Neuromuscular Electrical Stimulation in Chronic Kidney Failure: A Systematic Review and Meta-analysis

Abstract

ObjectiveTo systematically review the effects of neuromuscular electrical stimulation (NMES) in patients with chronic kidney failure (CKF) on hemodialysis (HD) on lower and upper limb muscle strength, functional capacity, and quality of life. Data SourcesData were obtained from MEDLINE (via PubMed), Embase, Scielo, Cochrane Central Register of Controlled Trials, and Physiotherapy Evidence Database. There were no mandatory language or publication date restrictions. Study SelectionClinical trials that assessed the chronic effect of NMES (alone or associated with other physical therapy) on lower limb muscle strength or functional capacity of CKF patients on HD compared with control, placebo, or another intervention were selected. Data ExtractionTwo independent reviewers extracted data using a predesigned data extraction form. Risk of bias was assessed with RoB 2.0 and ROBINS-I, and quality of evidence was assessed with Grading of Recommendations Assessment, Development, and Evaluation. Data SynthesisTen studies were included, totaling 242 patients. Randomized clinical trials showed some concerns or high risk of bias, and the nonrandomized ones showed moderate or critical risk of bias. Random-effects meta-analysis showed that NMES increases quadriceps muscle strength (standardized mean difference=1.46; 95% confidence interval [CI], 0.86-2.07; P<.0001 moderate quality of evidence), upper limb strength (mean difference [MD]=10.02kgF; 95% CI, 0.78-19.27; P=.03 low quality of evidence), and functional capacity (MD=30.11m; 95% CI, 15.57-44.65; P<.0001 moderate quality of evidence). It was impossible to quantitatively analyze quality of life data; however, NMES associated or not with exercise appears to have positive effects on them. ConclusionsNMES improves quadriceps muscle strength and the functional capacity of patients with CFK on HD. The effects on upper limb muscle strength and quality of life seem to be positive; however, the quality of evidence is very limited for these outcomes.