title: Effect of transcutaneous electrical muscle stimulation and passive cycling movements on blood pressure and removal of urea and phosphate during hemodialysis.
abstract: BACKGROUND
  Intradialytic exercise has been described to improve blood pressure stability and dialysis efficacy. However, comorbid conditions in the dialysis population often preclude the widespread use of active intradialytic exercise. Therefore, we investigated the effect of intradialytic transcutaneous muscle stimulation (TEMS) and passive cycling movements (PCMs) on blood pressure and dialysis efficacy in patients.
  
  
  METHODS
  Prospective, controlled, randomized, crossover investigation.
  
  
  METHODS
  Ten patients were randomly allocated to TEMS, PCMs, or no intervention (NI) for 9 consecutive dialysis sessions.
  
  
  METHODS
  Participants were studied with NI, PCMs using a motor-driven ergometer, and bilateral TEMS of the leg musculature. Individual dialysis prescriptions were unchanged during the investigation.
  
  
  METHODS
  The effect of TEMS and PCMs on blood pressure and dialysis efficacy in patients was assessed.
  
  
  RESULTS
  Mean blood pressure increased from 121/64 +/- 21/15 mm Hg with NI to 132/69 +/- 21/15 mm Hg (P < 0.001) during sessions with PCMs and 125/66 +/- 22/16 mm Hg (P < 0.05) during sessions with TEMS. Urea and phosphate removal during dialysis were significantly (P < 0.001) greater with TEMS (19.4 +/- 3.7 g/dialysis and 1,197 +/- 265 mg/dialysis) or PCMs (20.1 +/- 3.4 g/dialysis and 1,172 +/- 315 mg/dialysis) than with NI (15.1 +/- 3.9 g/dialysis and 895 +/- 202 mg/dialysis). Body weight, ultrafiltration, Kt/V, and increases in hemoglobin and albumin levels during dialysis did not differ among the NI, PCMs, and TEMS groups.
  
  
  CONCLUSIONS
  The study design does not allow extension of the findings to prolonged treatment.
  
  
  CONCLUSIONS
  Future studies during longer observation periods will have to prove the persistence of these acute findings. Both TEMS and PCMs deserve future investigations in dialysis patients because they increase intradialytic blood pressure and facilitate urea and phosphate removal when applied short term.
authors.affiliation: Department of Nephrology/Hypertension, University of Berne, Berne, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Farese
authors.forename: Raphael
authors.initials: R
authors.lastname: Budmiger
authors.forename: Fabienne
authors.initials: F
authors.lastname: Aregger
authors.forename: Ivo
authors.initials: I
authors.lastname: Bergmann
authors.forename: Felix J
authors.initials: FJ
authors.lastname: Frey
authors.forename: Dominik E
authors.initials: DE
authors.lastname: Uehlinger
mesh_terms: D000328:Adult; D000368:Aged; D001642:Bicycling; D001794:Blood Pressure / Q000502:physiology*; D018592:Cross-Over Studies; D004558:Electric Stimulation; D004599:Electric Stimulation Therapy / Q000009:adverse effects / Q000379:methods*; D005081:Exercise Therapy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000294:innervation / Q000503:physiopathology; D009393:Nephritis / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D010710:Phosphates / Q000097:blood*; D011446:Prospective Studies; D006435:Renal Dialysis; D016896:Treatment Outcome; D014508:Urea / Q000097:blood*
chemical_list: D010710:Phosphates; D014508:Urea