Far Infrared Therapy on Arteriovenous Fistulas in Hemodialysis Patients
NCT ID: NCT04011072
Last Updated: 2024-02-29
Study Results
Results pending
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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Recruitment Status
COMPLETED
Clinical Phase
NA
Total Enrollment
206 participants
Study Classification
INTERVENTIONAL
Study Start Date
2019-10-03
Study Completion Date
2023-08-29
Brief Summary
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The number of hemodialysis patients in the world are increasing. In order to receive a sufficient dialysis, the patients needs a well functioning and stable vascular access - preferably an arteriovenous fistula (AVF). Unfortunately, the AVF has a high incidence of stenosis with percutaneous trans luminal angioplasty (PTA) as the only treatment option and a short lifetime. Little do we know of how to improve the survival of the AVF.
With this study we want to explore the effect of far infrared therapy on the stenosis, maturation and survival of the arteriovenous fistula.
The investigators will divide the patients into 2 groups: A treatment group and a control group.
The treatment group will receive infrared therapy on their fistula during their dialysis session. The control group will not receive any infrared therapy.
The investigators hope to reduce the risk of stenosis in the fistula and improve the fistula survival with this treatment.
Furthermore, the investigators want to explore the change in several biochemical markers during the treatment with infrared therapy.
With this study we want to explore the effect of far infrared therapy on the stenosis, maturation and survival of the arteriovenous fistula.
The investigators will divide the patients into 2 groups: A treatment group and a control group.
The treatment group will receive infrared therapy on their fistula during their dialysis session. The control group will not receive any infrared therapy.
The investigators hope to reduce the risk of stenosis in the fistula and improve the fistula survival with this treatment.
Furthermore, the investigators want to explore the change in several biochemical markers during the treatment with infrared therapy.
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Detailed Description
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Background:
The number of hemodialysis patients in the world are increasing. In order to receive an efficient dialysis, the patient needs a well-functioning and stable vascular access. Presently there is three options: an arteriovenous fistula (AVF), an arteriovenous graft (AVG) and a central venous catheter (CVC). CVCs are associated with an increased risk of stenosis of the central vessels, thrombosis in the AVF, infections and death. AVGs are associated with increased risk of infections, stenosis in the AVG and loss of access. This is why, the AVF is the preferred vascular access. But this vascular access does not come without risks. After the creation of an AVF there is a risk of 50 % for never maturing, which means the AVF cannot be used. Furthermore, the risk of stenosis in the AVF is also high, up to 67 % of the AVFs will have a stenosis, that needs an intervention. During this time the patient needs an alternative vascular access, such as a central venous catheter, which is related to an increased risk of infection, more hospital days and death.
The maturation of the AVF depends on several patient related, but also surgically related factors. Factors such as comorbidity, female sex, length of end stage renal disease, anatomy of the vessel, surveillance after AVF placement and the operations itself have all been shown to affect the AVF maturation. Fistula stenosis emerges from an endothelial dysfunction, inflammation and smooth muscle cell proliferation leading to intimal hyperplasia and in the end stenosis. Factors such as increased blood flow, inflammation, uremia and percutaneous transluminal angioplasty has been shown to affect the stenosis, It is not well understood, which molecular mechanism are responsible for the intimal hyperplasia.
There are few and not well established studies on how to improve the AVF survival and maturation.
Far infrared radiation (FIR) is an electromagnetic radiation (heat therapy), that is given directly on the skin above the AVF. In a few single center studies in Taiwan it has been shown to decrease the risk of stenosis and increase the fistula survival and maturation. However another study is disputing this. The mechanism behind FIR and better fistula survival is not fully understood. The infrared light is supposed to have a thermal effect, which leads to vasodilatation and a non-thermal effect, which influence the endothelial function and vasodilation and thereby it may decrease the inflammation and proliferation in the fistula, primarily through the releasing of several anti-inflammatory and vasodilating factors. This is not well documented.
