Neuromuscular electrical STIMulation for sarcopenia in people on HaemoDialysis (STIM-HD)
Sarcopenia in people on haemodialysis
Current interventions as of 31/03/2026: Treatment method, duration and frequency: Participants randomised to the intervention group will receive NMES at each dialysis session they attend for 3 months. It will be administered using a commercially available four-channel portable stimulator with participants either sitting or lying down (however they are usually positioned for dialysis). The skin will be cleaned and then electrodes will be placed upon the thigh muscles. The participants will have control of the NMES device so they can change the current that is administered. During the first two to three sessions participants will be encouraged to find their initial comfortable level of stimulation intensity (the current) and to get used to how it feels. After the first week the training will be progressed by two methods: (1) Increasing session duration up to a maximum of 30 minutes, if this is not initially achievable (excluding warm up and cool down); (2) Increasing stimulation intensity (current) which determines the strength of the muscle contraction that is induced and therefore how uncomfortable it can feel. Participants will be encouraged to increase the stimulation intensity beyond their initial comfort level for a portion of each session. As participants become increasingly familiar with NMES and as they adapt they will be encouraged to progressively increase the stimulation intensity further. This progression will also be guided by their individual rating of perceived exertion (RPE). RPE is a scale that guides exercise intensity. Participants will be familiarised with this in the first few NMES sessions. Participants will be encouraged to achieve a of about ‘4’ or ‘somewhat’ hard. In addition, a discomfort scale will be shown to the participants to help ensure the stimulation intensity is at the correct level. Exercise intensity will be monitored by measuring blood lactate. This will be performed weekly to closely monitor progress. Randomisation: After pro
Current inclusion criteria as of 27/08/2025: 1. Undertaking HD for >3 months (home or unit-based) 2. Age >18 years 3. Has sarcopenia diagnosed by either: 3.1. Low handgrip strength 3.2. Prolonged Sit to Stand 5 score (>15 seconds for both men and women) if handgrip strength is above the sarcopenia threshold 4. Able to give written informed consent Previous inclusion criteria: 1. Undertaking HD for >3 months (home or unit-based) 2. Age >18 years 3. Has sarcopenia diagnosed by low muscle strength on patient screening (<27 kg for men and <16 kg for women for handgrip strength) 4. Able to give written informed consent
Current exclusion criteria as of 31/03/2026: 1. Contraindications to neuromuscular electrical stimulation therapy including: 1.1. Lower limb amputation 1.2. Active skin ulceration or infection 1.3. Critical lower limb ischaemia, including pain at rest or functional impairment that precludes completion of study assessments 1.4. Lower limb deep vein thrombosis <3 months 1.5. Cardiac pacemaker or implantable cardiac defibrillator 2. Conditions known to cause muscle wasting: 2.1. Known neuromuscular disease 2.2. Active malignancy 3. Scheduled for living donor kidney transplant or plan to change dialysis modality or centre in the next 6 months 4. Life expectancy of <6 months 5. Current participation in an interventional trial with conflicting therapies or outcomes 6. Unable to give written informed consent 7. Vascular access in the lower limbs that may interfere with intervention delivery Previous exclusion criteria as of 27/08/2025: 1. Contraindications to neuromuscular electrical stimulation therapy including: 1.1. Lower limb amputation 1.2. Active skin ulceration or infection 1.3. Critical lower limb ischaemia, including pain at rest or functional impairment that precludes completion of study assessments 1.4. Lower limb deep vein thrombosis <3 months 1.5. Cardiac pacemaker or implantable cardiac defibrillator 1.6. Metallic hip or knee joint 2. Conditions known to cause muscle wasting: 2.1. Known neuromuscular disease 2.2. Active malignancy 3. Scheduled for living donor kidney transplant or plan to change dialysis modality or centre in the next 6 months 4. Life expectancy of <6 months 5. Current participation in an interventional trial with conflicting therapies or outcomes 6. Unable to give written informed consent 7. Vascular access in the lower limbs that may interfere with intervention delivery Previous exclusion criteria: 1. Contraindications to neuromuscular electrical stimulation therapy including: 1.1. Lower limb amputation 1.2. Active skin ulceration or infe