Role of far infra-red therapy in dialysis arteriovenous fistula maturation and survival: systematic review and meta-analysis

Introduction: 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, AVFsmain disadvantage is the high rate of maturation failure, with approximately one-third (2050 %) 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. Method: 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. Results: 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(1.121.35), = 0.00001]. In addition, the two studies that reported secondary patency rates showed significant difference in favour of FIR therapy160 168 patientscompared to 140 163 controls [pooled risk ratio of 1.11(1.04-1.19], p = 0.003). Conclusion: FIR therapy positively influences the complex process of AVF maturation increasing both primary and secondary patency rates.