Abstract: Objective  To investigate the factors affecting vascular endothelial dysfunction (VED) after hemodialysis with low sodium dialysate in chronic kidney disease (CKD) patients.  Methods The CKD patients undergoing maintenance hemodialysis (MHD) in Yuyao People's Hospital from January 2019 to February 2023 were included in this study. The sodium concentration in dialysate was set at 137mmol/L. The percentage of increased reactive diastolic diameter in brachial artery was compared at baseline and after 6 months of dialysis with low sodium dialysate. Logistic regression was used to analyze the risk factors for VED. A nomograph model was built and validated with self-sampling method. The discrimination and accuracy of the model were evaluated by receiver operating characteristic (ROC) curves and calibration curves. Results A total of 80 CKD patients were enrolled, including 42 with mild VED and 18 with severe VED. Multifactorial logistic regression showed that dialysis age (OR=1.429, 95% CI: 1.241～1.657, P＜0.001), brachial artery blood flow (OR=1.611, 95% CI: 1.472～1.713, P＜0.001), hypersensitive C-reactive protein (OR=1.376, 95% CI: 1.194～1.582, P＜0.001), and malonic dialdehyde (OR=1.376, 95% CI: 1.194～1.582, P＜0.001) were the independent risk factors for VED; albumin (OR=0.472, 95% CI: 0.318～0.609, P＜0.001) and superoxide dismutase (OR=0.658, 95% CI: 0.523～0.791, P＜0.001) were the protective factors for VED. The nomograph showed a high discrimination ability in predicting the risk of VED. The area under the ROC curve was 0.889 (95% CI: 0.841～0.937); the sensitivity was 90.79% and the specificity was 80.73%. The calibration curve showed a good fit between predicted and actual probabilities.  Conclusion  Longer dialysis age, higher brachial artery blood flow, higher serum hypersensitive C-reactive protein, higher serum malonic dialdehyde, low serum albumin, and lower serum superoxide dismutase are the risk factors for VED after hemodialysis with low sodium dialysate in CKD patients. The nomograph model can be used for close monitoring and early warning of these risk factors.

Key words: Maintenance hemodialysis, Low sodium dialysis, Endothelial dysfunction