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Intradialytic cardiac output (CO) decline normally occurs during hemodialysis (HD) resulting in short-term intradialytic hypotension and longer-term increased risk of cardiovascular morbidity and mortality in chronic HD patients through repeated myocardial ischemia. Enhanced External Counter Pulsation (EECP) is a novel non-invasive device that is demonstrated to improve coronary flow and maintain systemic hemodynamics in patients without kidney dysfunction. This study is the first to investigate the effect of EECP application during HD on intradialytic changes of CO and other hemodynamic parameters.
Stable chronic HD patients without recent cardiovascular events were randomly allocated into the EECP group receiving a single session of 60-minute EECP therapy at the early period of 4-hour HD (Figure 1), and the control group receiving standard 4-hour HD. Measurements of intradialytic CO by Transonic HD03 device, intradialytic central aortic blood pressure by AtCor Medical SphygmoCor-XCEL device, and heart rate were done. All investigations and data collection were done in the mid-week HD session. Changes in these parameters in both groups were compared with a linear mixed model. style="font-size: 1rem; font-weight: var(--bs-body-font-weight); text-align: var(--bs-body-text-align);" alt="Figure 1: Application of enhanced external counter pulsation (EECP) device and other measurement equipment during the hemodialysis session">
Of 14 patients included in the study, EECP could maintain CO within the baseline level along the HD session compared to a significant CO decline of 2.4 L/min after 4-hour HD in the control group (p-value 0.001). A comparison of cardiac index changes also revealed similar results. However, central systolic blood pressure, central diastolic blood pressure, mean arterial pressure, and heart rate were stable across the HD session and indifferent between the two groups (Figure 2). No intolerable EECP-related adverse events were reported.
EECP application during HD provided beneficial hemodynamic effects in maintaining CO during HD. The mechanism might be due to the improved venous return or preload since other hemodynamic parameters were unchanged. This effect on CO might reduce the risk of intradialytic hypotension and silent myocardial ischemia, which theoretically reduces long-term cardiovascular events in HD patients. These longer-term effects of EECP in HD patients warranted further studies.