NEW YORK (Reuters Health) – Passive cycling movements and transcutaneous electrical muscle stimulation during hemodialysis can improve blood pressure and enhance removal of urea and phosphate, according to a report in the American Journal of Kidney Diseases for October.

Prior research has suggested that exercise during dialysis can enhance blood pressure stability and dialysis efficacy, note Dr. Dominik E. Uehlinger and colleagues, from the University of Berne Medical School in Switzerland,. However, other diseases are often present in dialysis patients that preclude active exercise.

In the present study, the researchers examined whether transcutaneous electrical muscle stimulation (TEMS) and passive cycling movements (PCMs) could achieve the benefits seen with active exercise. They randomly assigned 10 patients to start on TEMS, PCMs, or no intervention and then to rotate through the other modalities during nine consecutive dialysis sessions.

TEMS was performed bilaterally on leg musculature and PCMs were performed using a motor-driven ergometer, the report indicates. No change in dialysis prescriptions were made during the study.

The average blood pressure during dialysis rose from 121/64 mm Hg with no intervention to 132/69 with PCMs (p < 0.001) and 125/66 with TEMS (p < 0.05). Urea and phosphate removal was also enhanced with PCMs and TEMS. With these treatments, 20.1 g and 19.4 g urea, respectively, and 1172 mg and 1197 mg phosphate, were removed on average per session; with no intervention, 15.1 g urea and 895 mg phosphate were removed. No significant differences in body weight, ultrafiltration, Kt/V, and increases in hemoglobin or albumin levels were seen between PCMs, TEMS, and no intervention. “Larger studies with consecutive dialysis sessions using the same intervention repetitively are needed to show the clinical relevance of these single-session findings on the persistence of increased removal and a concomitant decrease in serum urea and/or phosphorus levels over time,” Dr. Uehlinger’s team concludes. Reference:
Am J Kidney Dis 2008;52:745-752.