Access-Related Hand Dysfunction After Hemodialysis Access Placement

Patients with chronic kidney disease (CKD) or end-stage kidney disease (ESKD) frequently experience access-related hand dysfunction (ARHD) following hemodialysis access placement, negatively impacting clinical outcomes and quality of life. Despite its prevalence, the mechanisms underlying ARHD remain poorly understood, and its impact on subsequent access maturation failure has not been well-characterized.

We conducted a longitudinal study of 39 patients with CKD or ESKD undergoing hemodialysis access surgery. Functional assessments, including grip strength, finger pressure, patient-reported hand or arm disability, dexterity, and sensory testing were performed preoperatively and 6 weeks postoperatively. Brachioradialis muscle biopsies were analyzed for morphological changes, mitochondrial function, and transcriptomic profiles. Dialysis access maturation failure was evaluated at 6-month follow-up.

Six weeks after surgery, grip strength declined by 13.5 ± 19.4% (P = 0.0001), finger pressure decreased by 30.6 ± 38.0 mm Hg (P = 0.0008), and patient-reported limb disability scores worsened (P = 0.0213). Dexterity and sensation showed no changes. Histological analysis revealed an approximately 12% reduction in myofiber cross-sectional area (P = 0.0340), which is significantly correlated with grip strength (P = 0.0488). Mitochondrial content increased (P = 0.0683) and was inversely correlated with finger pressure (P = 0.0321), whereas mitochondrial respiration and antioxidant capacity remained unchanged. RNA sequencing revealed alterations in the genes regulating myofiber development. Notably, patients with ARHD had an approximately 20% higher incidence of unassisted maturation failure at 6 months (P = 0.0046).

In patients with CKD or ESKD, hemodialysis access surgery results in ARHD, which is associated with muscle atrophy, altered transcriptomic profiles, and higher incidence of access maturation failure. These findings underscore the need for early identification and targeted interventions to prevent ARHD and improve dialysis-access surgery outcomes.