Effect of Transcutaneous Electrical Muscle Stimulation and Passive Cycling Movements on Blood Pressure and Removal of Urea and Phosphate During Hemodialysis

Farese, Stefan; Budmiger, Raphael; Aregger, Fabienne; Bergmann, Ivo P.; Frey, Felix J.; Uehlinger, Dominik E.

doi:10.1053/j.ajkd.2008.03.017

Cited by 40 publications

(51 citation statements)

References 22 publications

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“…Although the results of the current study concur with three others demonstrating intradialytic exercise to have no significant effect on urea clearance [13,14,16], the results contrast with previous investigations reporting 15-25% increases in dialysis adequacy following intradialytic exercise [10,12,15,25,26,27,28]. Possible explanations as to why our study conflicts with the aforementioned positive findings include the previous use of suboptimal study designs, with varying use of control groups and reliance on observations of single HD sessions.…”

Section: Discussionsupporting

confidence: 63%

“…This is particularly important considering the variability that can occur between and within individuals regarding dialysis adequacy. Notably some previous investigations with positive findings [27,28] also relied on less pragmatic interventions such as 3 h of intradialytic cycling or transcutaneous muscle stimulation. Thus the current study implemented a rigorous repeated measures design to provide adequate control but was powered to detect clinically important and statistically significant effects.…”

Section: Discussionmentioning

confidence: 99%

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Interaction between Intradialytic Exercise and Hemodialysis Adequacy

Kirkman¹,

Roberts²,

Kelm³

et al. 2013

Am J Nephrol

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Background/Aims: According to mathematical modeling, intradialytic exercise of sufficient intensity and duration implemented in the second half of dialysis should be as efficacious as increasing dialysis time for dialysis adequacy. This assumption has not been tested in vivo. Methods: In this controlled trial, 11 hemodialysis (HD) patients (mean (SD) age 56 (13) years) were recruited. Each patient completed three trial arms in a randomized order: routine care (CONT), increased HD time of 30 min (TIME), and intradialytic exercise (EXER), 60 min of cycling at 90% of the lactate threshold in the last 90 min of HD. The primary outcome was eKt/V_urea. Secondary outcomes included reduction and rebound ratios of urea, creatinine, phosphate and β₂-microglobulin.Outcomes were calculated from blood sampling collected pre-, post- and 30 min post-HD and confirmed with dialysate sampling. Results: Exercise was not as efficacious as increased HD time for eKt/V_urea (EXER vs. CONT, mean change (95% CI): 0.03 (-0.05 to 0.12); TIME vs. CONT: 0.15 (0.05-0.26)). Exercise was less efficacious at improving reduction ratios of urea and creatinine. However, exercise was more efficacious than increased dialysis time for phosphate reduction ratio (EXER vs. CONT: 8.6% (0.5-16.7); TIME vs. CONT: 5.0% (-1.0 to 11.1)). Conclusion: This study utilized a rigorously controlled in vivo design to test mathematical models and assumptions regarding dialysis adequacy. Intradialytic exercise towards the end of HD cannot replace the prescription of increased HD time for dialysis adequacy, but may be an adjunctive therapy for serum phosphate control.

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Section: Discussionsupporting

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Interaction between Intradialytic Exercise and Hemodialysis Adequacy

Kirkman¹,

Roberts²,

Kelm³

et al. 2013

Am J Nephrol

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show abstract

“…Intradialytic motor-driven passive leg cycling movements or transcutaneous electrical muscle stimulation of both thighs and calves increased P i removal by 31% (1,172 8 315 vs. 895 8 202 mg) and 34% (1,197 8 265 vs. 895 8 202 mg), respectively. This translates into an increase in weekly P i removal from 2.6 to 3.5 g with passive leg cycling movements and to 3.6 g with transcutaneous electrical muscle stimulation, effects similar in size to an additional HD treatment per week ( table 1 ) [9] .…”