Hypothesis:
Treatment with FIR for 40 minutes three times a week on the patients AVF will improve the AVF survival and maturation
Method:
This study is a randomized, controlled multicenter study on western patients
There will be 2 patient categories:
1. A group (82 patients) of dialysis patients with a newly created AF
2. A group (104 patients) of dialysis patients with an existing AVF
The patients will randomly be randomized 1:1 to either the treatment group or a control group. For group 2 the patients will be block randomized according to their access flow (AF) (above or below 950 ml/min). Furthermore these patients will be stratified according to interventions in there AVF (no interventions \>/= 1 intervention) For the FIR treatment Ws Far Infrared Therapy Unit, model TY-102F (Medical device Class 11a CE0434) is being used. The patients will receive 40 minutes of infrared radiation on the skin of their fistula during each dialysis treatment for one year. The control group will not receive any FIR treatment, but will be followed according to the protocol and in line with the treatment group.
The patients will be followed until end of study or lost-to-follow-up (death, transplantations, change of renal replacement therapy, abandoned AVF, change of vascular access to CVC, consent withdrawal or if the patients moves away).
In order to explore the long term effects of FIR the patients will be followed for an extra 6 months according to the endpoints. In a subset of 2x20 patients of the randomized controlled trial we further wish to explore the influence of infrared therapy on endothelial function and inflammation during a FIR treatment session. Blood samples will be collected before and immediately after infrared treatment directly from the treatment site, since 2 needles are placed in the fistula during the dialysis treatment. The same samples will be collected in the control group and in the intervention group during the dialysis before the first infrared intervention in order to reduce the interindividual variation in the biomarkers.The changes in markers of endothelial dysfunction and inflammation during treatment and control dialysis session will be examined and compared.
Furthermore a blood sample from each patient will be collected at study start. The predictive value of the biomarkers of endothelial dysfunction and inflammation for the treatment response to infrared therapy and the prognosis for fistula maturation, stenosis and survival will be evaluated after the randomised controlled trial has ended.
Arterial stiffness (measured by Mobil-O-Graph) will also be evaluated as a marker for fistula survival and maturation.
A total of 186 participants will be recruited from 9 dialysis centres. If the study shows positive results, the implication of FIR in the clinic will have a huge beneficial effect for the hemodialysis patients vascular access and perhaps also patient survival. FIR is an easy treatment with a low cost-effectiveness and minimal or no side effects for the patient.
The number of hemodialysis patients in the world are increasing. In order to receive an efficient dialysis, the patient needs a well-functioning and stable vascular access. Presently there is three options: an arteriovenous fistula (AVF), an arteriovenous graft (AVG) and a central venous catheter (CVC). CVCs are associated with an increased risk of stenosis of the central vessels, thrombosis in the AVF, infections and death. AVGs are associated with increased risk of infections, stenosis in the AVG and loss of access. This is why, the AVF is the preferred vascular access. But this vascular access does not come without risks. After the creation of an AVF there is a risk of 50 % for never maturing, which means the AVF cannot be used. Furthermore, the risk of stenosis in the AVF is also high, up to 67 % of the AVFs will have a stenosis, that needs an intervention. During this time the patient needs an alternative vascular access, such as a central venous catheter, which is related to an increased risk of infection, more hospital days and death.
The maturation of the AVF depends on several patient related, but also surgically related factors. Factors such as comorbidity, female sex, length of end stage renal disease, anatomy of the vessel, surveillance after AVF placement and the operations itself have all been shown to affect the AVF maturation. Fistula stenosis emerges from an endothelial dysfunction, inflammation and smooth muscle cell proliferation leading to intimal hyperplasia and in the end stenosis. Factors such as increased blood flow, inflammation, uremia and percutaneous transluminal angioplasty has been shown to affect the stenosis, It is not well understood, which molecular mechanism are responsible for the intimal hyperplasia.
