Far infrared therapy on arteriovenous fistula among hemodialysis patients: A systematic review and meta-analysis

Background: Far-infrared (FIR) is one of the alternative therapies used to improve the performance of arteriovenous fistula (AVF) in hemodialysis patients. This review was done to pool the mean difference of vascular access flow and AVF diameter between the FIR and the control group. It also pooled the risk ratio of 1-year unassisted AVF patency, AVF occlusion, surgical intervention, and AVF malfunction between groups. Methods: The studies were reviewed using a systematic review, meta-analysis, and a search of four databases. The risk of bias in non-randomized studies of interventions (ROBINS-I) and the Revised Cochrane risk-of-bias instrument for randomized trials (RoB 2) were used to assess the risk of poor data quality. The meta-analysis was performed using the random effects model by inverse variance to measure the mean difference for continuous data and the Mantel-Haenszel method for dichotomous data. Results: FIR therapy group had a significant difference in risk ratio in 1-year unassisted AVF patency (Risk ratio:1.23 [95% CI: 1.12, 1.36]), AVF occlusion (Risk ratio: 0.24 [95% CI: 0.08, 0.68]), surgical intervention (Risk ratio: 0.45 [95% CI: 0.23, 0.86]) and AVF malfunction (Risk ratio: 0.44 [95% CI: 0.30, 0.62]) compared to the control group. However, for vascular access flow and AVF diameter, there was no difference between the groups (Mean difference: 68.38 [95% CI: -3.84, 140.61] and -0.07 [95% CI: -0.31, 0.17], respectively). Conclusion: The findings showed that the FIR therapy improved AVF performance. However, the limited number of studies primarily from Taiwanese may act differently from others.