Effect of Far Infrared Radiation on the Proportion of Interventions in Arteriovenous Fistulas in Patients on Hemodialysis: A Randomized Trial.

Abstract

Key points: Far infrared radiation did not improve the proportion of interventions in arteriovenous fistulas in patients on hemodialysis after 12 months of treatment. No difference was seen between treatment groups in time to intervention, number of thrombosed fistulas, and change in access flow. This study does not support the effect of far infrared radiation on fistula survival as proposed in previous vascular access guidelines.

Introduction: In patients on hemodialysis, the risk of arteriovenous fistula (AVF) failure is unacceptably high. Up to 67% of AVFs need an intervention within 1 year after placement. There are no effective treatments to prolong AVF longevity. Far infrared radiation (FIR) treatment has been suggested to enhance AVF survival. The present trial investigated the effect of FIR on the proportion of interventions in the AVF.

Methods: In a multicenter, randomized, controlled trial, patients were allocated to receive FIR treatment or no FIR. Eligible patients were patients on chronic hemodialysis with a well-functioning AVF. The FIR group received FIR above the skin of their AVF for 40 minutes at every hemodialysis session for 1 year. The primary outcome was the difference in the proportion of patients with at least one intervention (thrombectomy or percutaneous transluminal angioplasty) after 12 months. The chi-squared test analyzed the difference. Secondary outcomes included differences in the number of thrombosed AVFs, intervention rate, access flow at various time points, and time to first intervention between groups.

Results: A total of 115 patients were randomized to the FIR group ( n =58) or the control group ( n =57). Baseline characteristics were similar in both groups. There was no significant difference in the proportion of patients with interventions between the FIR and control groups (19% versus 28%, P = 0.25) or in the proportion with thrombosed AVFs (5% versus 3%, P = 0.26). Time to first intervention was 164 (interquartile range, 86-272) days in the FIR group and 127 (interquartile range, 44-164) days in the control group ( P = 0.26). No differences in the change of access flow occurred ( P = 0.86).

Conclusion: During 12 months of treatment, FIR did not affect the overall patency of the AVF. No difference was found in the number of patients with interventions or in any of the secondary endpoints (Clinicaltrials.gov: NCT04011072 ).

Clinical trial registry name and registration number: Clinicaltrials.gov: NCT04011072.