SP461EFFECTS OF TRANSCUTANEOUS ELECTRICAL MUSCLE STIMULATION ON INTRADIALYTIC HYPOTENSION AND HEMODIALYSIS EFFICIENCY IN HD PATIENTS WITH SEVERE DISABILITY

Abstract

INTRODUCTION AND AIMS: It has been shown that physical activity during hemodialysis (HD) may have a positive effect on patients' hemodynamic stability during the procedure and improve the HD effectiveness. However, patients with severe disability unable to perform adequate physical activity and require other methods of muscle activation, such as Transcutaneous Electrical Muscle Stimulation (TEMS). The aim of this study was to evaluate the effectiveness of TEMS on intradialytic hypotension and hemodialysis efficiency in HD patients with severe disability. METHODS: 71 hemodialysis patients with severe disability (Barthel Index score < 90) were randomized to the TEMS treatment group (N=37) or control group (CG, N=34). For the TEMS treatments, an alternating electrical stimulation frequency from 6 to 35 Hz was used. TEMS was performed on quadriceps and calf muscles, during HD sessions, 3 times per week for 12 weeks. The CG received usual care with routine HD treatment. Serum urea levels before and after HD with spKt/V calculation were evaluated on a monthly basis. Blood pressure monitoring during HD was carried out at each session, every hour of the procedure. Episodes of hypotension during HD were recorded throughout the study. RESULTS: The two treatment groups were similar in terms of baseline characteristics. The TEMS procedures were well tolerated. The compliance level was near 79%. TEMS treatment resulted in a significant increase in spKt/V index based on the results of the monthly determination of this indicator (from 1.57±0.2 to 1.7±0.22 in the TEMS group, from 1.6±0,21 to 1.6±0.18 in the CG; p<0,05; Fig.1). Among patients with a history of intradialytic hypotension episodes the TEMS group (N=21) in contrast to the CG (N=18) showed an increase in both mean systolic (from 114±19 to 121±15 mmHg in the TEMS group, from 118±17 to 117±18 mmHg in the CG; p<0,05), and mean diastolic (from 74±10 to 78±8 mmHg in the TEMS group, from 73±10 to 72±10 mmHg in the CG; p<0,05) blood pressure, as well as reducing the frequency of intradialysic hypotension episodes (from 3.7±1.9 to 2.1±1.5 in the TEMS group, from 3.9±2.3 to 3.4±2.2 the CG, episodes per month; p<0,05). CONCLUSIONS: For HD patients with severe disability the TEMS treatment is effective methods of muscle activation, resulting in improvement of HD efficiency and hemodynamic stability during the procedure. (Table Presented).