Enhancing Hemodialysis Efficacy through Neuromuscular Stimulation

Madhavan, Guruprasad; Nemcek, Mary A.; Martínez, David Granado; McLeod, Kenneth J.

doi:10.1159/000167010

Cited by 5 publications

(3 citation statements)

References 28 publications

(16 reference statements)

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“…Anti‐embolism stockings have been shown to have some effects on haemodynamic variables early in HD sessions, but with no clear improvement over the treatment as a whole (Kim et al, 2010). Electrical stimulation of the muscles, a passive approach to activation of the muscle pump, has been shown to improve vascular refilling and achievement of UF targets in people receiving HD Madhavan et al (2009) and reduce the extent of oedema in people with chronic heart failure Pierce and McLeod (2009). In our six participants there was no evidence that use of either intervention improved mobilisation of fluid from lower limb oedema, however we must acknowledge a small sample size.…”

Section: Discussionmentioning

confidence: 99%

Measurement and mobilisation of localised oedema in haemodialysis

Longley

Keane

2022

Journal of Renal Care

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Background The presence of localised oedema can make measurement and removal of excess fluid in haemodialysis challenging. Objectives To evaluate (i) the effectiveness of intermittent pneumatic compression and neuromuscular electrical stimulation at mobilising oedema and (ii) the impact of localised fluid on bioimpedance measured fluid status. Design A single centre, cross‐over study design. Participants were monitored weekly during mid‐week dialysis sessions. Four sessions with each of the interventions and no interventions, with washout periods between, were included. Participants Six participants with lower limb oedema and established on haemodialysis for at least 3 months. Measurements The effectiveness of mobilising oedema and improving haemodynamic stability was assessed by: reduction in ankle circumference; ultrafiltration volume achieved; blood pressure changes; participant symptoms and achievement of target weight. The impact of localised fluid on bioimpedance measurements was assessed by comparing measurements across affected tissue with measurements avoiding the site of oedema. Results There were no differences in ultrafiltration volumes, achievement of target weight, participant symptoms or reductions in ankle circumference and systolic blood pressure between intermittent pneumatic compression and neuromuscular electrical stimulation sessions compared to control sessions. Measurements of fluid overload with bioimpedance were 1.7 and 1.8 L higher when measuring across oedematous tissue compared to non‐oedematous tissue. Conclusions We were unable to demonstrate improved mobilisation of fluid in the participant's lower limb, though there was a low number of study participants and notable interindividual variation observed. Bioimpedance offers potential for monitoring fluid management in individuals with lower limb oedema but specific protocols are necessary.

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Section: Discussionmentioning

confidence: 99%

Measurement and mobilisation of localised oedema in haemodialysis

Longley

Keane

2022

Journal of Renal Care

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“…The device delivers vibration to the plantar surface of the foot, which results in contraction of the soleus muscles in the calves. The effectiveness of this non‐invasive device to reduce lower extremity venous pooling has been demonstrated in a number of studies in samples with fibromyalgia, postural hypotension, delayed hypotension, dialysis‐related hypotension, lower limb edema, and congestive heart failure (Baniak, Pierce, Hiester, & McLeod, ; Madhavan, Goddard, & McLeod, ; Madhavan, Nemcek, Martinez, & McLeod, ; Madhavan, Stewart, & McLeod, ; Pierce & McLeod, ; Stewart, Karman, Montgomery, & McLeod, ).…”

Section: Methodsmentioning

confidence: 99%

Association of Calf Muscle Pump Stimulation With Sleep Quality in Adults

Baniak

Pierce

McLeod

et al. 2016

Research in Nursing & Health

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Prevention of lower extremity fluid pooling (LEFP) is associated with improved sleep quality. Physical activity and compression stockings are non-invasive methods used to manage LEFP, but both are associated with low adherence. Calf muscle pump (CMP) stimulation is an alternative and more convenient approach. Convenience sampling was used to recruit 11 participants between ages 45 and 65 with poor sleep quality. A within-person single-group pre-test–post-test design was used to evaluate changes in sleep quality, daytime sleepiness, and functional outcomes sensitive to impaired sleep as measured by the Pittsburgh Sleep Quality Index (PSQI), Functional Outcomes of Sleep Questionnaire, and Epworth Sleepiness Scale after 4 weeks of CMP stimulation. Statistical analysis included effect size (ES) calculations. After daily use of CMP stimulation, participants demonstrated improvement in overall sleep quality (ES = = −.97) and a large reduction in daily disturbance from poor sleep (ES = −1.25). Moderate improvements were observed in daytime sleepiness (ES = −.53) and functional outcomes sensitive to sleepiness (ES = .49). Although causality could not be determined with this study design, these results support further research to determine whether CMP stimulation can improve sleep quality.

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“…This rapid volume decrease was then followed by a sustained slower decrease in calf volume consistent with interstitial fluid migration to the initial lymphatics with subsequent ejection to the collecting lymphatics and back to the heart. Sustained stimulation with continuous blood pressure monitoring confirms that the ejected fluid is returning to the heart per the associated increase in systolic blood pressure ( Figure 9) [21]. The potential for second heart stimulation to assist individuals with diastolic heart failure, and at stage NYHA III has been tested in a pilot clinical study wherein individuals were provided with a plantar reflex stimulation device to use in their home for a four week period of time [22].…”

Section: Intervention For Second Heart Failurementioning

confidence: 99%