Introduction: The goal of arterio-venous fistula (AVF) creation is to achieve a well-functioning access that can be cannulated repetitively and can provide adequate flow for the dialysis. The objective of this study was to assess the role of far infrared (FIR) therapy in the unassisted maturation of newly created AVF in patients with chronic kidney disease (CKD).
Materials and Methods: In this prospective open labeled randomised control trial, 107 patients were randomized. Participants in the control arm received oral clopidogrel 75 mg once daily for 30 days along with isometric hand exercise, whereas those in the test arm received FIR therapy twice weekly, 40 min session each, for 4 weeks. A biopsy from venous end was taken during fistula surgery. Doppler study of AVF was done at the end of the 4th and 12th week to assess AVF. Vascular access guidelines proposed by National Kidney Foundation -Kidney Disease Outcomes Quality Initiative (NKF- KDOQI) in 2006 were adapted to define the maturation of AVF.
Results: Out of 107 patients, 51 were randomized to the test arm and 56 to the control arm. During follow-up, the blood flow rate through AVF (Qa) and the diameter of the cephalic vein draining (CVd) the AVF were measured. At the end of 3 months, Qa in Radio-Cephalic Fistula (RCF) was high in the test arm (p-0.003). The AVF failures were 5 (10.2%) and 14 (28%) in the test and control arms, respectively (p: 0.025). However, when adjusted for AVF failure within 6 h of surgery (may be related to surgical technique) this difference in AVF patency was statistically insignificant (p: 0.121). The mean Qa was high in patients with an arterial intimal medial thickness (AIMT) <0.5 mm. The IMT of the anastomosed artery had statistically significant correlation with the primary failure rate of AVF (P < 0.001).
Conclusion: In patients with CKD, FIR therapy was effective in increasing the AVF blood flow rate at the end of 3 months, though the difference in primary failure rate was statistically insignificant.
Source： Anand SM, Fernando ME, Suhasini B, et al. The Role of Far Infrared Therapy in the Unassisted Maturation of Arterio-venous Fistula in Patients with Chronic Kidney Disease[J]. Indian J Nephrol, 2020, 30(5):307-315. DOI: 10.4103/ijn.IJN_122_19.
简介：动静脉内瘘（AVF）的建立目的是为实现功能良好的通路，以供重复穿刺，并为透析提供足够的流量。这项研究的目的是评估远红外（FIR）治疗在慢性肾脏病（CKD）患者新建立的AVF无辅助成熟中的作用。
材料和方法：在这项前瞻性开放标签化随机对照试验中，将107例患者随机分组。对照组的参与者接受同样的手法锻炼，每天口服一次口服氯吡格雷75 mg，共30天，而对照组的参与者则每周接受两次FIR治疗，每次40分钟，共4周。在内瘘手术期间，留取静脉末端进行活检。在第4周和第12周结束时对AVF进行多普勒研究，以评估AVF。美国国家肾脏基金会-肾脏疾病预后质量计划（NKF-KDOQI）在2006年提出的血管通路指南经过了修改，以定义AVF的成熟度。
结果：在107例患者中，有51例被随机分配到试验组，而56例被随机分配到对照组。在随访期间，测量通过AVF的血流量（Qa）和头静脉引流直径（CVd）。在3个月末，试验组的桡-头内瘘（RCF）中的Qa偏高（p=0.003）。试验组和对照组的AVF失败率分别为5（10.2％）和14（28％）（p=0.025）。但是，如果在手术后6小时内校正了AVF失败（可能与手术技术有关），则AVF通畅性的差异在统计学上不显着（p=0.121）。动脉内膜中层厚度（AIMT）<0.5 mm的患者的Qa平均值更高。吻合动脉的IMT与AVF的初次失败率具有统计学意义的相关性（P <0.001）。
结论：对于CKD患者，FIR治疗可有效提高3个月末AVF血流量，尽管初次失败率差异无统计学意义。
启发：远红外（FIR）治疗在内瘘的应用已经比较普遍了，前瞻性的设计结果更有说服力，结果有助于医患沟通。
