{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T08:05:32Z","timestamp":1762070732012,"version":"build-2065373602"},"reference-count":49,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2022,10,5]],"date-time":"2022-10-05T00:00:00Z","timestamp":1664928000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Healthcare"],"abstract":"<jats:p>Decreased functional capacity (FC) in patients undergoing hemodialysis (HD) is associated with adverse health events and poor survival. Acupuncture is recognized as a safe and effective integrative treatment. The aim of this study is to evaluate the effect of acupuncture treatment on the FC in chronic kidney disease with GFR category 5 (CKG G5) patients undergoing HD. In this patient-assessor blinded randomized controlled trial, seventy-two KF patients were randomly assigned to experimental (n = 24), placebo (n = 24) and control groups (n = 24). The primary outcome was the improvement in FC assessed by the 6-Minute Walk Test (6-MWT). Secondary outcomes included assessment of peripheral muscle strength by the Handgrip Strength Test (HGS) and the 30-Second Sit-to-Stand Test (STS-30) at baseline, after treatment and at 12-week follow up. A mixed ANOVA with interaction time*group was used. The experimental group increased walk distance (p &lt; 0.001), lower limbs strength (p &lt; 0.001) and handgrip strength (p = 0.012) after nine acupuncture sessions and stabilized in the follow-up (p &gt; 0.05). In the placebo and control groups the 6-MWT and 30STS results decreased (p &lt; 0.001) and the HGS scores did not change through time (p &gt; 0.05). Acupuncture treatment improved FC and muscle strength in patients undergoing HD.<\/jats:p>","DOI":"10.3390\/healthcare10101947","type":"journal-article","created":{"date-parts":[[2022,10,8]],"date-time":"2022-10-08T20:43:21Z","timestamp":1665261801000},"page":"1947","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Effect of Acupuncture on Functional Capacity in Patients Undergoing Hemodialysis: A Patient-Assessor Blinded Randomized Controlled Trial"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5624-3306","authenticated-orcid":false,"given":"Marta","family":"Correia de Carvalho","sequence":"first","affiliation":[{"name":"ICBAS\u2013School of Medicine and Biomedical Sciences, University of Porto, 4050-313 Porto, Portugal"}]},{"given":"Jos\u00e9","family":"Nunes de Azevedo","sequence":"additional","affiliation":[{"name":"TECSAM-Tecnologia e Servi\u00e7os M\u00e9dicos SA, 5370-530 Mirandela, Portugal"}]},{"given":"Pedro","family":"Azevedo","sequence":"additional","affiliation":[{"name":"TECSAM-Tecnologia e Servi\u00e7os M\u00e9dicos SA, 5370-530 Mirandela, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9190-1119","authenticated-orcid":false,"given":"Carlos","family":"Pires","sequence":"additional","affiliation":[{"name":"Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, 3000-115 Coimbra, Portugal"}]},{"given":"Manuel","family":"Laranjeira","sequence":"additional","affiliation":[{"name":"ICBAS\u2013School of Medicine and Biomedical Sciences, University of Porto, 4050-313 Porto, Portugal"},{"name":"INC\u2013Instituto de Neuroci\u00eancias, 4100-141 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4570-5445","authenticated-orcid":false,"given":"Jorge Pereira","family":"Machado","sequence":"additional","affiliation":[{"name":"ICBAS\u2013School of Medicine and Biomedical Sciences, University of Porto, 4050-313 Porto, Portugal"},{"name":"CBSin\u2014Center of BioSciences in Integrative Health, 4000-105 Porto, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1016\/j.semnephrol.2016.05.008","article-title":"The Economic Burden of Chronic Kidney Disease and End-Stage Renal Disease","volume":"36","author":"Wang","year":"2016","journal-title":"Semin. Nephrol. J."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Elshahat, S., Cockwell, P., Maxwell, A.P., Griffin, M., O\u2019Brien, T., and O\u2019Neill, C. (2020). The impact of chronic kidney disease on developed countries from a health economics perspective: A systematic scoping review. