As a hemodialysis patient, I have long-term experience living with an arteriovenous fistula (AVF). I still have my first fistula, which is located in my left lower arm, and it is now 16 years old. Over the years, I have been very fortunate to maintain a well-functioning AVF, and I have needed only one surgical intervention, a small thrombectomy performed 3 years ago. In the last 2 years, I also started self-cannulating using the “standard” technique (not buttonhole), as it gives me a better sense of which needle sites are the best and safest to use, as well as better dialysis-to-dialysis care of my AVF. An AVF is a very specific surgically created vein system, and there are many different factors that can affect whether an AVF works properly. First, it depends on the patient's veins, surgeon's expertise and experience in creating AVF, nurses' cannulation techniques, and also patient's home care of the fistula. All of these different factors can contribute to AVF injuries, scarring, functionality, and ultimately its long-term function. As a patient, I welcome any research and innovative approaches aimed at prolonging AVF lifespan. An interesting study was conducted by Lindhard et al.1 The researchers investigated whether far-infrared radiation (FIR) therapy, electromagnetic waves that transfer energy beneath the skin, promoting vasodilation and potentially reducing neointimal hyperplasia, could prevent thrombosis in AVFs. This is the first multicenter randomized trial of FIR in a non-Asian dialysis population, extending evidence beyond previous single-center Taiwanese studies. FIR was applied during dialysis sessions for 40 minutes three times per week over 1 year. Unfortunately, it did not show any significant difference compared with controls (19% versus 28%, P = 0.25). These findings were a bit disappointing because we hemodialysis patients must keep our arms still for hours during dialysis anyway, and FIR treatment could be a practical add-on therapy. As a patient, I also wonder about skin side effects not addressed in the study. Fragile AVF skin, particularly over aneurysms, on thinly stretched skin areas, could theoretically be vulnerable to chronic infrared exposure.2 Since we, dialysis patients, are already advised to protect our fistulas from sun exposure, the long-term effects of FIR on the skin around the AVF should also be studied as a potential side effect. Nevertheless, I am pleased that work is being done on these kinds of ideas, but I also think there are fields where we can still do much more. In my opinion, there is not enough awareness about protecting the AVF at home. Patients should be better educated about the protection of the fistula from cuts and hits, avoid heavy lifting with the AVF arm, and not apply bandages too tightly after dialysis. Most importantly, patients should regularly check if their AVF is still working properly simply by placing their hand over the fistula a few times a day to sense the vibration in the fistula, especially after any stress on the AVF arm. If they notice that something feels wrong, they should react quickly and contact or get to their dialysis center as soon as possible in order to potentially save the fistula. Sometimes this can be achieved just with anticoagulant medication if treated early enough per my viewpoint. There is another preventive measure that medical staff could implement. I personally think every patient should have an AVF ultrasound at least once per year. Of course, it depends on the country, but from my experience in the European Union, France is already doing this regularly, while in Slovenia and Spain, AVF ultrasounds are usually performed only when there is already a suspected problem, and some patients do not have a proper AVF checkup for a few years or even longer. Sometimes that can simply be too late or may even cause other complications in the patient's system (heart problems, etc.). I believe there should be policy changes in this field, making regular AVF monitoring mandatory for hemodialysis patients, together with keeping historical information about blood flow, vessel size, and other important parameters. If there is already a policy to perform blood tests every month, why not also regularly monitor the AVF, which is literally a lifeline for hemodialysis patients? Because if the AVF stops working, the consequences for the patient can be serious and often require urgent medical intervention. This can significantly affect the patient's short-term quality of life, while the associated costs can be considerable for the individual or health care system. Therefore, prevention and patient education have to be the first priority.
Gal Hostnik (Thu,) studied this question.