Respiratory muscle weakness has been shown to be frequent in patients undergoing hemodialysis. In this context, inspiratory muscle training (IMT) emerges as an alternative to improve the respiratory condition of these patients.

To evaluate the effect of IMT on dyspnea and lung capacity in dialysis patients. The effect on respiratory muscle strength was evaluated as a secondary outcome, as well as the dialysis efficacy index (Kt/V).

A 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. Searches were completed in February 2025 in the Medline/PubMed, Cochrane Library, LILACS, CINAHL, PEDro, Web of Science, Embase and Google Scholar databases. The search strategy consisted of the following Keywords “Renal Institution, Chronic”, “Dialyses, Renal”, “Breathing Exercises”, “Dyspnea” and “Respiratory Function Tests” in different combinations. Studies with adult participants (> 18 years) with CKD on hemodialysis were included. The intervention was evaluating inspiratory muscle training with linear load. Study quality was assessed using the Cochrane RoB2 tool.

Six studies were analyzed (n = 210). One study showed an improvement in dyspnea [4.17±0.58; 95%CI (0.0073-0.884); p = 0.022], and the meta-analyses found a mean difference of 0.34 L/min [95%CI (0.08–0.61); p = 0.010] in forced vital capacity (FVC) and 25.15 cmH2O [95%CI (17.05–33.24); p < 0.001] 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.

IMT 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.

Understanding the effects of IMT on patients receiving hemodialysis leads to more effective interventions for common respiratory symptoms in these individuals.