Department of Nursing, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan.
School of Nursing, China Medical University Hospital, Taichung, Taiwan.
PLoS One. 2024 Aug 28;19(8):e0307586. doi: 10.1371/journal.pone.0307586. eCollection 2024.
Hemodialysis patients rely on stable vascular access to perform effective hemodialysis and reach good dialysis quality. However, an obstructed or under-matured arteriovenous fistula (AVF) may increase infection rate and mortality in hemodialysis patients. Far infrared (FIR) therapy might help to promote AVF maturation and reduce obstruction rate. Therefore, this meta-analysis was conducted to evaluate the effect of FIR therapy on AVF obstruction rate and maturation.
PubMed, Embase, the Cochrane Library, and other databases which provide publications in randomized controlled trials (RCTs) of FIR to improve AVF in patients with CKD (Chronic Kidney Disease) or HD (hemodialysis) were used to collect articles which published before February 2023. Two authors selected relevant articles independently based on pre-defined inclusion and exclusion criteria, and assessed the quality of the articles by using the Cochrane Handbook before performing a meta-analysis in Review Manager (RevMan) 5.4 software.
Four RCTs with 475 patients were included. The results of the meta-analysis showed that the FIR therapy groups had better physiological maturation at 3 months (RR = 1.22; 95% CI = 1.07 to 1.39; p = .002) and clinical maturation at 12 months (RR = 1.35; 95% CI = 1.14 to 1.60; p < .001) than the control groups without FIR therapy. The obstruction rates within 12 months were much lower in the FIR therapy groups than in the control groups (RR = 0.24; 95% CI = 0.08 to 0.68; p = .007), also, there was no statistical heterogeneity.
FIR could promote fistula maturation and reduce the incidence of AVF obstruction.
血液透析患者依赖稳定的血管通路来进行有效的血液透析并达到良好的透析质量。然而，动静脉瘘（AVF）阻塞或不成熟可能会增加血液透析患者的感染率和死亡率。远红外（FIR）治疗可能有助于促进 AVF 成熟并降低阻塞率。因此，进行了这项荟萃分析，以评估 FIR 治疗对 AVF 阻塞率和成熟度的影响。
使用 PubMed、Embase、Cochrane 图书馆和其他数据库，收集发表于 2023 年 2 月之前的关于 FIR 改善 CKD（慢性肾脏病）或 HD（血液透析）患者 AVF 的随机对照试验（RCT）的文章。两位作者根据预先设定的纳入和排除标准独立选择相关文章，并使用 Cochrane 手册评估文章质量，然后在 Review Manager（RevMan）5.4 软件中进行荟萃分析。
纳入了四项 RCT，共 475 名患者。荟萃分析结果表明，FIR 治疗组在 3 个月时具有更好的生理成熟度（RR=1.22；95%CI=1.07 至 1.39；p=0.002），在 12 个月时具有更好的临床成熟度（RR=1.35；95%CI=1.14 至 1.60；p<0.001），而未接受 FIR 治疗的对照组则较差。FIR 治疗组在 12 个月内的阻塞率明显低于对照组（RR=0.24；95%CI=0.08 至 0.68；p=0.007），且无统计学异质性。
FIR 可促进瘘管成熟并降低 AVF 阻塞的发生率。
