Intradialytic Plantar Electrical Nerve Stimulation to Improve Mobility and Plantar Sensation Among Adults with Diabetes Undergoing Hemodialysis: a Randomized Double-blind Trial

Overview

Journal J Nephrol

Publisher Springer

Specialty Nephrology

Date 2023 Jun 16

PMID 37326952

Authors

Ram Kinker Mishra

Bijan Najafi

Abdullah Hamad

Rasha Bara

Myeounggon Lee

Rania Ibrahim

Mincy Mathew

Talal Talal

Fadwa Al-Ali

Affiliations

Soon will be listed here.

Abstract

Background: Impaired mobility is a debilitating consequence of hemodialysis. We examined the efficacy of intradialytic-plantar-electrical-nerve-stimulation (iPENS) to promote mobility among diabetes patients undergoing hemodialysis..

Methods: Adults with diabetes undergoing hemodialysis received either 1-h active iPENS, (Intervention-Group) or non-functional iPENS (Control-Group) during routine hemodialysis for 12 weeks (3 sessions/week). Participants and care-providers were blinded. Mobility (assessed using a validated pendant-sensor) and neuropathy (quantified by vibration-perception-threshold test) outcomes were assessed at baseline and 12 weeks.

Results: Among 77 enrolled subjects (56.2 ± 2.6 years old), 39 were randomly assigned to the intervention group, while 38 were assigned to the control group. No study-related adverse events and dropouts were reported in the intervention group. Compared to the control group, significant improvements with medium to large effect sizes were observed in the intervention group at 12 weeks for mobility-performance metrics, including active-behavior, sedentary-behavior, daily step counts, and sit-to-stand duration variability (p < 0.05), Cohen's d effect size (d = 0.63-0.84). The magnitude of improvement in active-behavior was correlated with improvement in the vibration-perception-threshold test in the intervention group (r = - 0.33, p = 0.048). A subgroup with severe-neuropathy (vibration-perception-threshold > 25 V) showed a significant reduction in plantar numbness at 12 weeks compared to baseline (p = 0.03, d = 1.1).

Conclusions: This study supports feasibility, acceptability, and effectiveness of iPENS to improve mobility and potentially reduce plantar numbness in people with diabetes undergoing hemodialysis. Considering that exercise programs are not widely used in hemodialysis clinical practice, iPENS may serve as a practical, alternative solution to reduce hemodialysis-acquired weakness and promote mobility.

References

Najafi B, Talal T, Grewal G, Menzies R, Armstrong D, Lavery L . Using Plantar Electrical Stimulation to Improve Postural Balance and Plantar Sensation Among Patients With Diabetic Peripheral Neuropathy: A Randomized Double Blinded Study. J Diabetes Sci Technol. 2017; 11(4):693-701. PMC: 5588835. DOI: 10.1177/1932296817695338. View

Moreno J, Razjouyan J, Lester H, Dadabhoy H, Amirmazaheri M, Reesor-Oyer L . Later sleep timing predicts accelerated summer weight gain among elementary school children: a prospective observational study. Int J Behav Nutr Phys Act. 2021; 18(1):94. PMC: 8273994. DOI: 10.1186/s12966-021-01165-0. View

Luyckx V, Tonelli M, Stanifer J . The global burden of kidney disease and the sustainable development goals. Bull World Health Organ. 2018; 96(6):414-422D. PMC: 5996218. DOI: 10.2471/BLT.17.206441. View

Valenzuela P, Morales J, Ruilope L, de la Villa P, Santos-Lozano A, Lucia A . Intradialytic neuromuscular electrical stimulation improves functional capacity and muscle strength in people receiving haemodialysis: a systematic review. J Physiother. 2020; 66(2):89-96. DOI: 10.1016/j.jphys.2020.03.006. View

Carrero J, Stenvinkel P, Cuppari L, Ikizler T, Kalantar-Zadeh K, Kaysen G . Etiology of the protein-energy wasting syndrome in chronic kidney disease: a consensus statement from the International Society of Renal Nutrition and Metabolism (ISRNM). J Ren Nutr. 2013; 23(2):77-90. DOI: 10.1053/j.jrn.2013.01.001. View

Marcelli D, Brand K, Ponce P, Milkowski A, Marelli C, Ok E . Longitudinal Changes in Body Composition in Patients After Initiation of Hemodialysis Therapy: Results From an International Cohort. J Ren Nutr. 2015; 26(2):72-80. DOI: 10.1053/j.jrn.2015.10.001. View

