Suzuki 2018.

Study characteristics
Methods	Study design Parallel RCT Study dates Duration of follow‐up: 8 weeks Time frame: October 2013 to September 2015
Participants	Study characteristics Setting: single centre (Jikei University Katsushika Medical Center in Japan) Country: Japan Inclusion criteria: ≥ 20 years; dialysis duration for a minimum of 2 months with adequate dialysis delivery; stable medical condition Exclusion criteria: severe or symptomatic cardiovascular disease; orthopaedic complaints interfering with physical function test; severe dementia; implanted medical devices contraindicating MRI scans Baseline characteristics Number (analysed/randomised): intervention group (13/15); control group (13/14) Mean age ± SD (years): intervention group (66.2 ± 12.8); control group (65.± 1 8.1) Sex (M/F): intervention group (14/1); control group (13/1) Dialysis type: HD Mean dialysis vintage ± SD (years): intervention group (2.3 ± 2.0); control group (2.5 ± 2.0) Comorbidities CVD: not reported Diabetes: intervention group (7/13); control group (10/13) Hypertension: intervention group (11/13); control group (13/13) Depression (clinician diagnosis): not reported
Interventions	Intervention classification Non‐pharmacological intervention Indication: study targeting fatigue Intervention group Electrical muscle stimulation Control group No intervention Co‐interventions Not reported
Outcomes	Outcomes reported Fatigue outcome measures used: validation data available Isometric knee extensor strength Physical function Timed up‐and‐go test HRQoL SF‐8: assessed at baseline and end of treatment Laboratory parameters (albumin, Hb, lipids, IGF‐1): assessed at baseline and end of treatment BP: assessed at baseline and end of treatment) Dry weight: assessed at baseline and end of treatment Adverse events
Notes	Additional information Funding: This study received no external funding Conflicts of interest/disclosures: none Trial registration identification number: UMIN000012061 A priori published protocol was reported
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote: "A total of 29 HD patients were eligible for inclusion in the study and were randomly assigned to either the EMS or the control (no training) group by simple random allocation (drawing lots)." Comment: Sequence generation methods were not reported in sufficient detail to permit judgement
Allocation concealment (selection bias)	Unclear risk	Method of allocation concealment was not reported in sufficient detail to permit judgement
Blinding of participants and personnel (performance bias) All outcomes	High risk	Quote: "This was a prospective, open‐label, randomised controlled trial." Comment: An open‐label study is considered as high risk of bias
Blinding of outcome assessment (detection bias) All outcomes	High risk	The outcomes (including vitality) were assessed with an appropriate measure, without differences between groups. However, subjective measures were used, it was not stated whether outcomes were assessed without knowledge of treatment allocation, and knowledge of treatment assignment may have influenced reporting. Participant beliefs about the superiority/inferiority of either intervention could have influenced their assessment of the outcome, but there was no evidence that this was likely. However, objective and subjective outcomes were assessed
Incomplete outcome data (attrition bias) All outcomes	High risk	Quote: "The EMS group included 14 men and 1 woman, while the control group included 13 men and 1 woman. Thirteen (86.7%) participants in the EMS group completed EMS training. The reasons for failure to complete training were hospitalisation before intervention (n51) and dropout due to discomfort of the wet electrode bands (n51). Likewise, 13 (92.9%) participants in the control group completed the protocol. One participant in the control group withdrew consent to join the study. The final analyses included 13 patients in each group." Comment: 13/15 participants in the intervention group and 13/14 participants in the control group completed the study (> 5% lost to follow‐up, with difference between group). Reasons for discontinuations were reported
Selective reporting (reporting bias)	High risk	Information about the protocol were reported. Vitality was reported using multiple eligible outcome measurements (scales, time points). Vitality was reported in a format that was extractable for meta‐analysis. All outcomes that should be addressed (fatigue, cardiovascular disease, and death) were not reported
Other bias	Low risk	There was no evidence of different baseline characteristics, or different non‐randomised co‐interventions between groups. Funding was unlikely to influence the data analysis and authors did not have conflicts of interest. No other source of bias were apparent