Does electrical stimulation of the leg muscles improve muscle structure and function in adults with kidney failure undergoing dialysis?

Key messages

• The evidence is very uncertain about whether neuromuscular electrical stimulation (NMES) (small electrical impulses delivered through the skin to make muscles contract) improves daily activities and independence or affects the risk of death in adults with kidney failure receiving haemodialysis.

• NMES may result in little to no difference in blood pressure or resting heart rate. No studies reported fatigue, pain, infection, or problems with dialysis access.

• More research is needed because many important outcomes, including fatigue, pain, infection, and dialysis access problems, were not reported. None of the studies included adults undergoing peritoneal dialysis.

What is the problem?

Adults with kidney failure (a condition where the kidneys no longer function well enough to keep a person alive) receiving dialysis (a procedure where a machine is used to remove waste products and excess salts and fluid from the blood when the kidneys stop working properly) often experience muscle weakness and loss of strength because of reduced physical activity and the effects of kidney disease. Exercise can help, but many adults on dialysis find it difficult to take part due to fatigue, illness, or limited time. Neuromuscular electrical stimulation (NMES) delivers small electrical impulses through the skin to make muscles contract. This technique can strengthen muscles without the need for voluntary exercise and may be especially helpful for those who cannot take part in active exercise. NMES has been used successfully in other medical conditions, but its effectiveness in adults with kidney failure receiving dialysis is not yet clear.

What did we want to find out?

This review looked at whether NMES can help adults receiving dialysis. We wanted to find out whether it improves daily activities and independence, cardiovascular health, death, fatigue, pain, infection, and problems with dialysis access.

What did we do?

We searched multiple scientific databases for studies that examined the effects of NMES on the legs of adults receiving dialysis. Studies were included if they compared NMES with those who did not receive NMES.

What did we find?

We found 12 studies involving 348 adults with kidney failure receiving haemodialysis. Results from 299 participants were available for one or more outcomes. Most studies were small, lasted between four and 20 weeks, and were carried out in haemodialysis centres across eight countries. In most studies, NMES was applied to the leg muscles during dialysis treatment.

• Only one small study looked at whether NMES helped adults take part in everyday activities and live independently. The evidence was very uncertain, so we do not know whether NMES makes a difference.

• Four studies found that NMES may make little to no difference to blood pressure, and two studies found that it may make little to no difference to resting heart rate.

• One participant receiving usual care died during a study. The evidence was very uncertain, so we do not know whether NMES affects the risk of death.

• No studies measured whether NMES reduced fatigue, pain, infections, or problems with dialysis access.

• None of the studies included adults undergoing peritoneal dialysis.

What are the limitations of the evidence?

We are not very confident in most of the findings. Most studies included only small numbers of people, so it is difficult to know whether the results would be the same in larger groups. Some studies did not clearly describe how they were carried out, making it harder to judge the reliability of the results. Many studies also did not measure or report outcomes that are important to people receiving dialysis, such as fatigue, pain, infection, or problems with dialysis access. The NMES programmes also varied in how they were delivered, so it is difficult to know which treatment programme works best.

How up-to-date is the evidence?

The evidence is based on searches up to June 2025.