease patients with arteriovenous fistula pre-creation.

Methods:

A blind randomized clinical trial consisting of 26 chronic kidney disease patients allocated into a blood flow restriction training group (blood flow restriction; n = 12) and a group without blood flow restriction training (control group; n = 14). Blood flow restriction was performed at 50% of systolic blood pressure and using 40% of handgrip strength as load for the isometric exercises in both groups.

Results:

An increase in the diameter of the cephalic vein in the 2 cm (p = 0.008) and 10 cm segments (p = 0.001) was observed in the control group. The diameter of the radial artery increased in all segments in the blood flow restriction group (2, 10 and 20 cm; p = 0.005, p = 0.021 and p = 0.018, respectively) and in the 10 and 20 cm segments (p = 0.017 and p = 0.026) in the control group. Handgrip strength only increased in the control group (p = 0.003).

Conclusion:

Physical training associated with blood flow restriction increased cephalic vein diameters in both groups and was effective in increasing the diameter of the radial artery; however, it did not demonstrate superiority over the exercise group protocol without blood flow restriction.

Keywords

Arteriovenous fistula chronic renal insufficiency isometric exercise vascular endothelium

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References

Solid

Carlin

. Timing of arteriovenous fistula placement and Medicare costs during dialysis initiation. Am J Nephrol 2012; 35(1): 498–508.

Dember

Beck

Allon

et al . Effect of clopidogrel on early failure of arteriovenous fistulas for hemodialysis: a randomized controlled trial. JAMA 2008; 299(18): 2164–2171.

Al-Jaishi

Oliver

Thomas

et al . Patency rates of the arteriovenous fistula for hemodialysis: a systematic review and meta-analysis. Am J Kidney Dis 2014; 63(3): 464–478.

Mcgrogan

Maxwell

Inston

et al . Preserving arteriovenous fistula outcomes during surgical training. J Vasc Access 2014; 15(6): 474–480.

Chemla

Velazquez

D’abate

et al . Arteriovenous fistula construction with the VasQ™ external support device: a pilot study. J Vasc Access 2016; 17(3): 243–248.

Jindal

Herndon

et al . Impact of isometric handgrip exercises on cephalic vein diameter in non-AVF candidates, a pilot study. J Vasc Access 2013; 14(2): 157–163.

Vascular Access Work Group. Clinical practice guidelines for vascular access. Am J Kidney Dis 2006; 48(Supl 1): 176–247.

Abe

Kearns

Sato

. Muscle size and strength are increased following walk training with restricted venous blood flow from the leg muscle, Kaatsu-walk training. J Appl Physiol 2006; 100(5): 1460–1466.

Credeur

Hollis

Welsch

. Effects of handgrip training with venous restriction on brachial artery vasodilation. Med Sci Sports Exerc 2010; 42(7): 1296–1302.

10.

Rus

Ponikvar

Kenda

et al . Effects of handgrip training and intermittent compression of upper arm veins on forearm vessels in patients with end-stage renal failure. Ther Apher Dial 2005; 9(3): 241–244.

11.

Salimi

Nassiri

Moradi

et al . Assessment of effects of upper extremity exercise with arm tourniquet on maturity of arteriovenous fistula in hemodialysis patients. J Vasc Access 2013; 14(3): 239–244.

12.

Nakajima

Kurano

Iida

et al . Use and safety of KAATSU training: results of a national survey. Int J 2006; 2: 5–13.

13.

Horiuchi

Okita

. Blood flow restricted exercise and vascular function. Int J Vasc Med 2012; 2012: 543218.

14.

National Kidney Foundation. K/DOQI: clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002; 39(2 suppl 1): S1–S266.

15.

Schulz

Altman

Moher

. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. Trials 2010; 11(32): c332.

16.

Faul

Edfelder

Buchner

et al . Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods 2009; 41(4): 1149–1160.

17.

Robbin

Galincho

Deierhoi

et al . US vascular mapping before hemodialysis access placement. Radiology 2000; 217: 83–88.

18.

Kumar

Seward

Wilcox

et al . Influence of muscle training on resting blood flow and forearm vessel diameter in patients with chronic renal failure. Br J Surg 2010; 97(1): 835–838.

19.

Kong

Lee

Kim

et al . 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; 38(5): 648–657.

20.

Loenneke

Kim

Fahs

et al . Effects of exercise with and without different degrees of blood flow restriction on torque and muscle activation. Muscle Nerve 2015; 51(1): 713–721.

21.

Hunt

JEA

Walton

Ferguson

. Brachial artery modifications to blood flow-restricted handgrip training and detraining. J Appl Physiol 2012; 112(1): 956–961.

22.

Marston

Sedgwick

. Randomised controlled trials: missing data. BMJ 2014; 349: g4656.

23.

Tinken

Thijssen

Hopkins

et al . Shear stress mediates endothelial adaptations to exercise training in humans. Hypertension 2010; 55(2): 312–318.

24.

Ceriello

Quatraro

Caretta

et al . Evidence for a possible role of oxygen free radicals in the abnormal functional arterial vasomotion in insulin dependent diabetes. Diabete Metab 1990; 16: 318–322.

25.

Henning

Chow

. Lipid peroxidation and endothelial cell injury: implications in atherosclerosis. Free Radic Biol Med 1988; 4: 99–106.

26.

Annuk

Zilmer

Lind

et al . Oxidative stress and endothelial function in chronic renal failure. J Am Soc Nephrol 2001; 12: 2747–2752.

27.

Rus

Ponikvar

Kenda

et al . Effect of intermittent compression of upper arm veins on forearm vessels in patients with end-stage renal disease. Hemodial Int 2005; 9(1): 275–280.

28.

Pyke

Tschakovsky

. The relationship between shear stress and flow-mediated dilatation: implications for the assessment of endothelial function. J Physiol 2005; 568(Pt 2): 357–369.

29.

Thijssen

Cable

Green

. Review: impact of exercise training on arterial wall thickness in humans. Clin Sci 2012; 122: 311–322.

30.

Yasuda

Abe

Brechue

et al . Venous blood gas and metabolite response to low-intensity muscle contractions with external limb compression. Metabolism 2010; 59: 1510–1519.

31.

Lockhart

Robbin

Allon

. Preoperative sonographic radial artery evaluation and correlation with subsequent radiocephalic fistula outcome. J Ultrasound Med 2004; 23(1): 161–168.

32.

Fujita

Abe

Drummond

et al . Blood flow restriction during low-intensity resistance exercise increases S6K1 phosphorylation and muscle protein synthesis. J Appl Physiol 2007; 103(3): 903–910.

33.

Lecker

Goldberg

Mitch

et al . Multiple types of skeletal muscle atrophy involve a common program of changes in gene expression. FASEB J 2004; 18: 39–51.

34.

Miller

MacDougall

Tarnopolsky

et al . Gender differences in strength and muscle fiber characteristics. Eur J Appl Physiol Occup Physiol 1993; 66(3): 254–262.