No effect of intradialytic neuromuscular electrical stimulation on inflammation and quality of life: a randomized and parallel design clinical trial.

Neuromuscular electrical stimulation (NMES) elicits muscle contraction and has been shown to improvement of quality of life. However, if NMES improvement the quality of life and attenuate the inflammation is not fully understood. Therefore, our aim sought to assess the effects of short-term of intradialytic NMES on inflammation and quality of life in patients with chronic kidney disease patients undergoing hemodialysis. A randomized clinical trial conducted with parallel design enrolled adult hemodialysis patients three times a week during 1 month. Patients were randomly assigned to two groups (control group, n = 11; 4F/7 M) or (NMES group, n = 10; 4F/6 M). Pre-and post-intervention, was measured the high-sensitivity C reactive protein, interleukin-6, interleukin-10, and TNFα by the ELISA, and quality of life was applied using the SF-36. During each hemodialysis session, NMES was applied bilaterally at thigh and calves for 40 min. There was not change in cytokines (hs-CRP, IL-6, IL-10, and TNFα) concentrations time × group interaction. In addition, no difference was found in eight domains of quality of life. In addition, the groups did not differ for muscle strength and muscle mass. In conclusion, we found that intradialytic NMES did not change inflammation neither quality of life.

Short-term intradialytic NMES targeting muscles of the legs improves the phase angle: A pilot randomized clinical trial.

PURPOSE: Neuromuscular electrical stimulation (NMES) elicits muscle contraction and has been shown to attenuate muscle atrophy when physical activity is not possible. Thus, we hypothesized that intradialytic NMES would attenuate the loss leg lean mass and improve the phase angle in patients undergoing hemodialysis (HD). METHODS: A randomized controlled trial was performed with twenty-one adult HD patients (n = 8 F, n = 13 M; 45.8 ± 10.6 y) randomly assigned to usual care (control group, n = 11; 4F/7M) or to the NMES group (n = 10; 4F/6M). NMES was applied bilaterally at the origin and insertion points of the quadriceps or gastrocnemius muscles for 40 min during each HD session (3x/wk for one month). Pre-and post-intervention, we measured leg lean mass using dual-energy x-ray absorptiometry and phase angle using bioelectrical impedance analysis. RESULTS: NMES did not change leg lean mass compared to the control group. Phase angle increased in the NMES compared to the control group (Δ: +0.71 ± 0.27° vs. -0.46 ± 0.23°, p = 0.004) with interaction time x treatment (ANOVA p = 0.004). CONCLUSION: Short-term intradialytic NMES targeting muscles of the legs improved the phase angle but did not change leg lean mass. BRAZILIAN REGISTRY OF CLINICAL TRIALS UNDER THE CODE: RBR-98wzgn.

Short-Term Creatine Supplementation May Alleviate the Malnutrition-Inflammation Score and Lean Body Mass Loss in Hemodialysis Patients: A Pilot Randomized Placebo-Controlled Trial.

BACKGROUND: Creatine supplementation has been proposed to alleviate muscle loss in various populations, but has not been investigated in hemodialysis (HD) patients. Thus, our objective was to evaluate whether creatine supplementation could attenuate the loss of lean body mass (LBM) and malnutrition-inflammation score (MIS) in HD patients. METHODS: A randomized, placebo-controlled, double blind, parallel-design study included HD patients, of both sexes, aged 18-59 years. The patients were allocated to a Placebo Group (PG; n = 15; received maltodextrin, 1st week: 40 g/day and 2nd-4th weeks: 10 g/day) and a Creatine Group (CG; n = 15; received creatine plus maltodextrin, 1st week: 20 g/day of creatine plus 20 g/day of maltodextrin and 2nd-4th weeks: 5 g/day of creatine plus 5 g/day of maltodextrin). Pre and post the intervention, patients were evaluated for food intake, MIS, body composition and biochemical parameters. RESULTS: CG group attenuated the MIS (Pre: 5.57 ± 0.72 vs. Post: 3.85 ± 0.47 score, P = 0.003) compared with PG (Pre: 5.71 ± 0.97 vs. Post: 5.36 ± 0.95 score, P = 0.317) (supplement × time P = 0.017, effect size: 0.964). The change of LBM was greater in CG than in PG (CG: Δ0.95 vs PG: Δ0.13 kg). At post-intervention, 28.6% of PG patients presented LBM loss and 71.4% remain stable. In contrast, 14.4% of CG patients had LBM loss, 42.8% remain stable and 42.8% gained. Food intake and quality of life did not change. CG increased the BMI and gait speed in post-compared to pre-moment, but no difference among the groups. CONCLUSION: In HD patients, four weeks of creatine supplementation may alleviate the MIS as well as attenuate the LBM loss compared to placebo.