There are few and not well established studies on how to improve the AVF survival and maturation.
Far infrared radiation (FIR) is an electromagnetic radiation (heat therapy), that is given directly on the skin above the AVF. In a few single center studies in Taiwan it has been shown to decrease the risk of stenosis and increase the fistula survival and maturation. However another study is disputing this. The mechanism behind FIR and better fistula survival is not fully understood. The infrared light is supposed to have a thermal effect, which leads to vasodilatation and a non-thermal effect, which influence the endothelial function and vasodilation and thereby it may decrease the inflammation and proliferation in the fistula, primarily through the releasing of several anti-inflammatory and vasodilating factors. This is not well documented.
Hypothesis:
Treatment with FIR for 40 minutes three times a week on the patients AVF will improve the AVF survival and maturation
Method:
This study is a randomized, controlled multicenter study on western patients
There will be 2 patient categories:
1. A group (82 patients) of dialysis patients with a newly created AF
2. A group (104 patients) of dialysis patients with an existing AVF
The patients will randomly be randomized 1:1 to either the treatment group or a control group. For group 2 the patients will be block randomized according to their access flow (AF) (above or below 950 ml/min). Furthermore these patients will be stratified according to interventions in there AVF (no interventions \>/= 1 intervention) For the FIR treatment Ws Far Infrared Therapy Unit, model TY-102F (Medical device Class 11a CE0434) is being used. The patients will receive 40 minutes of infrared radiation on the skin of their fistula during each dialysis treatment for one year. The control group will not receive any FIR treatment, but will be followed according to the protocol and in line with the treatment group.
The patients will be followed until end of study or lost-to-follow-up (death, transplantations, change of renal replacement therapy, abandoned AVF, change of vascular access to CVC, consent withdrawal or if the patients moves away).
In order to explore the long term effects of FIR the patients will be followed for an extra 6 months according to the endpoints. In a subset of 2x20 patients of the randomized controlled trial we further wish to explore the influence of infrared therapy on endothelial function and inflammation during a FIR treatment session. Blood samples will be collected before and immediately after infrared treatment directly from the treatment site, since 2 needles are placed in the fistula during the dialysis treatment. The same samples will be collected in the control group and in the intervention group during the dialysis before the first infrared intervention in order to reduce the interindividual variation in the biomarkers.The changes in markers of endothelial dysfunction and inflammation during treatment and control dialysis session will be examined and compared.
Furthermore a blood sample from each patient will be collected at study start. The predictive value of the biomarkers of endothelial dysfunction and inflammation for the treatment response to infrared therapy and the prognosis for fistula maturation, stenosis and survival will be evaluated after the randomised controlled trial has ended.
Arterial stiffness (measured by Mobil-O-Graph) will also be evaluated as a marker for fistula survival and maturation.
A total of 186 participants will be recruited from 9 dialysis centres. If the study shows positive results, the implication of FIR in the clinic will have a huge beneficial effect for the hemodialysis patients vascular access and perhaps also patient survival. FIR is an easy treatment with a low cost-effectiveness and minimal or no side effects for the patient.
Conditions
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Arterio-venous Fistula
Study Design
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Allocation Method
RANDOMIZED
Intervention Model
PARALLEL
Primary Study Purpose
PREVENTION
Blinding Strategy
NONE
Study Groups
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Infrared treatment arm
Far infrared radiation will be given for 40 minutes on the skin above the patients fistula in each dialysis session for one year
Group Type
ACTIVE_COMPARATOR
Far infrared radiation
Intervention Type
RADIATION
The treatment group will receive FIR for 40 minutes on the skin above the fistula during each dialysis session for one year.
Control arm
The control group will not receive any intervention, but will be followed with the same data as the treatment group
Group Type
NO_INTERVENTION
No interventions assigned to this group
Interventions
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Far infrared radiation
The treatment group will receive FIR for 40 minutes on the skin above the fistula during each dialysis session for one year.
