LAUSR

OBJECTIVE To systematically review the effects of neuromuscular electrical stimulation (NMES) in chronic kidney failure (CKF) patients on hemodialysis (HD) on lower and upper limb muscle strength, functional capacity and quality of life. DATA SOURCES Data were obtained from MEDLINE (via PubMed), Embase, Scielo, Cochrane Central Register of Controlled Trials and Physiotherapy Evidence Database (PEDro) databases. There were no mandatory language or publication date restrictions. STUDY SELECTION Clinical trials that assessed the chronic effect of NMES (alone or associated with other physical therapy) on lower limb muscle strength and/or functional capacity of CKF patients on HD compared to control, placebo or another intervention were selected. DATA EXTRACTION Two independent reviewers extracted data using a pre-designed data extraction form. Risk of bias was assessed with RoB 2.0 and Robin-I, and quality of evidence with Grading of Recommendations Assessment, Development and Evaluation (GRADE). DATA SYNTHESIS Ten studies were included, totaling 242 patients. Randomized clinical trials showed some concerns/high risk of bias and the non-randomized ones moderate/critical risk of bias. Random-effects meta-analysis showed that NMES increases quadriceps muscle strength [SMD = 1.46 (95%CI: 0.86 to 2.07), p< 0.0001 - moderate quality of evidence], upper limb strength [MD = 10.02KgF (95%CI: 0,78 to 19.27), p=0.03 - low quality of evidence] and functional capacity [MD = 30.11m (95% CI: 15.57 to 44.65), p< 0.0001 - moderate quality of evidence]. It was impossible to quantitatively analyze quality of life data, however, NMES associated or not with exercise appears to have positive effects on them. CONCLUSIONS NMES improves quadriceps muscle strength as well as the functional capacity of CKF patients on HD. The effects on upper limb muscle strength and quality of life seem to be positive, however, the quality of evidence is very limited for these outcomes.