{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T04:39:09Z","timestamp":1760243949926,"version":"build-2065373602"},"reference-count":40,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2010,11,9]],"date-time":"2010-11-09T00:00:00Z","timestamp":1289260800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/3.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>Hypotension is frequently reported during hemodialysis. This study aimed to examine the effect of the intermittent pneumatic circulator on blood pressure during hemodialysis. Sixteen subjects with chronic hemodialysis were recruited. Each subject randomly received two test conditions on separate days, hemodialysis with and without the circulator. The circulator was applied to the subject on lower extremities during 0.5\u20131 hr, 1.5\u20132 hr, 2.5\u20133 hr, and 3.5\u20134 hr of hemodialysis. Systolic and diastolic blood pressures (SBP and DBP) and heart rate (HR) were analyzed at pre-dialysis, 1 hr, 2 hr, and 3 hr of hemodialysis. Stroke volume (SV) and cardiac output (CO) were evaluated between 2.5 and 3.0 hr of hemodialysis. Blood chemicals (sodium, calcium, potassium, and phosphorous) and Kt\/V before and after each hemodialysis session were analyzed. The number of episodes of hypotension was also recorded. The circulator intervention significantly improved SBP and DBP across all time points (P = 0.002 for SBP; P = 0.002 for DBP). The frequency of hypotension was significantly decreased (P = 0.028). SV and CO were significantly improved with the circulator intervention (P = 0.017 for SV; P = 0.026 for CO) and no statistical significances were found on blood chemicals or Kt\/V analyses. The results suggested that the circulator intervention helps stabilize blood pressure and appears to be a practical treatment. Future studies are suggested to develop new circulator innovations with sensor feedback systems to enhance safety and maximize treatment efficiency.<\/jats:p>","DOI":"10.3390\/s101110014","type":"journal-article","created":{"date-parts":[[2010,11,9]],"date-time":"2010-11-09T11:57:47Z","timestamp":1289303867000},"page":"10014-10026","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Effects of the Intermittent Pneumatic Circulator on Blood Pressure during Hemodialysis"],"prefix":"10.3390","volume":"10","author":[{"given":"Tzu-Chao","family":"Hsu","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Pao-Chien Hospital, Ping-Tung City, Taiwan"}]},{"given":"Ya-Ju","family":"Chang","sequence":"additional","affiliation":[{"name":"Physical Therapy Department and Graduate Institute of Rehabilitation Science, Chang Gung University, Tao-Yuan, Taiwan"}]},{"given":"Yu-Yao","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Pao-Chien Hospital, Ping-Tung City, Taiwan"}]},{"given":"Miao-Ju","family":"Hsu","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan"},{"name":"Department of Rehabilitation, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan"}]}],"member":"1968","published-online":{"date-parts":[[2010,11,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1038\/ki.1986.228","article-title":"Hemodynamic Instability during Hemodialysis","volume":"30","author":"Henrich","year":"1986","journal-title":"Kidney Int"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1159\/000168077","article-title":"Epidemiology of Symptomatic Hypotension in Hemodialysis: Is Cool Dialysate Beneficial for All Patients?","volume":"10","author":"Orofino","year":"1990","journal-title":"Am. J. Nephrol"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1726","DOI":"10.1038\/sj.ki.5000382","article-title":"The Importance of Residual Renal Function in Dialysis Patients","volume":"69","author":"Wang","year":"2006","journal-title":"Kidney Int"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"914","DOI":"10.2215\/CJN.03900808","article-title":"Hemodialysis-Induced Cardiac Injury: Determinants and Associated Outcomes","volume":"4","author":"Burton","year":"2009","journal-title":"Clin. J. Am. Soc. Nephrol"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1925","DOI":"10.2215\/CJN.04470709","article-title":"Hemodialysis-Induced Repetitive Myocardial Injury Results in Global and Segmental Reduction in Systolic Cardiac Function","volume":"4","author":"Burton","year":"2009","journal-title":"Clin. J. Am. Soc. Nephrol"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1016\/0002-9149(91)90827-8","article-title":"Stunned Left Ventricular Myocardium after Exercise Treadmill Testing in Coronary Artery