A Prospective Randomized Controlled Trial of Effect of Enhanced External Counter Pulsation to Arterial Stiffness in Chronic Hemodialysis Patient

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 \> 160 mmHg or diastolic blood pressure \> 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