Hendriks F, Smeets J, Broers N, VAN Kranenburg J, van der Sande F, Kooman J . End-Stage Renal Disease Patients Lose a Substantial Amount of Amino Acids during Hemodialysis. J Nutr. 2020; 150(5):1160-1166. PMC: 7198312. DOI: 10.1093/jn/nxaa010. View

Huang M, Lv A, Wang J, Xu N, Ma G, Zhai Z . Exercise Training and Outcomes in Hemodialysis Patients: Systematic Review and Meta-Analysis. Am J Nephrol. 2019; 50(4):240-254. DOI: 10.1159/000502447. View

Deligiannis A, DAlessandro C, Cupisti A . Exercise training in dialysis patients: impact on cardiovascular and skeletal muscle health. Clin Kidney J. 2021; 14(Suppl 2):ii25-ii33. PMC: 8101623. DOI: 10.1093/ckj/sfaa273. View

10.

Najafi B, Crews R, Wrobel J . A novel plantar stimulation technology for improving protective sensation and postural control in patients with diabetic peripheral neuropathy: a double-blinded, randomized study. Gerontology. 2013; 59(5):473-80. DOI: 10.1159/000352072. View

11.

Thakral G, Kim P, Lafontaine J, Menzies R, Najafi B, Lavery L . Electrical stimulation as an adjunctive treatment of painful and sensory diabetic neuropathy. J Diabetes Sci Technol. 2013; 7(5):1202-9. PMC: 3876364. DOI: 10.1177/193229681300700510. View

12.

Esteve Simo V, Junque Jimenez A, Carneiro Oliveira J, Moreno Guzman F, Fulquet Nicolas M, Pou Potau M . Efficacy of neuromuscular electrostimulation intervention to improve physical function in haemodialysis patients. Int Urol Nephrol. 2015; 47(10):1709-17. DOI: 10.1007/s11255-015-1072-3. View

13.

Schardong J, Dipp T, Bozzeto C, da Silva M, Baldissera G, Ribeiro R . Effects of Intradialytic Neuromuscular Electrical Stimulation on Strength and Muscle Architecture in Patients With Chronic Kidney Failure: Randomized Clinical Trial. Artif Organs. 2017; 41(11):1049-1058. DOI: 10.1111/aor.12886. View

14.

Assimon M, Wenger J, Wang L, Flythe J . Ultrafiltration Rate and Mortality in Maintenance Hemodialysis Patients. Am J Kidney Dis. 2016; 68(6):911-922. PMC: 5123913. DOI: 10.1053/j.ajkd.2016.06.020. View

15.

Lee Y, Okuda Y, Sy J, Lee Y, Obi Y, Cho S . Ultrafiltration Rate, Residual Kidney Function, and Survival Among Patients Treated With Reduced-Frequency Hemodialysis. Am J Kidney Dis. 2019; 75(3):342-350. PMC: 7042057. DOI: 10.1053/j.ajkd.2019.08.019. View

16.

Mishra R, Park C, York M, Kunik M, Wung S, Naik A . Decrease in Mobility during the COVID-19 Pandemic and Its Association with Increase in Depression among Older Adults: A Longitudinal Remote Mobility Monitoring Using a Wearable Sensor. Sensors (Basel). 2021; 21(9). PMC: 8125705. DOI: 10.3390/s21093090. View

17.

Sheehan T, Fifield J, Reisine S, Tennen H . The measurement structure of the Center for Epidemiologic Studies Depression Scale. J Pers Assess. 1995; 64(3):507-21. DOI: 10.1207/s15327752jpa6403_9. View

18.

Tiffin-Richards F, Costa A, Holschbach B, Frank R, Vassiliadou A, Kruger T . The Montreal Cognitive Assessment (MoCA) - a sensitive screening instrument for detecting cognitive impairment in chronic hemodialysis patients. PLoS One. 2014; 9(10):e106700. PMC: 4209968. DOI: 10.1371/journal.pone.0106700. View

19.

Alradaydeh M, Khalil A . The association of spiritual well-being and depression among patients receiving hemodialysis. Perspect Psychiatr Care. 2017; 54(3):341-347. DOI: 10.1111/ppc.12249. View

20.

Bosi E, Conti M, Vermigli C, Cazzetta G, Peretti E, Cordoni M . Effectiveness of frequency-modulated electromagnetic neural stimulation in the treatment of painful diabetic neuropathy. Diabetologia. 2005; 48(5):817-23. DOI: 10.1007/s00125-005-1734-2. View