Disease","volume":"68","author":"Kloner","year":"1991","journal-title":"Am. J. Cardiol"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1139\/Y09-011","article-title":"Hibernating Myocardium: Pathophysiology, Diagnosis, and Treatment","volume":"87","author":"Slezak","year":"2009","journal-title":"Can. J. Physiol. Pharmacol"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2053","DOI":"10.1093\/ndt\/gfh306","article-title":"Predictors of Haemodynamic Instability and Heart Rate Variability during Haemodialysis","volume":"19","author":"Rubinger","year":"2004","journal-title":"Nephrol. Dial. Transplant"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"276","DOI":"10.5414\/CNP63276","article-title":"Hypotension during Hemodialysis Results from an Impairment of Arteriolar Tone and Left Ventricular Function","volume":"63","author":"Nette","year":"2005","journal-title":"Clin. Nephrol"},{"key":"ref_10","first-page":"67","article-title":"Acute Cardiovascular Complications of Hemodialysis","volume":"62","author":"Coppolino","year":"2010","journal-title":"Minerva Urol. Nefrol"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1305","DOI":"10.1093\/ndt\/gfk070","article-title":"Norepinephrine-Induced Vasoconstriction Results in Decreased Blood Volume in Dialysis Patients","volume":"21","author":"Nette","year":"2006","journal-title":"Nephrol. Dial. Transplant"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1111\/j.0894-0959.2004.17310.x","article-title":"Nitric Oxide and Hemodialysis","volume":"17","author":"Sarkar","year":"2004","journal-title":"Semin Dial"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1038\/sj.ki.5001885","article-title":"Vasopressin Administration Facilitates Fluid Removal during Hemodialysis","volume":"71","author":"Thompson","year":"2007","journal-title":"Kidney Int"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1681\/ASN.V4198","article-title":"Assessment of Postdialysis Dry Weight: A Comparison of Techniques","volume":"4","author":"Kouw","year":"1993","journal-title":"J. Am. Soc. Nephrol"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1634","DOI":"10.1136\/bmj.296.6637.1634","article-title":"Is Dialysis Hypotension Caused by an Abnormality of Venous Tone?","volume":"296","author":"Bradley","year":"1988","journal-title":"Br. Med. J. (Clin. Res. Ed.)"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"S11","DOI":"10.1053\/ajkd.2001.28090","article-title":"Pathophysiology of Dialysis Hypotension: An Update","volume":"38","author":"Daugirdas","year":"2001","journal-title":"Am. J. Kidney Dis"},{"key":"ref_17","first-page":"1283","article-title":"Assessment of Refill and Hypovolaemia by Continuous Surveillance of Blood Volume and Extracellular Fluid Volume","volume":"9","author":"Boggard","year":"1994","journal-title":"Nephrol. Dial. Transplant"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"S17","DOI":"10.1177\/0003319797048005S03","article-title":"Fifteen Years of Experience in Treating 2177 Episodes of Foot and Leg Lesions with the Circulator Boot. Results of Treatments with the Circulator Boot","volume":"48","author":"Dillon","year":"1997","journal-title":"Angiology"},{"key":"ref_19","unstructured":"Nissenson, AR, and Fine, RN (2005). Clinical Dialysis, McGraw-Hill Companies, Inc. [4th ed]."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1097\/MBP.0b013e3282f13f75","article-title":"Dialysis-Induced Hypotension Is Associated with Impaired Aortic Elasticity in Patients Undergoing Chronic Hemodialysis","volume":"13","author":"Duman","year":"2008","journal-title":"Blood Press. Monit"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1046\/j.1523-1755.2002.00099.x","article-title":"Relationship between Volume Status and Blood Pressure during Chronic Hemodialysis","volume":"31","author":"Leypoldt","year":"2002","journal-title":"Kidney Int"},{"key":"ref_22","first-page":"1421","article-title":"Failure of Arginine-Vasopressin and Other Pressor Hormones to Increase in Severe Recurrent Dialysis Hypotension","volume":"10","author":"Friess","year":"1995","journal-title":"Nephrol. Dial. Transplant"},{"key":"ref_23","first-page":"331","article-title":"Chronic Hypotension in the Dialysis Patient","volume":"15","author":"Cases","year":"2002","journal-title":"J. Nephrol"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1097\/00002480-199609000-00121","article-title":"Increased Nitric Oxide Production in Hypotensive Hemodialysis Patients","volume":"42","author":"Lin","year":"1996","journal-title":"Asaio J"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1159\/000047404","article-title":"Hemodynamic Response to Fluid Withdrawal