Effects of inspiratory muscle training on dyspnea and lung capacity in patients with chronic kidney disease on hemodialysis: a systematic review and meta-analysis

IntroductionInspiratory muscle training (IMT) is an alternative to improve the respiratory condition of hemodialysis (HD) patients with respiratory muscle weakness. ObjectiveTo evaluate the effect of IMT on dyspnea and lung capacity in dialysis patients. MethodA systematic review of randomized controlled trials (RCTs) which evaluated the effects of IMT in dialysis patients on the outcomes of dyspnea, lung capacity, respiratory muscle strength and dialysis effectiveness index (Kt/V) was conducted. The searches were conducted in February 2025 and were performed in the Medline/PubMed, Cochrane Library, LILACS, CINAHL, PEDro, Web of Science, Embase and Google Scholar databases. Study quality was assessed using the Cochrane RoB2 tool. ResultsSix studies were analyzed (n = 210). One study showed an improvement in dyspnea [4.17 +/- 0.58; 95%CI (0.0073-0.884); p = .022], and the meta-analyses found a mean difference of 0.34 L/min [95%CI (0.08-0.61); p = .010] in forced vital capacity (FVC) and 25.15 cmH2O [95%CI (17.05-33.24); p < .001] in maximum inspiratory pressure (MIP) in the IMT groups. There was no difference in Kt/V. Only one study showed a low risk of bias. ConclusionIMT in patients with CKD on HD improved dyspnea, FVC and MIP. Considering the low quality of the studies, new RCTs with greater methodological rigor are needed.