Background and Aims: Introduction Arteriovenous fistula (AVF) creation may be controversial in elderly population, given their comorbidities, reduced life expectancy and vascular access (VA) complications. Postoperative upper limbs isometric exercise improves AVF maturation. Nevertheless, scarce scientific evidence has been reported about their utility in elderly population until date. Objectives To assess the effect of a postoperative isometric exercises program on native VA maturation in our patients older than 75 years old with stages 5-5D chronic kidney disease. Method A 24 months prospective single-center study. After surgery, all patients were randomized to an isometric exercise group (EG) or a control group (CG). Isometric exercises protocolled programm, was performed in EG. CO received usual care. Demographical data, muscle strength using handgrip (HG) dynamometer, main Doppler ultrasound (DUS) measurements (outflow vein (OV) diameter and humeral artery blood flow rate (BFR), clinical and DUS maturation as well as medical (hematoma, stenosis, thrombosis, pseudoaneurysm, aneurysm) or surgical VA complications were assessed at 8 weeks postoperatively. Results 27 patients. 14 EG, 13 CO. 74,1% men. Mean age 79,9±2,8 years. 59,2% Radiocephalic AVF. Demographic data, HG and DUS measurement at baseline were similar. A significant increase in HG was observed only in EG at the end of study (19,1±7,8 vs 22,9±9,7Kg, p=0,001). DUS measurements statistically increased for both groups (OV diameter: EG 3,1 ± 0,8 vs. 5,9 ± 1,7 mm; CG 2,9 ± 0,6 vs. 5,8 ± 1,4mm; humeral artery BFR: EG 150,7± 42,7 vs. 1165,0 ± 664,5 ml/min; CG 132,9± 30,3 vs. 1310,2 ± 691,8ml/min) at the end of study. EG group obtained highest clinical (CG 46,2% vs EG 78,6%;p=0,049) and DUS maturation (CG 30,8% vs EG 71,4%; p=0,041) at 8 weeks, significantly. Despite no significant differences, the number of complications was lower in the EG, mainly hematomas and significant stenosis. Conclusion The upper limb isometric exercises protocolled program improved clinical and DUS maturation in our elderly patients. With our results, isometric exercises should be guaranteed in elderly patients in order to obtain a correct maturation of the performed AVF. Further studies are required to support these outcomes in this population.