Total protein or leucine intakes are not associated with handgrip strength in hemodialysis patients: A pilot study.

BACKGROUND & AIMS: Inadequate protein intake is associated with lean body mass (LBM) loss. However, it is unclear whether high protein diet and leucine intake are associated with handgrip strength (HGS), a validated marker of muscle function. This study aims to: i) assess the prevalence of patients with low HGS; and ii) verify if HGS is correlated with high protein diet and leucine consumption in hemodialysis patients. METHODS: This cross-sectional study analysed patients at two center hemodialysis (HD) clinic and sixty-two patients aged ∼39 years with length of time on HD ∼60 months undergoing HD was carried out. Body weight (kg), LBM (kg) and body fat mass (%) assessments were performed by dual-energy X-ray absorptiometry and height (m) through portable stadiometer. Body mass index (BMI) (kg/m2) was calculated using the body weight and height. HGS (kg) was measured using a hydraulic dynamometer. Fisher's exact test, Chi-square, Pearson's correlation, and logistic regression were done to test the hypothesis. RESULTS: Out of 62 patients, 47 (75.8%) presented low HGS. In addition, no correlation was found between protein intake (if in percentage or g/kg/d) and HGS (r = 0.07, p = 0.58; r = -0.04, p = 0.70, respectively). Although there is a low correlation among leucine intake (g/d) and HGS (r = 0.39, p = 0.01), low HGS was not associated with leucine intake in the crude model (OR: 0.86 95%CI(0.60-1.24) p = 0.441), nor after adjustment for age, sex and BMI (OR: 0.84 95%CI(0.56-1.26), p = 0.422). CONCLUSIONS: Approximately 75% of patients undergoing hemodialysis presented low HGS. Additionally, neither a high protein diet nor leucine intake was associated with the HGS values.

Pre-sarcopenia in patients undergoing hemodialysis: Prevalence and association with biochemical parameters.

BACKGROUND & AIMS: Albumin and C reactive protein (CRP) concentrations are associated with the loss of lean body mass in the elderly. However, it remains to be ascertained whether these parameters are associated with pre-sarcopenia of chronic renal failure adult's patients undergoing replacement therapy. Therefore, we aimed to investigate the prevalence of pre-sarcopenia and it association with serum albumin and CRP concentrations in adult patients. METHODS: A cross-sectional study was conducted enrolling hemodialysis patients. Body weight, body mass index (BMI), and arm, thigh and calf circumferences were assessed using the inelastic tape; handgrip strength using a dynamometer; and body fat mass and appendicular lean mass (ALM) using the DXA. The classification of pre-sarcopenia was obtained by ALM values. RESULTS: From sixty-two patients, 35.5% were diagnosed with pre-sarcopenia. Logistic regression analysis revealed no show association between pre-sarcopenia (absence or presence) with serum CRP or albumin concentrations in both models, crude or adjusted by body fat mass. CONCLUSIONS: Approximately one-third of patients undergoing replacement therapy presented pre-sarcopenia, but no association with serum albumin and CRP concentrations were found.