Efficacy of Neuromuscular Electrical Stimulation in Patients on Hemodialysis: An Updated Systematic Review and Meta-analysis.

RATIONALE &

OBJECTIVE

Kidney disease is associated with reduced physical function, muscle mass, and quality of life (QoL). Neuromuscular electrical stimulation (NMES) is a promising intervention to address these outcomes. This study aimed to update previous meta-analyses by including the latest randomized controlled trials (RCTs).

STUDY

DESIGN

Systematic review and meta-analysis of RCTs.

SETTING & STUDY POPULATIONS: RCTs evaluating effects of NMES in adult patients with kidney disease.

SELECTION CRITERIA FOR STUDIES: Outcomes included muscle strength, muscle mass, functional capacity, physical performance, activities of daily living, physical activity, health-related QoL, and adverse events.

DATA EXTRACTION: A systematic search was conducted in PubMed, Cochrane Library, and ICHUSHI (April 27, 2024).

ANALYTICAL APPROACH: Random-effects meta-analyses were performed using Review Manager 5.4. Risk of bias and certainty of evidence were assessed using RoB 2.0 and GRADE.

RESULTS

Twelve RCTs involving 289 participants were included. All participants underwent hemodialysis; no studies included patients on peritoneal dialysis, with predialysis chronic kidney disease, or post-kidney transplant recipients. NMES significantly improved lower-limb muscle strength (standardized mean difference, 0.84; 95% CI, 0.56-1.11; P < 0.001), 6-minute walk distance (mean difference, 48.15; 95% CI, 15.86-80.44; P = 0.003), and sit-to-stand performance (standardized mean difference, 0.80; 95% CI, 0.17-1.43; P = 0.01), without significantly increasing adverse events. No significant effects were found on appendicular skeletal muscle mass, timed up and go test, Short Physical Performance Battery, activities of daily living, physical activity, or HRQoL. The certainty of evidence ranged from very low to moderate across outcomes.

LIMITATIONS: Most studies had small sample sizes and high risk of bias.

CONCLUSIONS

NMES is a safe and effective intradialytic intervention for improving lower-limb muscle strength and functional capacity in patients undergoing hemodialysis. High-quality RCTs involving broader kidney disease populations are warranted to further establish its clinical utility.