Low-Level Laser Therapy Versus Isometric Handgrip Exercise On Arteriovenous Fistula Maturation in Hemodialysis Patients

The purpose of this study is to evaluate the effectiveness of low-level laser therapy (LLLT) compared with isometric handgrip exercise and standard care in promoting vascular remodeling of arteriovenous fistulas (AVFs) among hemodialysis patients.

Inclusion Criteria: * Patients of both genders. * Patient age between 35 and 50 years. * Diagnosed with chronic kidney disease (CKD) Stage 4 or 5 with a newly created radiocephalic arteriovenous fistula (RC-AVF), including both pre-dialysis patients and those temporarily receiving hemodialysis via central venous catheter pending fistula maturation. * Distal forearm cephalic vein diameter ≥ 2.5 mm in the non-dominant hand Exclusion Criteria: * History of prior vascular access surgery on the same limb. * Physical or mental disability limiting the ability to perform exercises. * Positive Allen's test. * Absent or thrombosed distal forearm cephalic vein. * Already undergoing regular exercise (including manual workers). * History of hemophilia or known coagulation disorder. * Personal or family history of cancer. * Severe cardiac disease (congestive heart failure with ejection fraction ≤ 20%). * Known central venous stenosis \> 50% on the side of planned arteriovenous fistula creation.