Effects of Arteriovenous Fistula and Hand Dominance on Upper Limb Function in Patients Undergoing Hemodialysis：A protocol for a scoping review

Physical function in patients undergoing hemodialysis (HD) is frequently impaired due to CKD-related factors such as uremic toxin accumulation, chronic inflammation, and amino acid loss during dialysis. Reduced physical function is clinically important because it is associated with ADL and QOL as well as adverse outcomes, including mortality, hospitalization, and cardiovascular events. Although prior research has largely focused on lower limb function (e.g., SPPB, TUG, gait speed), HD patients also experience clinically meaningful upper limb impairments, such as reduced handgrip and pinch strength, impaired dexterity, and limited joint range of motion, which are closely linked to ADL difficulties and QOL. Upper limb dysfunction in HD may result from uremic neuropathy, carpal tunnel syndrome, and dialysis-related reductions in local oxygenation, and these complications tend to occur more often in the arteriovenous fistula (AVF) arm. Moreover, clinical recommendations to rest or avoid excessive use of the AVF arm for fistula protection may further contribute to functional decline on the AVF side. Because AVFs are typically created in the non-dominant arm—and non-dominant hands generally show lower performance in the general population—it is essential to differentiate the effects of AVF presence from those of hand dominance. However, no review has systematically synthesized evidence comparing upper limb function between AVF and non-AVF arms while accounting for hand dominance. Therefore, this scoping review aims to summarize existing evidence on upper limb function in HD patients and to clarify functional differences between AVF and non-AVF limbs, considering the influence of hand dominance, to inform assessment, rehabilitation, and lifestyle guidance that balance fistula protection with functional maintenance.