Abstract: 【Abstract】Objective To systematically evaluate the effect of preoperative grip strength exercise on forearm vascular diameter in chronic kidney disease (CKD) patients preparing for arteriovenous fistula (AVF) surgery. Methods We searched the China Biology Medicine disc, China National Knowledge Infrastructure, VIP database, Wanfang data, PubMed, Medline and Cochrane library for relevant literature from inception to February 26, 2021. Literature screening, data extraction and bias assessment of all eligible studies were conducted independently by two reviewers. Meta-analysis was conducted by using the RevMan 5.3 software. Results
A total of 12 studies including 343 participants were analyzed. Meta-analysis showed that ①the blood vessel diameter after exercise was larger than that before exercise (SMD=1.03, 95% CI 0.62～1.45, P<0.01); ② pressurized exercises increased the diameter of blood vessels (SMD=1.31, 95% CI 0.26～2.36, P=0.01), and non-pressurized exercise also increased the endovascular meridian (SMD=0.92, 95% CI 0.49～1.34, P＜0.01). ③ comparison of vascular diameter at different exercise time nodes and before exercise found that the vascular diameter was statistically greater after exercise at the second week (SMD=0.72, 95% CI 0.05～1.38, P=0.03), the fourth week (SMD=1.60, 95% CI 0.75～2.45, P＜0.01) and the sixth to eighth week (SMD=1.47, 95% CI 0.77～2.18, P＜0.01); and ④ there was no significant difference between the vascular diameter at the fourth week and that at the eighth week of the exercise (SMD=0.31, 95% CI - 0.43～1.05, P=0.41). Conclusion Preoperative grip strength exercise can increase the forearm vascular diameter in CKD patients preparing for AVF surgery. Both pressurized exercise and non-pressurized exercise were beneficial to the increase of vascular diameter. Grip exercise should be preceded by 4-8 weeks of the surgery.

Key words: Chronic kidney disease, Arteriovenous fistula, Preoperative grip strength exercise, Blood vessel diameter, Meta-analysis