Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide synthase and plays a significant role in the pathogenesis of arteriovenous fistula (AVF) dysfunction. The aim of this study is to evaluate the effect of far-infrared (FIR) therapy on the maturation and patency of newly-created AVFs in patients with advanced diabetic kidney disease (DKD) as well as the concurrent change in plasma ADMA. The study enrolled 144 participants with advanced DKD where 101 patients were randomly allocated to the FIR therapy group (N = 50) and control group (N = 51). Patients receiving FIR therapy had a decreased AVF failure rate within 12 months (16% versus 35.3%; p = 0.027); decreased incremental change of ADMA concentration at the 3rd and 12th month; increased AVF blood flow at the 1st, 3rd, and 12th month; increased 3-month physiologic maturation rate (88% versus 68.6%; p = 0.034); increased 1-year unassisted AVF patency rate (84% versus 64.7%; p = 0.017); and increased clinical AVF maturation rate within 12 months (84% versus 62.7%; p = 0.029) compared to the control group. The study demonstrates that FIR therapy can reduce the incremental changes in plasma ADMA concentration, which may be associated with the improvement of AVF prognosis in patients with advanced DKD.

Peritoneal dialysis (PD) is a treatment modality for end-stage renal disease (ESRD) patients. Dextrose is a common osmotic agent used in PD solutions and its absorption may exacerbate diabetes mellitus, a common complication of ESRD. PD solutions also contain glucose degradation products (GDPs) that may lead to encapsulating peritoneal sclerosis (EPS), a severe complication of PD. A previous study showed that far-infrared (FIR) therapy improved a patient’s gastrointestinal symptoms due to EPS. Due to limited literature on the matter, this study aims to investigate dialysate GDPs and peritoneal function in diabetic patients on PD. Thirty-one PD patients were enrolled and underwent 40 min of FIR therapy twice daily for six months. We demonstrated the effect of FIR therapy on the following: (1) decrease of methylglyoxal (p = 0.02), furfural (p = 0.005), and 5-hydroxymethylfurfural (p = 0.03), (2) increase of D/D0 glucose ratio (p = 0.03), and (3) decrease of potassium levels (p = 0.008) in both DM and non-DM patients, as well as (4) maintenance and increase of peritoneal Kt/V in DM and non-DM patients, respectively (p = 0.03). FIR therapy is a non-invasive intervention that can decrease dialysate GDPs in PD patients by improving peritoneal transport rate and solute removal clearance, while also maintaining dialysis adequacy.

Hyperlipidemia is increasing in prevalence and is highly correlated with cardiovascular disease (CVD). Lipid-lowering medications prevent CVD but may not be suitable when the side effects are intolerable or hypercholesterolemia is too severe. Double-filtration plasmapheresis (DF) has shown its therapeutic effect on hyperlipidemia, but its side effects are not yet known. We enrolled 45 adults with hyperlipidemia in our study. The sera before and two weeks after DF were evaluated, and we also analyzed perfluorochemicals to see if DF could remove these lipophilic toxins. After DF, all lipid profile components (total cholesterol, triglycerides, high-density lipoprotein [HDL], and low-density lipoprotein [LDL]) had significantly decreased. Leukocyte counts increased while platelet levels decreased, which may have been caused by the puncture wound from DF and consumption of platelets during the process. As for uremic toxins and inflammation, levels of C-reactive protein, uric acid, and alanine transaminase (ALT) all decreased, which may be related to the removal of serum perfluorooctane sulfonate (PFOS) and improvement of renal function. The total cholesterol/HDL ratio and triglycerides were significantly higher in the diabetes mellitus (DM) group at baseline but did not significantly differ after DF. In conclusion, DF showed potential for improving inflammation and removing serum lipids and PFOS in adults with hyperlipidemia.