Intervention Type
RADIATION
Other Intervention Names
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FIR
Eligibility Criteria
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Inclusion Criteria
For incident AVF:
* Patients of 18 years of age or above
* Patients on chronic hemodialysis with a central venous catheter, who is having an AVF placed
* An AVF, that are maximum 3 weeks old
For prevalent AVF:
* Patients in chronic hemodialysis with a functioning AVF
* Patients of 18 yeas of age or above
* Patients of 18 years of age or above
* Patients on chronic hemodialysis with a central venous catheter, who is having an AVF placed
* An AVF, that are maximum 3 weeks old
For prevalent AVF:
* Patients in chronic hemodialysis with a functioning AVF
* Patients of 18 yeas of age or above
Exclusion Criteria
* Not obtainable informed consent
* Non compliant patients
* Patients who use both a CVC and an AVF as their vascular access
* Patient on both hemodialysis and peritoneal dialysis
* Planned living donor kidney transplantation
* Short life expectancy, less than a 1 year
* Patients on hemodialysis less than 3 times per week
* Non compliant patients
* Patients who use both a CVC and an AVF as their vascular access
* Patient on both hemodialysis and peritoneal dialysis
* Planned living donor kidney transplantation
* Short life expectancy, less than a 1 year
* Patients on hemodialysis less than 3 times per week
Minimum Eligible Age
18 Years
Eligible Sex
ALL
Accepts Healthy Volunteers
No
Sponsors
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Rigshospitalet, Denmark
OTHER
Sponsor Role
collaborator
Hillerod Hospital, Denmark
OTHER
Sponsor Role
collaborator
Holbaek Sygehus
OTHER
Sponsor Role
collaborator
Zealand University Hospital
OTHER
Sponsor Role
collaborator
Herlev and Gentofte Hospital
OTHER
Sponsor Role
lead
Responsible Party
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Kristine Lindhard
Principal Investigator
Responsibility Role
PRINCIPAL_INVESTIGATOR
Principal Investigators
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Ditte Hansen, Doctor
Role: STUDY_CHAIR
Herlev Hospital, Department of Nephrology
Locations
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Rigshospitalet
Copenhagen, , Denmark
Site Status
Frederiksberg Hospital
Frederiksberg, , Denmark
Site Status
Herlev Hospital
Herlev, , Denmark
Site Status
Hilleroed Hospital
Hillerød, , Denmark
Site Status
Holbæk Hospital
Holbæk, , Denmark
Site Status
Hvidovre Hospital
Hvidovre, , Denmark
Site Status
Nykøbing Falster Hospital
Nykøbing Falster, , Denmark
Site Status
Roskilde Hospital
Roskilde, , Denmark
Site Status
Slagelse Hospital
Slagelse, , Denmark
Site Status
Countries
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Denmark
References
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Lacson E Jr, Wang W, Hakim RM, Teng M, Lazarus JM. Associates of mortality and hospitalization in hemodialysis: potentially actionable laboratory variables and vascular access. Am J Kidney Dis. 2009 Jan;53(1):79-90. doi: 10.1053/j.ajkd.2008.07.031. Epub 2008 Oct 18.
Reference Type
BACKGROUND
Bray BD, Boyd J, Daly C, Donaldson K, Doyle A, Fox JG, Innes A, Khan I, Peel RK, Severn A, Shilliday I, Simpson K, Stewart GA, Traynor J, Metcalfe W; Scottish Renal Registry. Vascular access type and risk of mortality in a national prospective cohort of haemodialysis patients. QJM. 2012 Nov;105(11):1097-103. doi: 10.1093/qjmed/hcs143. Epub 2012 Aug 20.
Reference Type
BACKGROUND
Vascular Access Work Group. Clinical practice guidelines for vascular access. Am J Kidney Dis. 2006 Jul;48 Suppl 1:S248-73. doi: 10.1053/j.ajkd.2006.04.040. No abstract available.
