A pilot study of intradialytic epicutaneous bilateral electromyostimulation of lower extremities

AIM OF RESEARCH: to evaluate the effectiveness of the bilateral epicutaneous electromyostimulation (BEEM) of lower extremities in the rehabilitation of hemodialysis patients. PATIENTS AND METHODS. The study included 24 patients with CKD Vd. Patients were divided on 2 groups: the BEEM group (N=12) and control group (N=12), comparable by sex, age, duration of renal replacement therapy and Charlson comorbidity index. The BEEM group underwent the procedures of muscle stimulation of the lower extremities during hemodialysis sessions for 4 weeks, 3 times per week and 3 BEEM treatments each session for 30 minutes each procedure, while the CG remained on previous dialysis regimen. In both groups before and after the investigations were carried out blood tests, a 6-minute walk test (6MWT) with oxygen saturation sensor and data collection by Total Symptom Score (TSS) polyneuropathy questionnaire. During the study the adverse events was monitored in both groups. RESULTS. Significant decreasing in serum levels of creatinine (from 0,85±0,21 to 0,80±0,17 mmol/l, p < 0.05) and urea (from 23,5±5,1 to 20,4±3,9, p < 0.05) was observed in the BEEM group compared with the control group. Other laboratory parameters were not significantly changed. There was noted a certain decreasing in the TSS pain scale from 1,8±1,0 to 1,11±0,7 points (p < 0.05) and in the resulting TSS from 3,66±2,3 to 2,22±1,2 points (p < 0.05) in BEEM group compared with the control. Unlike the control group, the distance walked in the 6MWT in the BEEM group increased from 431±113 to 455±99 m (p < 0.05) and there was significant reduction of the dyspnea (from 3,7±1,1 to 2,9±1,4 points, p < 0.05) and fatigue (from 4,3±2,0 to 2,5±1.6 points, p < 0.05) after the 6-minute walk test. Significant adverse events during the study were not observed. CONCLUSION: The BEEM procedure during hemodialysis is a safe intervention, what can enhance the efficiency of the procedures in form of lowering baseline creatinine and urea, reduce symptoms of polyneuropathy, and increase the physical adaptation of the hemodialysis patients.

hemodialysis, physical rehabilitation, electromyostimulation, polyneuropathy, 6-minute walk test

1. Paffenbarger R.S. Jr., Hyde R.T., Wing A.L., et al. The association of changes in physical-activity level and other lifestyle characteristics with mortality among men. N Engl J. Med 1993; 328: 538-545

2. Коростелева Н.Ю., Румянцев А.Ш., Шевякова Е.В., Дегтерева О.А. Физическая работоспособность у больных с концентрической и эксцентрической гипертрофией левого желудочка, получающих лечение программным гемодиализом. Нефрология 2008; 12(3): 66-71

3. Коростелева Н.Ю., Румянцев А.Ш., Смирнов А.В. Показатели транспорта кислорода в организме больных на программном гемодиализе. Нефрология 2012; 16(3) вып 1: 93-97

4. Tentori F., Elder J., Thumma J. et al. Physical Exercise among Participants in the Dialysis Outcomes and Practice Patterns Study (DOPPS): Predictors and Associated Outcomes. Nephrol Dial Transplant 2010; 25(9): 3050-3062

5. Васильева И.А., Добронравов В.А., Панина И.Ю., Трофименко И.И., Смирнов А.В. Качество жизни больных на различных стадиях хронической болезни почек. Нефрология 2013; 17(2): 60-65

6. Смирнов А.В., Добронравов В.А., Каюков И.Г. Кардиоренальный континуум: патогенетические основы превентивной нефрологии. Нефрология 2005; 9(3): 7-15

7. Karavidas A., Raisakis G., Parissis J. et al. Functional electrical stimulation improves endothelial function and reduces peripheral immune responses in patients with chronic heart failure. Eur J. Cardiovasc Prev Rehabil 2006; 13: 592-7

8. Deley G., Kervio G., Verges B. et al. Comparison of low-frequency electrical myostimulation and conventional aerobic exercise training in patients with chronic heart failure. Eur J. Cardiovasc Prev Rehabil 2005; 12: 226-33

9. Karavidas A., Parissis J., Arapi S. et al. Effects of functional electrical stimulation on quality of life and emotional stress in patients with chronic heart failure secondary to ischaemic or idiopathic dilated cardiomyopathy: A randomised, placebo-controlled trial. Eur J. Heart Fail 2008; 10(7): 709 - 713

10. Krishnan A.V., Kiernan M.C. Uremic neuropathy: clinical features and newpathophysiological insights. Muscle Nerve 2007; 35, 273-290

11. Kumar D., Marshall H. Diabetic peripheral neuropathy: amelioration of pain with transcutaneous electrostimulation. Diabetes Care 1997; 20: 1702-1705