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0230512"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2052","DOI":"10.1016\/S0140-6736(18)31694-5","article-title":"Forecasting life expectancy, years of life lost, and all-cause and cause-specific mortality for 250 causes of death: Reference and alternative scenarios for 2016\u20132040 for 195 countries and territories","volume":"392","author":"Foreman","year":"2018","journal-title":"Lancet"},{"key":"ref_4","unstructured":"Group KDIGOKCW (2013). KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int. Suppl., 2, 1\u2013163."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1111\/nep.13449","article-title":"Perspectives in renal replacement therapy: Haemodialysis","volume":"23","author":"Liew","year":"2018","journal-title":"Nephrology"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1111\/tri.13490","article-title":"Burden of end-stage renal disease and evolving challenges in kidney transplantation","volume":"32","author":"Golshayan","year":"2019","journal-title":"Transpl. Int."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1159\/000514550","article-title":"Global Epidemiology of End-Stage Kidney Disease and Disparities in Kidney Replacement Therapy","volume":"52","author":"Thurlow","year":"2021","journal-title":"Am. J. Nephrol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1046\/j.1523-1755.2003.00704.x","article-title":"Muscle atrophy in patients receiving hemodialysis: Effects on muscle strength, muscle quality, and physical function","volume":"63","author":"Johansen","year":"2003","journal-title":"Kidney Int."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1111\/hdi.12564","article-title":"Physical function was related to mortality in patients with chronic kidney disease and dialysis","volume":"21","author":"Morishita","year":"2017","journal-title":"Hemodial. Int."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"101593","DOI":"10.1016\/j.ctcp.2022.101593","article-title":"Manipulative and body-based methods in chronic kidney disease patients: A systematic review of randomized controlled trials","volume":"48","author":"Chu","year":"2022","journal-title":"Complement. Ther. Clin. Pract."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"102609","DOI":"10.1016\/j.ctim.2020.102609","article-title":"Complementary and alternative medicine therapies for uremic pruritus\u2014A systematic review of randomized controlled trials","volume":"56","author":"Yeam","year":"2021","journal-title":"Complement. Ther. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1169","DOI":"10.1142\/S0192415X18500611","article-title":"Acupuncture Application in Chronic Kidney Disease and its Potential Mechanisms","volume":"46","author":"Xiong","year":"2018","journal-title":"Am. J. Chin. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1089\/acm.2010.0206","article-title":"Acupuncture for symptom management in hemodialysis patients: A prospective, observational pilot study","volume":"17","author":"Kim","year":"2011","journal-title":"J. Altern. Complement. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.1089\/acm.2018.0030","article-title":"Effect of Acupuncture or Massage on Health-Related Quality of Life of Hemodialysis Patients","volume":"24","author":"Bullen","year":"2018","journal-title":"J. Altern. Complement. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1089\/acm.2016.0119","article-title":"Acupuncture on Renal Function in Patients with Chronic Kidney Disease: A Single-Blinded, Randomized, Preliminary Controlled Study","volume":"23","author":"Yu","year":"2017","journal-title":"J. Altern. Complement. Med."},{"key":"ref_16","first-page":"Cd009440","article-title":"Acupuncture and related interventions for symptoms of chronic kidney disease","volume":"6","author":"Kim","year":"2016","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_17","first-page":"8483576","article-title":"Acupuncture Treatment in Elderly People with Sarcopenia: Effects on the Strength and Inflammatory Mediators","volume":"2019","author":"Teixeira","year":"2019","journal-title":"J. Aging Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/j.apmr.2011.08.010","article-title":"Bilateral effects of 6 weeks\u2019 unilateral acupuncture and electroacupuncture on ankle dorsiflexors muscle strength: A pilot study","volume":"93","author":"Zhou","year":"2012","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e13812","DOI":"10.1111\/nmo.13812","article-title":"Acupuncture of different treatment frequency in postprandial distress syndrome: A pilot randomized clinical trial","volume":"32","author":"Wang","year":"2020","journal-title":"Neurogastroenterol. Motil."