Effect of Electronic Moxibustion in Patients with IDH: A Randomized Crossover Pilot Study

Tai-Jan Liu,1,2 Heng-Chih Pan,3– 6 Chin-Chan Lee,3,4,6 Chun-Yu Chen,3,4,6 I-Wen Wu,3,7,8 Chiao-Yin Sun,3,4 Kuo-Su Chen,3,4 Heng-Jung Hsu,3,4,6 Yih-Ting Chen,3,4 Cheng-Kai Hsu,3,4 Yuan-Chieh Yeh1,9 1Department of Traditional Chinese Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan; 2Department of Traditional Chinese Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan; 3Division of Nephrology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan; 4Chang Gung University College of Medicine, Taoyuan, Taiwan; 5Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; 6Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan; 7Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; 8Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan; 9Program in Molecular Medicine, College of Life Sciences, National Yang Ming Chiao Tung University, Taipei, TaiwanCorrespondence: Yuan-Chieh Yeh, Department of Traditional Chinese Medicine, Keelung Chang Gung Memorial Hospital, No. 222, Maijin Road, Anle Dist, Keelung, Taipei, Taiwan, Tel +886975362713, Fax +886224313161, Email [email protected]: Intradialytic hypotension (IDH), a common complication of hemodialysis (HD), is associated with increased cardiovascular risk, morbidity, and mortality. Fatigue is one of the most frequent symptoms of IDH, and deteriorates the quality of life of patients. This study aimed to evaluate the efficacy and safety of electronic moxibustion for improving IDH and its associated symptoms.Methods: We prospectively recruited 32 end-stage renal disease patients with IDH who underwent regular HD at our hospital’s dialysis center between April 2019 and April 2020. A randomized, controlled, two-arm crossover trial was performed to evaluate the efficacy of adding one-hour electronic moxibustion during HD. The outcome measurements included patients’ subjective assessment of the degree of fatigue, recovery time of fatigue from HD, cold intolerance before and after each intervention, frequency of IDH episodes and nursing interventions needed during HD, and blood pressure changes during HD.Results: Thirty (94%) patients completed the study. Intervention with electronic moxibustion improved the degree of fatigue (95% CI, − 2.95 to − 0.18, p = 0.027), specifically in patients prescribed with midodrine (95% CI, − 4.20 to − 0.53, p = 0.013). The short-term use of electronic moxibustion during HD did not significantly alter the frequency of IDH or reduce the degree of decrease in blood pressure. Serious adverse effects were not observed. One patient complained of heat, whereas two patients had local transient erythema and pruritus.Conclusion: Electronic moxibustion appears to be safe and efficacious for improving IDH-related fatigue, thus acting as an adjuvant therapy in HD units to enhance patient comfort and treatment adherence. Further studies with larger sample sizes are required to confirm the benefits of this novel technique.Plain Language Summary: Intradialytic hypotension (IDH) during hemodialysis is linked to increased mortality, often results in fatigue, and reduces the patients’ quality of life. This study assessed the effectiveness of electronic moxibustion, an infrared device that mimics traditional moxibustion, in alleviating fatigue in IDH patients. In a 4-week randomized controlled crossover trial, patients underwent 12 sessions of electronic moxibustion at acupoint CV4 during hemodialysis. While the treatment notably improved fatigue, especially in patients on regular midodrine, it did not significantly affect IDH frequency or blood pressure drop. No major adverse events were reported. This pioneering study evaluated this device for IDH-related fatigue and offered insights for future research on its potential to stabilize blood pressure.Keywords: cross-over studies, moxibustion, fatigue, renal dialysis