a prospective randomized controlled trial of effect of enhanced external counter pulsation to arterial stiffness in chronic hemodialysis patient

Conditions: Hemodialysis

Summary: the objectives of this study are; * to study effect of enhanced external counter pulsation on arterial stiffness, as measured by pulse wave velocity, compared to standard hemodialysis treatment. * to study effect of enhanced external counter pulsation on central aortic blood pressure compared to standard hemodialysis treatment. * to study effect of enhanced external counter pulsation on cardiac index decline during hemodialysis compared to standard hemodialysis treatment. * to study effect of enhanced external counter pulsation on intradialytic hypotension events compared to standard hemodialysis treatment. * to study effect of enhanced external counter pulsation on blood biomarkers for endothelial dysfunction and vascular inflammation compared to standard hemodialysis treatment. * to identify any adverse events from utilizing enhanced external counter pulsation, such as pain or uncomfortable feeling, or even uncontrol hypertension.


Eligibility criteria:
inclusion criteria * patients aged 18 years old or older * patients received hemodialysis at king chulalongkorn memorial hospital for at least 3 months * patients received hemodialysis frequency for at least 3 times/week with adequate hemodialysis, named single pool kt/v of 1.2 or more, as calculated by chula urea kinetic model * patients achieving proper dry weight, as determined by clinical assessment or by body composition monitoring (fresineus company) exclusion criteria * patients with severe or unstable disease required emergent specific treatment such as severe infection or hemodynamic instability * patients with acute coronary syndrome within 1 month * patients received coronary artery bypass graft surgery or percutaneous transluminal coronary angioplasty within 3 months * patients with severe valvular heart disease and hypertrophic obstructive cardiomyopathy known before inclusion or detected by pre - allocation (within 12 months) echocardiographic assessment * patients with cardiac arrhythmia including atrial fibrillation or atrial flutter known before inclusion or detected by pre - allocation (within 12 months) 12 - lead electrocardiography * patients with known or suspected deep vein thrombosis or peripheral arterial disease * patients with thoracic aortic aneurysm detected pre - allocation (within 12 months) echocardiography or abdominal aortic aneurysm detected by pre - allocation (within 12 months) abdominal ultrasonography * patients with bleeding diathesis other than uremic bleeding, including anticoagulants use, but antiplatelets or local thrombolytics for vascular access stenosis/thrombosis are not included * patients with uncontrolled hypertension, defined as systolic blood pressure \&gt; 160 mmhg or diastolic blood pressure \&gt; 100 mmhg * patients with severe pulmonary hypertension known before inclusion or detected by pre - allocation (within 12 months) echocardiographic assessment * pregnant patients * patients who not willing to give a consent or who cannot legally give a consent

Keywords: enhanced external counterpulsation hemodialysis arterial stiffness pulse wave velocity central aortic blood pressure