12. Reichstein L., Labrezn S., Ziegler D. et al. Effective treatment of symptomatic diabetic polyneuropathy by high-frequency external muscle stimulation. Diabetologia 2005; 824-828

13. Dubinsky R.M., Miyasaki J. Assessment: efficacy of trans-cutaneous electric nerve stimulation in the treatment of pain in neurologic disorders (an evidence-based review); report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2010; 74(2): 173-176

14. Maltais F., LeBlanc P., Jobin J. et al. Peripheral muscle dysfunction in chronic obstructive pulmonary disease. Clin Chest Med 2000; 21: 665-77

15. Bourjeily G., Rochester C.L. Exercise training in chronic obstructive pulmonary disease. Clin Chest Med 2000; 21: 763-81

16. Bourjeily-Habr G., Rochester C.L., Alermo F. et al. Randomised controlled trial of transcutaneous electrical muscle stimulation of the lower extremities in patients with chronic obstructive pulmonary disease. Thorax 2002; Dec, 57(12): 1045-1049

17. Neder J.A., Sword D., Ward S.A. et al. Home based neuromuscular electrical stimulation as a new rehabilitative strategy for severely disabled patients with chronic obstructive pulmonary disease (COPD), Thorax 2002; 57: 333 7

18. Farese S., Budmiger R., Aregger F. et al. Effect of transcutaneous electrical muscle stimulation and passive cycling movements on blood pressure and removal of urea and phosphate during hemodialysis. Am J. Kidney Dis 2008; 52: 745-752

19. Шишкин А.Н., Федорова Ю.Ю. Интрадиализная гипотония: факторы, ассоциированные с процедурой гемодиализа. Нефрология 2012; 16(2): 64-68

20. Charlson M.E., Pompei P., Ales K.L. et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J. Chron Dis 1987; 40: 373-383

21. Ziegler D., Hanefeld M., Ruhnau K.J., et al. Treatment of symptomatic diabetic peripheral neuropathy with the anti-oxidant alpha-lipoic acid. A 3-week multicentre randomized controlled trial (ALADIN Study). Diabetologia 1995; 38: 1425-1433

22. American Thoracic Society. ATS statement: guidelines for the six-minute walk test. Am Respir Crit CareMed 2002; 166: 111-7

23. Manoch Rattanasompattikul, Usama Feroze, Miklos Z. Molnar, Ramanath Dukkipati et al. Charlson comorbidity score is a strong predictor of mortality in hemodialysis patients. Int Urol Nephrol 2012 December; 44(6): 1813-1823

24. Parsons T.L., Toffelmire E.B., King-Van Vlack C.E. The effect of an exercise program during hemodialysis on dialysis efficacy, blood pressure, and quality of life in end-stage renal disease patients. Clin Nephrol 2004; 61: 261-274

25. Trisha L. Parsons, Edwin B. Toffelmire, Cheryl E. King-VanVlack. Exercise Training During Hemodialysis Improves Dialysis Efficacy and Physical Performance. Arch Phys Med Rehabil 2006; 87: 680-687

26. Burn D.J., Bates D. Neurology and the kidney. J. Neurol Neurosurg Psychiatry 1998; 65: 810-821

27. Watkins E.S., Koeze T.H. Spinal cord stimulation and pain relief. BMJ 1993; 307: 462

28. Mima T., Oga T., Rothwell J. et al. Short-term high frequency transcutaneous electrical nerve stimulation decreases human motor cortex excitability. Neurosci Lett 2004; 355: 85-88

29. Lundeberg T., Kjartansson J., Samuelsson U. Effect of electrical nerve stimulation on healing of ischaemic skin flaps. Lancet 1988; 2: 712-714

30. Gibbons R.J., Balady G.J., Bricker J.T., et al. ACC/AHA 2002 guideline update for exercise testing: a report of the American College of Cardiology/American Heart Association Task Force on Practice. Guidelines (Committee on Exercise Testing) Circulation 2002; 106: 1883-92

31. Sietsema K.E., Amato A., Adler S.G., et al. Exercise capacity as a predictor of survival among ambulatory patients with endstage renal disease. Kidney Int 2004; 65(2): 719-24

32. Rubim V.S., Drumond Neto C., Romeo J.L., et al. Prognostic value of the Six-Minute Walk Test in heart failure. Arq Bras Cardiol 2006; 86(2): 120-125

33. Kohl L.M., Signori L.U., Ribeiro R.A., et al. Prognostic value of the six-minute walk test in end-stage renal disease life expectancy: a prospective cohort study. Clinics 2012; 67(6): 581-586

34. Karavidas A., Parissis J.T., Matzaraki V., et al. Functional electrical stimulation is more effective in severe symptomatic heart failure patients and improves their adherence to rehabilitation programs. J. Card Fail 2010; 16: 244-249