Comportamento das variáveis hemodinâmicas durante a estimulação transcraniana por corrente contínua intradialítica: ensaio clínico randomizado

Abstract

Introduction: Patients with end-stage renal disease are often subjected to an exhaustive routine of hemodialysis away from their homes, dietary restrictions, water intake limitations, and polypharmacy. A non-pharmacological approach such as transcranial direct current stimulation (tDCS) is being investigated for pain management in these patients. Its application occurs during hemodialysis, taking advantage of the patient's clinical routine. However, the hemodynamic variables during tDCS application during hemodialysis have not been previously analyzed, requiring safety evidence for its use. Objective: This study aims to evaluate the hemodynamic behavior of blood pressure and heart rate in patients with end-stage renal disease undergoing anodal tDCS application over the primary motor cortex during hemodialysis. We also aim to assess adverse and collateral effects during and after tDCS use in this population. Method: This is a parallel, double-blind, randomized, placebo-controlled clinical trial that included patients on hemodialysis. Patients received ten non-consecutive sessions of tDCS over the primary motor cortex (C3/Fp2 montage), with an intensity of 2mA for 20 minutes. Hemodialysis sessions lasted four hours, and hemodynamic variables of blood pressure and heart rate were analyzed at five time points: one hour before the start of the sessions and at the beginning of each of the subsequent four hours of the dialytic procedure. Results: There was no difference between groups in hemodynamic variables of systolic, diastolic, mean arterial pressure, and heart rate. Furthermore, no adverse effects occurred, and the few reported adverse effects are consistent with those described in the literature (tingling sensation, itching at the electrode site). Conclusion: tDCS applied with the C3/Fp2 montage did not alter hemodynamic variables during the hemodialysis procedure in patients with end-stage renal disease.