Reference Type
BACKGROUND
Vanholder R, Canaud B, Fluck R, Jadoul M, Labriola L, Marti-Monros A, Tordoir J, Van Biesen W. Diagnosis, prevention and treatment of haemodialysis catheter-related bloodstream infections (CRBSI): a position statement of European Renal Best Practice (ERBP). NDT Plus. 2010 Jun;3(3):234-246. doi: 10.1093/ndtplus/sfq041. No abstract available.
Reference Type
BACKGROUND
Dhingra RK, Young EW, Hulbert-Shearon TE, Leavey SF, Port FK. Type of vascular access and mortality in U.S. hemodialysis patients. Kidney Int. 2001 Oct;60(4):1443-51. doi: 10.1046/j.1523-1755.2001.00947.x.
Reference Type
BACKGROUND
Rayner HC, Pisoni RL, Gillespie BW, Goodkin DA, Akiba T, Akizawa T, Saito A, Young EW, Port FK; Dialysis Outcomes and Practice Patterns Study. Creation, cannulation and survival of arteriovenous fistulae: data from the Dialysis Outcomes and Practice Patterns Study. Kidney Int. 2003 Jan;63(1):323-30. doi: 10.1046/j.1523-1755.2003.00724.x.
Reference Type
BACKGROUND
Al-Jaishi AA, Oliver MJ, Thomas SM, Lok CE, Zhang JC, Garg AX, Kosa SD, Quinn RR, Moist LM. Patency rates of the arteriovenous fistula for hemodialysis: a systematic review and meta-analysis. Am J Kidney Dis. 2014 Mar;63(3):464-78. doi: 10.1053/j.ajkd.2013.08.023. Epub 2013 Oct 30.
Reference Type
BACKGROUND
Smith GE, Gohil R, Chetter IC. Factors affecting the patency of arteriovenous fistulas for dialysis access. J Vasc Surg. 2012 Mar;55(3):849-55. doi: 10.1016/j.jvs.2011.07.095. Epub 2011 Nov 8.
Reference Type
BACKGROUND
Bashar K, Conlon PJ, Kheirelseid EA, Aherne T, Walsh SR, Leahy A. Arteriovenous fistula in dialysis patients: Factors implicated in early and late AVF maturation failure. Surgeon. 2016 Oct;14(5):294-300. doi: 10.1016/j.surge.2016.02.001. Epub 2016 Mar 15.
Reference Type
BACKGROUND
Brahmbhatt A, Remuzzi A, Franzoni M, Misra S. The molecular mechanisms of hemodialysis vascular access failure. Kidney Int. 2016 Feb;89(2):303-316. doi: 10.1016/j.kint.2015.12.019.
Reference Type
BACKGROUND
Lin CC, Liu XM, Peyton K, Wang H, Yang WC, Lin SJ, Durante W. Far infrared therapy inhibits vascular endothelial inflammation via the induction of heme oxygenase-1. Arterioscler Thromb Vasc Biol. 2008 Apr;28(4):739-45. doi: 10.1161/ATVBAHA.107.160085. Epub 2008 Jan 17.
Reference Type
BACKGROUND
Shui S, Wang X, Chiang JY, Zheng L. Far-infrared therapy for cardiovascular, autoimmune, and other chronic health problems: A systematic review. Exp Biol Med (Maywood). 2015 Oct;240(10):1257-65. doi: 10.1177/1535370215573391. Epub 2015 Feb 25.
Reference Type
BACKGROUND
Lin CC, Yang WC, Chen MC, Liu WS, Yang CY, Lee PC. Effect of far infrared therapy on arteriovenous fistula maturation: an open-label randomized controlled trial. Am J Kidney Dis. 2013 Aug;62(2):304-11. doi: 10.1053/j.ajkd.2013.01.015. Epub 2013 Mar 6.
