Far infrared treatment on the arteriovenous fistula induces changes in sVCAM and sICAM in patients on hemodialysis

Abstract

Introduction There is a substantial risk of developing stenosis and dysfunction in the arteriovenous fistula (AVF) in patients on hemodialysis. Far infrared radiation (FIR) is a non-invasive local intervention with a potentially beneficial effect on AVF patency. The underlying mechanism is not clear. It was hypothesized that a single FIR treatment reduces factors of inflammation and promotes endothelial vasodilators in the AVF. Methods Forty hemodialysis patients with an AVF were included in an open-label intervention study.. Patients were randomized to receive either FIR (FIR group) or no FIR (control group). Blood samples were drawn directly from the AVF and from a peripheral vein in the non-AVF arm before (T0 minutes) and after (T40 minutes) treatment during a hemodialysis session. The changes (median [interquartile range]) in circulating factors of inflammation, endothelial function and vasoreactivity during FIR were measured. Results In the AVF a single FIR treatment during dialysis resulted in a significantly diminished decrease in soluble vascular cell adhesion molecule, sVCAM (−31.6 [−54.3;22.1] vs. −89.9 [−121.6; −29.3], P = 0.005) and soluble intercellular adhesion molecule, sICAM (−24.2 [−43.5;25.3] vs. −49 [−79.9; −11.6], P = 0.02) compared to the control group. Other factors, such as interleukins, nitrite, nitrate, and tumor-necrosis-factor 1 also declined during dialysis, but with no significant differences related to FIR in neither the AVF nor non-AVF arm. Conclusion A single FIR treatment attenuated the decrease in sVCAM and sICAM in the AVF compared to a control group during hemodialysis. Findings do not support the hypothesis of a vaso-protective effect of FIR. The long-term effects of FIR on the AVF are unknown.

Therapeutic strategies based on non-ionizing radiation to prevent venous neointimal hyperplasia: the relevance for stenosed arteriovenous fistula, and the role of vascular compliance

“… a Barton et al ( 65 ); Burgher et al ( 66 ); Jerjes et al ( 67 ); Houthoofd et al ( 68 ). b Lin et al ( 69 ); Lin et al ( 70 ); Bashar et al ( 71 ); Wan et al ( 72 ); Shemilt et al ( 73 ); Lindhard et al ( 74 ). c Goldstone et al 75 ; Salinas et al 76 ; Goldstone et al 77 ; Goldstein et al 78 .…”

“… b Lin et al ( 69 ); Lin et al ( 70 ); Bashar et al ( 71 ); Wan et al ( 72 ); Shemilt et al ( 73 ); Lindhard et al ( 74 ). …”

“…In contrast to PDT, the use of far-infrared (FIR) radiation therapy for improving the blood flow, maturation and the patency of AVFs has been frequently reported, and was the objective of several human randomized clinical trials such as those presented in some major reviews ( 69 – 72 , 74 , 92 , 93 ). It appears indeed that FIR therapy for AVF is a major application in cardiovascular medicine.…”

“…No sensitizing agents are required in this procedure. The trials reviewed in the above articles have involved thousands of hemodialysis patients ( 69 – 72 , 74 , 92 , 93 ). It is important to mention that most of the FIR trials were not blinded.…”

“…A range of evaluation criteria have been used, including changes in the access flow, survival number of AVF, quality of maturation, primary patency rate after one year of treatment, rate of stenosis and other AVF complications, cardiac output, assessment of inflammatory, vasoregulatory and endothelial functional factors, and changes in the content of asymmetric dimethylarginine (an inhibitor of nitric oxide synthase). However, based on changes in the content of vascular adhesion molecules, a recent clinical study ( 74 ) concluded that FIR might not have the expected vasoprotective effects, in spite of the previous favorable reports. In a prospective observational study including patients with both AVFs and AVGs ( 94 ), it was found that FIR therapy was not effective in preventing restenosis in AVFs after percutaneous translational angioplasty.…”