title: High-frequency external muscle stimulation in acute kidney injury (AKI): potential shortening of its clinical course.
abstract: BACKGROUND
  The prognosis of acute kidney injury (AKI) is markedly influenced by the degree of muscle protein catabolism. Since the current therapeutic strategies are rather limited, for the first time, we attempted to attenuate the hypercatabolism by high tone electrical muscle stimulation (HTEMS) in AKI patients. This kind of therapy may lower protein degradation via its effect on muscle activity as well as improving insulin resistance. Moreover, electrotherapy may improve renal function due to circulatory effects as well as lowering the sympathetic tone.
  
  
  METHODS
  34 patients with AKI Stage 3 were included; all required daily hemodialysis with a dose of Kt/V urea > 1. The patients were randomized into two groups of 17 patients each with and without HTEMS. The groups were comparable with regard to age, gender, underlying diseases, causes of AKI and the baseline biochemistry. HTEMS was performed intradialytically for 1 h. This new electromedical device is characterized by changes in the frequency between 4,100 and 33,000 Hz in short intervals (3 s) and also the amplitude and frequency are modulated simultaneously.
  
  
  RESULTS
  The treatment was well tolerated and associated with an improved clinical outcome. As compared to the untreated patients the HTEMS group showed a significant shorter duration of oliguria, a faster decline of serum creatinine and urea levels, less need of dialysis treatment and a shorter period of hospitalization. The decline of urea was more marked than that of serum creatinine resulting in a significant lowering of the urea/creatinine ratio. This finding suggests a reduced catabolism of muscle proteins which - via a lower release of amino acids into the circulation - results in a decline of hepatic ureapoiesis. We hypothesize that in our AKI patients the improved protein catabolism contributed to the shortening of the clinical course of acute renal failure.
  
  
  CONCLUSIONS
  This study suggests for the first time that HTEMS treatment of patients with AKI during hemodialysis is associated with an improved clinical outcome. To support this novel observation, a randomized controlled trial with a greater number of homogenous AKI patients should be performed.
authors.affiliation: Department of Internal Medicine, Divison of Nefrologia, Ospedale A. Landolfi, Solofra, Italy. br.diiorio@gmail.com
authors.forename: Biagio
authors.initials: B
authors.lastname: Di Iorio
authors.forename: Serena
authors.initials: S
authors.lastname: Torraca
authors.forename: Pasquale
authors.initials: P
authors.lastname: Gustaferro
authors.forename: Gholamreza
authors.initials: G
authors.lastname: Fazeli
authors.forename: August
authors.initials: A
authors.lastname: Heidland
mesh_terms: D058186:Acute Kidney Injury / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D003404:Creatinine / Q000097:blood; D004231:Diuresis / Q000502:physiology; D004599:Electric Stimulation Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D009124:Muscle Proteins / Q000378:metabolism; D018482:Muscle, Skeletal / Q000294:innervation / Q000502:physiology; D006435:Renal Dialysis; D016896:Treatment Outcome; D014508:Urea / Q000097:blood
chemical_list: D009124:Muscle Proteins; D014508:Urea; D003404:Creatinine