Effects of electrical muscle stimulation during hemodialysis in older patients with frailty: a crossover randomized controlled trial.

BACKGROUND

While electrical muscle stimulation during hemodialysis has been reported to improve physical performance in middle-aged patients, clinical evidence regarding its efficacy in older patients with frailty remains limited.

METHODS

In this crossover trial, we randomly assigned 18 older patients (aged ≥ 65 years) with frailty receiving maintenance hemodialysis in a 1:1 ratio to the study intervention. Group 1 underwent electrical muscle stimulation first, followed by a five-week washout period, and then the control session without electrical muscle stimulation. Group 2 received the control session first, followed by the electrical muscle stimulation sessions. Eligible patients had physical frailty defined by a Short Physical Performance Battery (SPPB) score of 4-9 points. Electrical muscle stimulation was conducted for 30-40 min per day, 3 days a week, over 5 weeks, during hemodialysis sessions. The primary outcome was the difference in quadriceps isometric strength before and after the treatment period.

RESULTS

Among 18 patients who were randomized, 16 patients were included in the intention-to-treat analysis (median age: 76 years [Q1 to Q3, 72 to 79]; men: 38%; median SPPB: 6 points [Q1 to Q3, 5 to 9]). The median change in quadriceps isometric strength (Q1 to Q3) was 1.5%dry weight (%DW) (0.2 to 4.2) during the electrical muscle stimulation intervention period and - 3.6%DW (- 7.7 to - 1.6) during the control period (P = 0.0027).

CONCLUSIONS

Our trial found that intradialytic electrical muscle stimulation was associated with improved quadriceps isometric strength in older patients with frailty, indicating a potential benefit of intradialytic electrical muscle stimulation intervention for physical performance, also in these subjects.

TRIAL REGISTRATION: The study was registered in a public trial registry (UMIN-CTR, number: UMIN000032501).