Handgrip exercise after arteriovenous fistula creation: Vascular access and hand function outcomes—A randomized controlled trial

Background: Postoperative exercise is widely recommended after arteriovenous fistula (AVF) creation, yet evidence for its effect on maturation remains inconsistent. We evaluated whether a structured isometric handgrip program improves AVF maturation and related functional outcomes. Methods: This single-center, parallel-group randomized controlled trial enrolled 80 patients undergoing radiocephalic or brachiocephalic AVF creation (October 2023–March 2025). Participants were randomized 1:1 to either a 12-week postoperative isometric handgrip exercise program ( n = 40) or standard care ( n = 40). Seventy-nine participants (exercise 39, control 40) were analyzed (modified intention-to-treat). The primary outcome was KDOQI-defined AVF maturation at 12 weeks. Secondary outcomes included handgrip strength, cannulation-related hematoma within 28 days, and time-to-access events. Results: AVF maturation at 12 weeks occurred in 84.6% (33/39) of the exercise participants and 92.5% (37/40) of the controls (adjusted risk ratio (RR) 0.91, 95% confidence interval (CI) 0.77–1.08; p = 0.283). AVF-arm grip strength increased progressively in the exercise group (21.9 to 26.4 kg vs 22.0 to 22.4 kg; group × time p < 0.001), with a smaller contralateral-arm gain (group × time p < 0.001). Cannulation-related hematoma within the first 28 days occurred in 0/39 exercise participants versus 6/40 controls (0% vs 15.0%; p = 0.026; number needed to treat ≈ 7, 95% CI 3–33). Conclusions: Postoperative isometric handgrip exercise did not improve AVF maturation but was associated with clinically meaningful gains in grip strength and, in an exploratory analysis, fewer cannulation-related hematomas. These findings support structured exercise as a safe, functionally beneficial adjunct to routine vascular access care rather than a stand-alone maturation therapy. Trial registration: Thai Clinical Trials Registry, TCTR 20230913009.