in Overhydrated Patients Treated with Intermittent Ultrafiltration and Slow Continuous Ultrafiltration: Role of Blood Volume Monitoring","volume":"96","author":"Ronco","year":"2002","journal-title":"Cardiology"},{"key":"ref_26","first-page":"308","article-title":"Blood Pressure Reduction during Hemodialysis Correlates to Intradialytic Changes in Plasma Volume","volume":"37","author":"Lins","year":"1992","journal-title":"Clin. Nephrol"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1016\/S0002-9378(16)32238-4","article-title":"The Contribution of the Beta-Adrenergic System to the Cardiovascular Response to Hypovolemia","volume":"147","author":"Ushioda","year":"1983","journal-title":"Am. J. Obstet. Gynecol"},{"key":"ref_28","first-page":"399","article-title":"Neurocardiogenic Syncope","volume":"41","author":"Somers","year":"1996","journal-title":"Adv. Intern. Med"},{"key":"ref_29","first-page":"55","article-title":"Different Cardiovascular Responses to Hemodialysis-Induced Fluid Depletion and Blood Pressure Compliance","volume":"23","author":"Graziani","year":"2010","journal-title":"J. Nephrol"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1038\/ki.1992.158","article-title":"Compliance and Reactivity of the Peripheral Venous System in Chronic Intermittent Hemodialysis","volume":"41","author":"Kooman","year":"1992","journal-title":"Kidney Int"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1535","DOI":"10.1681\/ASN.V981535","article-title":"Hyperkalemia: A Potential Silent Killer","volume":"9","author":"Weiner","year":"1998","journal-title":"J. Am. Soc. Nephrol"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1136\/bmj.1.5699.779","article-title":"Potassium Balance and Acid-Base Changes in Patients Undergoing Regular Haemodialysis Therapy","volume":"1","author":"Morgan","year":"1970","journal-title":"Br. Med. J"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2337","DOI":"10.1681\/ASN.V11122337","article-title":"Effect of Dialysate Sodium Concentration on Interdialytic Increase of Potassium","volume":"11","author":"Bellizzi","year":"2000","journal-title":"J. Am. Soc. Nephrol"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2927","DOI":"10.1093\/ndt\/14.12.2927","article-title":"The Effect of Exercise during Haemodialysis on Solute Removal","volume":"14","author":"Kong","year":"1999","journal-title":"Nephrol. Dial. Transplant"},{"key":"ref_35","unstructured":"de Domenico, G, and Wood, EC (1997). Beard\u2019s Massage, W.B Saunders Company. [4th ed]."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1177\/000331979804900702","article-title":"Improved Hemodynamics Shown by Continuous Monitoring of Electrical Impedance during External Counterpulsation with the End-Diastolic Pneumatic Boot and Improved Ambulatory EKG Monitoring after 3 Weeks of Therapy","volume":"49","author":"Dillon","year":"1998","journal-title":"Angiology"},{"key":"ref_37","unstructured":"Prentice, W (2002). Therapeutic Modalities for Physical Therapists, McGraw-Hill. [2nd ed]."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1793","DOI":"10.1038\/sj.ki.5001852","article-title":"Treatment of Post-Dialytic Orthostatic Hypotension with an Inflatable Abdominal Band in Hemodialysis Patients","volume":"70","author":"Yamamoto","year":"2006","journal-title":"Kidney Int"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1007\/s10286-004-0187-x","article-title":"Use of Lower Abdominal Compression to Combat Orthostatic Hypotension in Patients with Autonomic Dysfunction","volume":"14","author":"Smit","year":"2004","journal-title":"Clin. Auton. Res"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1425","DOI":"10.1016\/j.jacc.2006.06.052","article-title":"Lower Limb and Abdominal Compression Bandages Prevent Progressive Orthostatic Hypotension in Elderly Persons: A Randomized Single-Blind Controlled Study","volume":"48","author":"Podoleanu","year":"2006","journal-title":"J. Am. Coll. Cardiol"}],"container-title":["Sensors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8220\/10\/11\/10014\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T22:03:48Z","timestamp":1760220228000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8220\/10\/11\/10014"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2010,11,9]]},"references-count":40,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2010,11]]}},"alternative-id":["s101110014"],"URL":"https:\/\/doi.org\/10.3390\/s101110014","relation":{},"ISSN":["1424-8220"],"issn-type":[{"type":"electronic","value":"1424-8220"}],"subject":[],"published":{"date-parts":[[2010,11,9]]}}}