Reference Type
BACKGROUND
Lin CC, Chang CF, Lai MY, Chen TW, Lee PC, Yang WC. Far-infrared therapy: a novel treatment to improve access blood flow and unassisted patency of arteriovenous fistula in hemodialysis patients. J Am Soc Nephrol. 2007 Mar;18(3):985-92. doi: 10.1681/ASN.2006050534. Epub 2007 Jan 31.
Reference Type
BACKGROUND
Lai CC, Fang HC, Mar GY, Liou JC, Tseng CJ, Liu CP. Post-angioplasty far infrared radiation therapy improves 1-year angioplasty-free hemodialysis access patency of recurrent obstructive lesions. Eur J Vasc Endovasc Surg. 2013 Dec;46(6):726-32. doi: 10.1016/j.ejvs.2013.09.018. Epub 2013 Sep 25.
Reference Type
BACKGROUND
McGrogan DG, Stringer S, Cockwell P, Jesky M, Ferro C, Maxwell AP, Inston NG. Arterial stiffness alone does not explain arteriovenous fistula outcomes. J Vasc Access. 2018 Jan;19(1):63-68. doi: 10.5301/jva.5000791.
Reference Type
BACKGROUND
Dember LM, Imrey PB, Duess MA, Hamburg NM, Larive B, Radeva M, Himmelfarb J, Kraiss LW, Kusek JW, Roy-Chaudhury P, Terry CM, Vazquez MA, Vongpatanasin W, Beck GJ, Vita JA; Hemodialysis Fistula Maturation Study GroupFeldmanH.FarberA.KaufmanJ.SternL.LeSageP.KivorkC.SoaresD.MalikovaM.AllonM.YoungC.TaylorM.WoodardL.MangadiK.MundaR.LeeT.AllowayR.El-KhatibM.CanaanT.PflumA.ThiekenL.Campos-NaciffB.HuberT.BerceliS.JansenM.McCaslinG.TrahanY.DavidsonI.HwangC.LightfootT.LivingstonC.ValenciaA.DolmatchB.FenvesA.HawkinsN.CheungA.KinikiniD.TreimanG.IhnatD.SarfatiM.LavasaniI.MaloneyM.SchlotfeldtL.BuchananC.ClarkC.CrawfordC.HamlettJ.KundzinsJ.ManahanL.WiseJ.GassmanJ.GreeneT.LiL. Vascular Function at Baseline in the Hemodialysis Fistula Maturation Study. J Am Heart Assoc. 2016 Jul 22;5(7):e003227. doi: 10.1161/JAHA.116.003227.
Reference Type
BACKGROUND
Roy-Chaudhury P, Sukhatme VP, Cheung AK. Hemodialysis vascular access dysfunction: a cellular and molecular viewpoint. J Am Soc Nephrol. 2006 Apr;17(4):1112-27. doi: 10.1681/ASN.2005050615.
Reference Type
BACKGROUND
Lee T, Misra S. New Insights into Dialysis Vascular Access: Molecular Targets in Arteriovenous Fistula and Arteriovenous Graft Failure and Their Potential to Improve Vascular Access Outcomes. Clin J Am Soc Nephrol. 2016 Aug 8;11(8):1504-1512. doi: 10.2215/CJN.02030216. Epub 2016 Jul 11.
Reference Type
BACKGROUND
Lindhard K, Rix M, Heaf JG, Hansen HP, Pedersen BL, Jensen BL, Hansen D. Effect of far infrared therapy on arteriovenous fistula maturation, survival and stenosis in hemodialysis patients, a randomized, controlled clinical trial: the FAITH on fistula trial. BMC Nephrol. 2021 Aug 21;22(1):283. doi: 10.1186/s12882-021-02476-x.
Reference Type
DERIVED
Other Identifiers
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FIR HD
Identifier Type: -
Identifier Source: org_study_id
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