Bashar Khalid, Healy Donagh, Browne Leonard D, Kheirelseid Elrasheid A H, Walsh Michael T, Clarke-Moloney Mary, Burke Paul E, Kavanagh Eamon G, Walsh Stewart Redmond
Department of vascular surgery, University Hospital Limerick, Limerick, Ireland.
Centre for Applied Biomedical Engineering Research (CABER), Department of Mechanical, Aeronautical & Biomedical Engineering, Materials and Surface Science Institute, University of Limerick, Limerick, Ireland.
PLoS One. 2014 Aug 12;9(8):e104931. doi: 10.1371/journal.pone.0104931. eCollection 2014.
A well-functioning arteriovenous fistula (AVF) is the best modality for vascular access in patients with end-stage renal disease (ESRD) requiring haemodialysis (HD). However, AVFs' main disadvantage is the high rate of maturation failure, with approximately one third (20%-50%) not maturing into useful access. This review examine the use of Far-Infra Red therapy in an attempt to enhance both primary (unassisted) and secondary (assisted) patency rates for AVF in dialysis and pre-dialysis patients.
We performed an online search for observational studies and randomised controlled trials (RCTs) that evaluated FIR in patients with AVF. Eligible studies compared FIR with control treatment and reported at least one outcome measure relating to access survival. Primary patency and secondary patency rates were the main outcomes of interest.
Four RCTs (666 patients) were included. Unassisted patency assessed in 610 patients, and was significantly better among those who received FIR (228/311) compared to (185/299) controls (pooled risk ratio of 1.23 [1.12-1.35], p = 0.00001). In addition, the two studies which reported secondary patency rates showed significant difference in favour of FIR therapy--160/168 patients--compared to 140/163 controls (pooled risk ratio of 1.11 [1.04-1.19], p = 0.003).
FIR therapy may positively influence the complex process of AVF maturation improving both primary and secondary patency rates. However blinded RCTs performed by investigators with no commercial ties to FIR therapy technologies are needed.
对于需要进行血液透析（HD）的终末期肾病（ESRD）患者，功能良好的动静脉内瘘（AVF）是血管通路的最佳方式。然而，AVF的主要缺点是成熟失败率高，约三分之一（20%-50%）无法成熟为可用的通路。本综述探讨了远红外疗法的应用，以试图提高透析患者和透析前患者AVF的初次（无辅助）和二次（有辅助）通畅率。
我们进行了一项在线搜索，以查找评估AVF患者中远红外疗法的观察性研究和随机对照试验（RCT）。符合条件的研究将远红外疗法与对照治疗进行了比较，并报告了至少一项与通路存活相关的结局指标。初次通畅率和二次通畅率是主要关注的结局。
纳入了四项RCT（666例患者）。对610例患者评估了无辅助通畅情况，接受远红外疗法的患者（228/311）的通畅情况明显优于对照组（185/299）（合并风险比为1.23[1.12-1.35]，p = 0.00001）。此外，两项报告二次通畅率的研究显示，与140/163例对照组相比，远红外疗法组（160/168例患者）有显著差异（合并风险比为1.11[1.04-1.19]，p = 0.003）。
远红外疗法可能对AVF成熟的复杂过程产生积极影响，提高初次和二次通畅率。然而，需要由与远红外疗法技术无商业关联的研究人员进行盲法RCT。