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2532","DOI":"10.1097\/j.pain.0000000000001940","article-title":"Acupuncture of different treatment frequencies in knee osteoarthritis: A pilot randomised controlled trial","volume":"161","author":"Lin","year":"2020","journal-title":"Pain"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"295","DOI":"10.15761\/CRT.1000295","article-title":"Establishing an adequate dose of acupuncture is essential for clinical trial studies","volume":"6","author":"Ma","year":"2020","journal-title":"Clin. Res. Trials"},{"key":"ref_22","unstructured":"Maciocia, G. (2015). The Foundations of Chinese Medicine. A Comprehensive Text, Elsevier. [3rd ed.]."},{"key":"ref_23","unstructured":"Li, W.F.D. (2003). Clinical nephrology. Chinese Medicine, Blue Poppy Press."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Matos, L.C., Machado, J.P., Monteiro, F.J., and Greten, H.J. (2021). Understanding Traditional Chinese Medicine Therapeutics: An Overview of the Basics and Clinical Applications. Healthcare, 9.","DOI":"10.3390\/healthcare9030257"},{"key":"ref_25","unstructured":"Xu, B., and Yuan, C.S. (2013). Clinical Handbook of Chinese Medicine, World Scientific."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"MacPherson, H., Altman, D.G., Hammerschlag, R., Youping, L., Taixiang, W., White, A., and Moher, D. (2010). Revised STandards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA): Extending the CONSORT statement. PLoS Med., 7.","DOI":"10.1371\/journal.pmed.1000261"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories (2002). ATS Statement: Guidelines for the six-minute walk test. Am. J. Respir. Crit. Care, 166, 111\u2013117.","DOI":"10.1164\/ajrccm.166.1.at1102"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/j.jbmt.2021.02.020","article-title":"The reliability and validity of the 30-seconds sit-to-stand test and its capacity for assessment of the functional status of hemodialysis patients","volume":"27","author":"Figueiredo","year":"2021","journal-title":"J. Bodyw. Mov. Ther."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1080\/02701367.1999.10608028","article-title":"A 30-s chair-stand test as a measure of lower body strength in community-residing older adults","volume":"70","author":"Jones","year":"1999","journal-title":"Res. Q. Exerc. Sport"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1016\/j.apmr.2019.10.183","article-title":"Measurement Properties of the Hand Grip Strength Assessment: A Systematic Review With Meta-analysis","volume":"101","author":"Bobos","year":"2020","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_31","first-page":"83","article-title":"Test-Retest Reliability of Measurements of Hand-Grip Strength Obtained by Dynamometry from Older Adults: A Systematic Review of Research in the PubMed Database","volume":"6","author":"Bohannon","year":"2017","journal-title":"J. Frailty Aging"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1354","DOI":"10.1093\/ndt\/gfq487","article-title":"Use of handgrip strength in the assessment of the muscle function of chronic kidney disease patients on dialysis: A systematic review","volume":"26","author":"Leal","year":"2011","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_33","unstructured":"IBM Corp. (2020). IBM SPSS Statistics for Windows, IBM Corp.. Version 27.0."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1037\/0033-2909.112.1.155","article-title":"A power primer","volume":"112","author":"Cohen","year":"1992","journal-title":"Psychol. Bull."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1421","DOI":"10.1002\/(SICI)1097-0258(19960715)15:13<1421::AID-SIM266>3.0.CO;2-H","article-title":"An index for assessing blindness in a multi-centre clinical trial: Disulfiram for alcohol cessation\u2014A VA cooperative study","volume":"15","author":"James","year":"1996","journal-title":"Stat. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1111\/j.1600-0528.2009.00494.x","article-title":"Towards a proposal for assessment of blinding success in clinical trials: Up-to-date review","volume":"37","author":"Kolahi","year":"2009","journal-title":"Community Dent. Oral Epidemiol."