Section: Physical Activitymentioning

confidence: 86%

Phosphate Elimination in Modalities of Hemodialysis and Peritoneal Dialysis

Kuhlmann

2010

Blood Purif

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Hyperphosphatemia is highly prevalent in hemodialysis (HD) and peritoneal dialysis (PD) patients and is a major risk factor for cardiovascular mortality. Elimination of inorganic phosphate by dialysis is a cornerstone of the management of hyperphosphatemia. Phosphate clearance during HD is affected by various factors of dialysis prescription, such as blood and dialysate flow rate, dialyzer membrane surface area and ultrafiltration volume. Phosphate mass removal can be improved by hemodiafiltration, increased dialysis frequencies and extended treatment times. Short daily or extended daily or 3 times weekly nocturnal HD allow higher phosphate mass removal and potentially complete discontinuation of phosphate binder medication. In PD, phosphate mass removal appears to be correlated with peritoneal creatinine but not urea clearance. In hyperphosphatemic PD patients, the decision on the optimal PD modality should be based on peritoneal creatinine and ideally also on peritoneal phosphate transport characteristics.

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“…Previous studies have also reported that systolic blood pressure elevation is within 10 mmHg during NMES in patients who received hemodialysis or those who are critically ill and are in intensive care, and that no significant adverse events were observed. 28,29) Therefore, we believe that NMES can be safely performed in patients with AMI without inducing unstable hemodynamic conditions such as excessive elevations in blood pressure and heart rate, although it did enhance sympathetic activity. There are some limitations to this study.…”

Section: Discussionmentioning

confidence: 97%

A Single Session of Neuromuscular Electrical Stimulation Enhances Vascular Endothelial Function and Peripheral Blood Circulation in Patients With Acute Myocardial Infarction

et al. 2016

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SummaryThis study aimed to investigate whether a single session of neuromuscular electrical stimulation (NMES) can enhance vascular endothelial function and peripheral blood circulation in patients with acute myocardial infarction (AMI). Thirty-four male patients with AMI were alternately assigned to 2 groups, and received NMES with muscle contraction (NMES group, n = 17) or without muscle contraction (control group, n = 17) after admission. NMES was performed for quadriceps and gastrocnemius muscles of both legs for 30 minutes. We measured systolic blood pressure as a parameter of cardiovascular responses and the low-frequency component of blood pressure variability as an index of sympathetic activity. Reactive hyperemia peripheral arterial tonometry (RH-PAT) index and transcutaneous oxygen pressure in foot (Foot-tcPO 2 ) were also measured as parameters of vascular endothelial function and peripheral blood circulation, respectively. All patients completed the study without severe adverse events. Systolic blood pressure and the low-frequency component increased significantly during the NMES session in both groups (P < 0.01 and P < 0.05, respectively). However, elevation from systolic blood pressure at rest was < 10 mmHg in both groups. In the NMES group, the RH-PAT index and Foot-tcPO 2 increased significantly after NMES (P < 0.05 and P < 0.001, respectively). No significant changes were observed in these parameters throughout the session in the control group. In conclusion, a single session of NMES with muscle contraction enhanced vascular endothelial function, leading to improvement in peripheral blood circulation without inducing excessive cardiovascular and autonomic responses in patients with AMI (UMIN000014196). (Int Heart J 2016; 57: 676-681)

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Effect of Transcutaneous Electrical Muscle Stimulation and Passive Cycling Movements on Blood Pressure and Removal of Urea and Phosphate During Hemodialysis

Cited by 40 publications

References 22 publications

Interaction between Intradialytic Exercise and Hemodialysis Adequacy

Interaction between Intradialytic Exercise and Hemodialysis Adequacy

Phosphate Elimination in Modalities of Hemodialysis and Peritoneal Dialysis

A Single Session of Neuromuscular Electrical Stimulation Enhances Vascular Endothelial Function and Peripheral Blood Circulation in Patients With Acute Myocardial Infarction

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