Long-term peritoneal dialysis (PD) can lead to detrimental changes in peritoneal membrane function, which may be related to the accumulation of glucose degradation products. A previous study demonstrated that 6 months of far-infrared (FIR) therapy may decrease glucose degradation products in PD dialysate. Due to limited literature on this matter, this study aims to investigate the effect of FIR therapy on the peritoneal membrane transport characteristics of PD patients. Patients were grouped according to baseline peritoneal transport status: lower transporters (low and low-average) and higher transporters (high-average and high). Both groups underwent 40 min of FIR therapy twice daily for 1 year. In lower transporters, FIR therapy increased weekly dialysate creatinine clearance (6.91 L/wk/1.73 m²; p = 0.04) and D/P creatinine (0.05; p = 0.01). In higher transporters, FIR therapy decreased D/P creatinine (−0.05; p = 0.01) and increased D/D0 glucose (0.05; p = 0.006). Fifty percent of high transporter patients shifted to high-average status after FIR therapy. FIR therapy may decrease D/P creatinine for patients in the higher transporter group and cause high transporters to shift to high-average status, which suggests the potential of FIR therapy in improving peritoneal membrane function in PD patients.

While far-infrared (FIR) therapy has improved the treatment of various diseases, its effects on peritoneal dialysis (PD) remain understudied. The study aims to investigate the impact of FIR therapy on the cardiovascular and infectious outcomes in PD patients. A prospective observational study was conducted for six months, comparing a group receiving FIR therapy (n = 49) with a control group (n = 50). The primary outcome is defined as the composite outcome of three-point major adverse cardiovascular events (3P-MACE), coronary artery disease (CAD), congestive heart failure (CHF), or PD-related infection. The secondary outcomes are: (1) 3P-MACE; (2) 3P-MACE, CAD, or CHF; (3) PD-related infection. The FIR group consistently exhibited lower incidence rates for primary and secondary outcomes. The primary outcome occurred in six patients (12.2 %) in the FIR group and 15 patients (30 %) in the control group, with incidence rates of 0.26 vs. 0.75 events per patient-year, respectively (p = 0.03). The secondary outcomes for the FIR and control groups were: (1) 3P-MACE occurred in zero patients and four patients (8 %), respectively; (2) composite outcome of 3P-MACE, CAD, or CHF occurred in two patients (4.1 %) and six patients (12 %), respectively; (3) PD-related infection occurred in six patients (12.2 %) and 12 patients (24 %), respectively. Furthermore, FIR therapy significantly reduced hospitalizations for the primary outcome (HR = 0.22; 95 % CI = 0.07-0.71; p = 0.01) and demonstrated better survival rate at six months (85.7 % vs. 67.9 %, respectively). This study suggests that FIR therapy shows promise in reducing hospitalizations associated with cardiovascular and infectious outcomes in PD patients.

Background: Sacubitril/valsartan improves heart function in maintenance hemodialysis (HD) patients with heart failure with a reduced ejection fraction of <40% (HFrEF). However, the effect of sacubitril/valsartan on vascular access flow (Qa) in this population is still unclear. Methods: Hemodialysis patients with HFrEF were enrolled and divided into sacubitril/valsartan and non-sacubitril/valsartan treatment groups and received echocardiographic and Qa measurements at baseline and after 12 months. We compared the changes in Qa (△Qa) and echocardiographic parameters after 12 months. Correlations between △Qa and echocardiographic parameters were also examined. Multiple linear regression analysis was performed to predict △Qa. Results: Thirty-three HD patients with HFrEF were enrolled. Sixteen patients received sacubitril/valsartan treatment. Their mean Qa significantly increased from 633.8 to 948.8 mL/min (P < .001). There was no significant change in Qa for the non-sacubitril/valsartan treatment group (from 637.7 to 621.8 mL/min; P = .436). The change in left ventricular ejection fraction (△LVEF) differed significantly between the sacubitril/valsartan and conventional treatment groups (13.63 ± 11.35% and 1.59 ± 6.99%, respectively; P = .001). The △Qa was significantly correlated with △LVEF (rs = 0.929; P < .001) and with the change in interventricular septum thickness in diastole (△IVSd, rs = −0.736; P = .001) in the sacubitril/valsartan group. The △Qa was predicted as −44.034 + 15.868 × △LVEF−25.072 × △IVSd + 145.964 × A (A = 1 for sacubitril/valsartan use and A = 0 for non-sacubitril/valsartan treatment) mL/min (R2 = 0.909). Conclusion: In HD patients with HFrEF, treatment with sacubitril/valsartan is associated with improvement in LVEF and Qa over 12 months.