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Schwartz, M.M.N. (2022, September 24). Blinding Assessment Indexes for Randomized, Controlled, Clinical Trials. Available online: https:\/\/cran.r-project.org\/web\/packages\/BI\/index.html.","DOI":"10.32614\/CRAN.package.BI"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"175","DOI":"10.3758\/BF03193146","article-title":"G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences","volume":"39","author":"Faul","year":"2007","journal-title":"Behav. Res. Methods"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1016\/j.semnephrol.2016.05.007","article-title":"Consequences of CKD on Functioning","volume":"36","author":"Kittiskulnam","year":"2016","journal-title":"Semin. Nephrol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/j.ctim.2008.10.003","article-title":"Different frequencies of acupuncture treatment for chronic low back pain: An assessor-blinded pilot randomised controlled trial","volume":"17","author":"Yuan","year":"2009","journal-title":"Complement. Ther. Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1681\/ASN.2014020144","article-title":"Low-frequency electrical stimulation attenuates muscle atrophy in CKD--a potential treatment strategy","volume":"26","author":"Hu","year":"2015","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2275","DOI":"10.1096\/fj.01-0015hyp","article-title":"Mechanical signaling through connective tissue: A mechanism for the therapeutic effect of acupuncture","volume":"15","author":"Langevin","year":"2001","journal-title":"FASEB J."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"581","DOI":"10.6061\/clinics\/2012(06)06","article-title":"Prognostic value of the six-minute walk test in end-stage renal disease life expectancy: A prospective cohort study","volume":"67","author":"Signori","year":"2012","journal-title":"Clinics"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1053\/j.jrn.2019.01.002","article-title":"Handgrip Strength as a Predictor of All-Cause Mortality in Patients With Chronic Kidney Disease Undergoing Dialysis: A Meta-Analysis of Prospective Cohort Studies","volume":"29","author":"Hwang","year":"2019","journal-title":"J. Ren. Nutr."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1429","DOI":"10.1016\/j.clnu.2016.03.020","article-title":"Handgrip strength is an independent predictor of all-cause mortality in maintenance dialysis patients","volume":"35","author":"Vogt","year":"2016","journal-title":"Clin. Nutr."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1053\/j.jrn.2013.12.005","article-title":"Handgrip strength at baseline and mortality risk in a cohort of women and men on hemodialysis: A 4-year study","volume":"24","author":"Matos","year":"2014","journal-title":"J. Ren. Nutr."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"93","DOI":"10.2147\/IJNRD.S126615","article-title":"Anxiety and depression in patients with end-stage renal disease: Impact and management challenges\u2014A narrative review","volume":"11","author":"Goh","year":"2018","journal-title":"Int. J. Nephrol. Renovasc. Dis."},{"key":"ref_48","unstructured":"WHO Regional Office for the Western Pacific (2008). WHO Standard Acupuncture Point Locations in the Western Pacific Region."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"c332","DOI":"10.1136\/bmj.c332","article-title":"CONSORT 2010 statement: Updated guidelines for reporting parallel group randomised trials","volume":"340","author":"Schulz","year":"2010","journal-title":"BMJ"}],"container-title":["Healthcare"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9032\/10\/10\/1947\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:46:54Z","timestamp":1760143614000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9032\/10\/10\/1947"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,5]]},"references-count":49,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2022,10]]}},"alternative-id":["healthcare10101947"],"URL":"https:\/\/doi.org\/10.3390\/healthcare10101947","relation":{},"ISSN":["2227-9032"],"issn-type":[{"type":"electronic","value":"2227-9032"}],"subject":[],"published":{"date-parts":[[2022,10,5]]}}}