Effects of electrical stimulation on muscle power and biochemical markers during hemodialysis in elderly patients: a pilot randomized clinical trial

Abstract

Background: Decreased physical activity in hemodialysis (HD) patients causes various structural, metabolic, and functional abnormalities due to uremic changes in skeletal muscles. Electrical stimulation (ES) of the lower limbs was found to be effective in patients with cardiac insufficiency for exercise tolerance. This study compared the effects of ES and variable load ergometers on the lower limbs in HD patients. Methods: We performed a prospective, double-center, open-label, randomized controlled trial. Eligible patients were aged over 65 years, had end-stage renal disease, and underwent maintenance HD. The primary endpoint was muscle power, and the secondary endpoints included changes in dialysis efficiency, serum phosphorus, and inflammatory markers. Thirty HD outpatients were randomly assigned to the following groups: exercise (EX), ES, or control (SED). In EX and ES groups, patients were instructed to exercise twice a week for 12 weeks, depending on their physical capabilities. The safety and efficacy of aerobic training and ES during HD were confirmed when a sudden decrease in blood pressure or any other side effects did not occur. A repeated measures analysis of variance was performed as the principal method to evaluate time (baseline vs. 12 weeks) and group (EX vs. ES vs. SED) comparisons for the experimental outcomes. Results: The efficiency of HD significantly increased in the ES and EX groups (p ≤ 0.02). Moreover, the ES group experienced a significant increase in muscle power (p = 0.01) and the weight bearing index (p = 0.04) and a significant decrease in serum phosphorus level (p = 0.04) and tumor necrosis factor-alpha (TNF-α) level (p = 0.04) from baseline to 12 weeks. Furthermore, there was a significant increase in serum TNF-α level (p ≤ 0.03) over time in both the EX and SED groups. Conclusion: The safety and efficacy of aerobic training and ES during HD were confirmed when a sudden decrease in blood pressure or any other side effects did not occur. Therefore, ES may improve the patient's condition, similar to lower limb exercises, and ES should be considered as an option for rehabilitation programs in HD patients.

Intradialytic neuromuscular electrical stimulation with optional virtual reality distraction improves not only muscle strength and functional capacity but also serum albumin level in haemodialysis patients: a pilot randomized clinical trial

“…Albumin levels increased in both NMES groups from t0 to t1 while they decreased in the CO group. These finding are not consistent with previous research [ 34 , 44 , 47 – 50 ], which were summarized by a meta-analysis and resulted in no clear effects on albumin (MD -0.04, 95% CI -0.15 to 0.08, I 2 = 0, Q = 2.796) [ 30 ]. As serum albumin levels are a parameter to determine the sarcopenia status as well as malnutrition, we hypothesize that NMES has a positive effect on serum albumin levels in HD patients and, thus, could impact protein energy wasting and sarcopenia [ 5 , 14 – 16 , 42 , 51 ].…”

“…Therefore, NMES and NMES + VR were not associated with serious adverse events in this study. In contrast to most of the previous studies, our study resulted in a higher dropout rate of 35% (vs. < 15%) [ 34 , 44 , 45 , 47 – 50 ]. We see this increased drop-out rate most likely caused by the SARS-CoV-2 pandemic, which lead to uncertainties, fears [ 54 , 55 ] and dropouts due to Covid-19 disease, especially during our phase 1 in 2021.…”

Neuromuscular Electrical Stimulation during Hemodialysis Suppresses Postprandial Hyperglycemia in Patients with End-Stage Diabetic Kidney Disease: A Crossover Controlled Trial

“…It is possible that muscle strength will improve with further continuation of NMES. In fact, a 20 week, twice-weekly intervention study using NMES in hemodialysis patients reported improved knee extensor strength and prolonged 6MWT [ 28 , 29 ].…”

Gender Effect on Some Blood Parameters in Patients Undergoing Haemodialysis in North Western Algeria

“…Currently, nearly 2.6 million patients worldwide have different kidney diseases [1], the major problem in these patients remains the risk of developing different complications such as heart disease, high blood pressure, anaemia and inflammation [2]. However, when kidney failure becomes chronic, through gradual progression -over a period of weeks, months or years -the kidneys slowly stop functioning, there is a terminal kidney disease [3].…”