title: Muscle stimulation in elderly patients with CKD and sarcopenia.
abstract: OBJECTIVE
  Aim of our study was to assess the potential effects of high-tone external muscle stimulation (HTEMS) on improvement of endothelial dysfunction (ED) and kidney damage in elderly patients with chronic kidney disease (CKD), sarcopenia and/or serious physical disability with a high Multidisciplinary Prognostic Index (MPI).
  
  
  METHODS
  We enrolled 12 consecutive CKD patients with MPI > 0,66 from January 1st, 2008 to December 31st, 2014. Six patients underwent a 2-hours HTEMS during the first day (group A) and the other six patients (group B) underwent a sham experiment with HTEMS without power supply. After 24 hours, patients of group A were shifted to group B and vice-versa. Nitrite/nitrate (NOx), endotheline-1 (ET-1) and urine creatinine concentration were measured in all patients.
  
  
  RESULTS
  During HTEMS urine amount increased by 22% (p=0.049), so did urine creatinine that increased by 40%, (p=0.034) and creatinine clearance that increased by 26% (p=0.041). There was no statistical difference in urine nitrogen (that raised by 11%, p=0.526), urine sodium (that reduced by 42%, p=0.121) and urine potassium levels (p=0,491). At the same time, NOx changed from 44.15.1 to 38.45.3 M/L after 1 hour, to 36.44.8 M/L after 2 hours, to 41.15.7 M/L after 3 hours and to 46,95.0 M/L after 4 hours (p=0.008) during HTEMS, while it did not vary during the sham section of the experiment, respectively 43.66.1 M/L , 436.4 M/L, 42.85.5 M/L, 434.7 M/L, and 42.85.8 M/L (p=0.992).
  
  
  CONCLUSIONS
  Our study showed that HTEMS may improve microcirculation and, through this mechanism, may reduce kidney damage in elderly patients with CKD and severe muscle atrophy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Di Micco
authors.forename: Stefania
authors.initials: S
authors.lastname: Marzocco
authors.forename: Simona
authors.initials: S
authors.lastname: Adesso
authors.forename: Antonella
authors.initials: A
authors.lastname: De Blasio
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Autore
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Sirico
authors.forename: Biagio
authors.initials: B
authors.lastname: Di Iorio
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D018482:Muscle, Skeletal; D010812:Physical Stimulation; D026741:Physical Therapy Modalities; D051436:Renal Insufficiency, Chronic / Q000150:complications; D055948:Sarcopenia / Q000209:etiology / Q000628:therapy*