Neuromuscular Electrical Stimulation During Hemodialysis Enhances Exercise Capacity in Patients with End-Stage Renal Disease: A Pilot Randomized Controlled Trial

Background: Exercise capacity is markedly impaired in patients with end-stage renal disease (ESRD) due to neuromuscular dysfunction and reduced oxygen delivery. This study aimed to investigate the effects of NMES during HD on exercise capacity in patients with ESRD. It specifically examined neuromuscular and hemodynamic adaptations. Methods: Twenty-two patients with ESRD were randomized to a neuromuscular electrical stimulation training group (NSTG, n = 11) or a control group (CG, n = 11). The NSTG underwent intradialytic quadriceps NMES three times per week for 12 weeks (40 min/session). Exercise capacity was evaluated via sustained isometric contraction at 50% of maximal voluntary contraction (MVC) until exhaustion. Neuromuscular function was assessed through voluntary activation (ΔVA) and potentiated twitch force (ΔQtw,pot), while muscle oxygenation (ΔO2Hb, ΔHHb, ΔTHb) of the vastus lateralis was continuously monitored using near-infrared spectroscopy. Results: After the intervention, the NSTG showed a significant +20% increase in Tlim (103.9 ± 14.4 s to 123.3 ± 16.6 s; p = 0.01) and +30% improvement in MVC (421.3 ± 24.9 N to 550.4 ± 20.3 N; p < 0.01), while no improvements were observed in CG. Resting VA increased by ≈7% in NSTG (90.2 ± 3.7% to 96.8 ± 2.5%; p = 0.012). Improved muscle oxygenation and reduced twitch force suggest enhanced oxidative capacity and greater peripheral fatigue tolerance. Conclusions: Intradialytic NMES elicited robust improvements in exercise capacity, muscle strength, and oxygen utilization in ESRD patients by enhancing both central activation and peripheral oxidative adaptations. These findings support NMES as a feasible and effective rehabilitative strategy to counteract fatigue and functional decline in the ESRD population.