B10(T)
FAR INFRARED THERAPY – A NOVEL TREATMENT FOR AV FISTULA
MATURATION AND MAINTENANCE
Moore, I1, Sweeney, D1, Fenwick, S1, Mansy, H1, Adams, J1, Murray, J1, Ahmed, S1
1
Renal Unit, City Hospitals Sunderland NHS Trust
BACKGROUND: Having a functioning arterio-venous fistula (AVF) placed in a timely
manner before commencement of haemodialysis (HD) is associated with reduction in morbidity,
mortality and length of hospital stay1. UK renal units are now focused on achieving more than
85% incidence of permanent vascular access rates in their HD population, in view of the
preferential tariff for permanent access and Renal Association standards that 85% of all
prevalent HD patients should have a functioning AVF. Ensuring a fully functioning AVF in
each patient on (or about to commence) HD is of paramount importance in achieving this figure.
In Sunderland we have been using ‘Far Infrared’ (FIR) therapy to improve our AVF outcomes.
FIR therapy involves a non-invasive 40 minute treatment projected onto the AVF area which
induces expression of endothelial Heme Oxygenase-1. FIR therapy reduces monocyte adhesions
in the endothelium cells reducing inflammatory responses that cause further endothelial injury2.
METHODS: We used FIR therapy in the low clearance clinic and for patients on HD. We
studied FIR therapy use and outcomes over a 3 month period.
In the low clearance clinic, FIR therapy unit was used to improve:
1. Success of AVF surgery in patients with poor vessels on Doppler ultrasound
2. AVF patency before HD commencement
For patients on HD the FIR therapy unit was used to reduce:
1. Size of haematoma after needle tissue during AVF cannulation
2. Pain on AVF cannulation
RESULTS: In one 3 month period, 63 patients benefited from the use of the FIR therapy. 146
individual sessions were completed (median FIR sessions 2, range 1-4). 15/20 patients had
improvement of pain score on needling of AVF. 23/27 AVF needle-site haematomas resolved
quicker than expected with FIR therapy. Some of those patients with pain on needling also
developed haematomas responsive to FIR therapy. 15/20 AVFs matured with demonstrably
better blood flow rates on Doppler in patients with previous AVF maturation failure.
We have found improvement in AVF maturation, patency, and blood flow rates. FIR therapy
also reduces pain on needling and size of haematoma post-needle tissue.
CONCLUSIONS: By using FIR therapy, we have reduced our vascular access failure rate and
have also minimized surgical intervention and consequent patient co-morbidity. We have been
able to demonstrate that FIR therapy is cost effective and reduces effort and resources in
vascular access management.
Over the last 12 months due to overwhelmingly positive feedback from our patient group we
have expanded our FIR programme to cover our central unit and satellite units. We believe this
is the first systematic use of this effective, patient-centred innovation in the UK.
References
1. Increasing the Use of Arteriovenous Fistula in Hemodialysis: Economic Benefits and
Economic Barriers. Schon et al, CJASN March 2007 vol. 2; 2: 268-276
2. Far-Infrared Therapy: A Novel Treatment to Improve Access Blood Flow and Unassisted
Patency of Arteriovenous Fistula in Hemodialysis Patients. Lin et al, Journal of American
Society of Nephrology 2007; 18: 985-992