Chinese Journal of Blood Purification

12 June 2026, Volume 25 Issue 06 Previous Issue   

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Current situation of CKD-MBD and renal anemia management in Chinese dialysis centers: data from DOPPS medical director surveys MA Cheng-qian, ZHAO Xin-ju, GAN Liang-ying, CHEN Yu-qing, HOU Fan-fan, NI Zhao-hui, CHEN Xiao-nong, LIANG Xin-ling, ZUO Li 2026, 25 (06):  441-446.  doi: 10.3969/j.issn.1671-4091.2026.06.001 Abstract ( 16 )   Objective  Based on the data from the medical director survey questionnaire of the 7th phase of the Chinese Dialysis Outcomes and Practice Patterns Study (DOPPS 7), this study analyzed the current treatment practices for chronic kidney disease-mineral and bone disorder (CKD-MBD) and renal anemia in 43 dialysis centers in Beijing, Guangzhou, and Shanghai.  Methods  A cross-sectional survey design was adopted. Data from the medical director surveys of DOPPS 7 (2018 to 2021) were collected and analyzed for practice indicators such as CKD-MBD (phosphate binder use, secondary hyperparathyroidism management) and renal anemia (erythropoiesis-stimulating agents [ESA], iron therapy). Count data were described as percentages, and the χ² test was used for comparisons between groups (P＜0.05 was considered significant).  Results  Regarding the phosphate binder use: most nephrologists choose sevelamer as the long-term first-line treatment option, but calcium-containing phosphate binders are still widely used. When there are no cost limits, most doctors prefer non-calcium-containing phosphate binders mainly due to the risk of hypercalcemia. Concerning the treatment of hyperparathyroidism: most physicians consider a parathyroid hormone (PTH) level of 300 pg/mL as the critical value for initiating vitamin D therapy, and 92.7% prefer oral administration. For the treatment of renal anemia: most physicians concur that a hemoglobin (Hb) level of ＜100 g/L serves as the threshold for initiating erythropoiesis-stimulating agent (ESA) treatment, and a ferritin level of ≤300 ng/mL is regarded as the threshold for commencing iron supplementation. Notably, only 48.8% of centers adopt a ferritin level of ≥500 ng/mL as the cut-off point for discontinuing treatment.  Conclusion  There is room for improvement in the treatment of CKD-MBD and renal anemia in dialysis centers in China's first-tier cities. Although non-calcium-containing binders are the main first-line hypophosphatemia treatment, calcium-containing phosphate binders are still widely used. The administration route of vitamin D and the timing of iron therapy deviate from current guidelines. Standardized practices are needed to narrow the gap with the guidelines. Metrics

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Preliminary discussion on the clinical significance of atrial fibrillation on the prognosis of hemodialysis patients HUANG Jing, YU Ling, LI Yan-chun, SUN Qian-mei 2026, 25 (06):  447-451,457.  doi: 10.3969/j.issn.1671-4091.2026.06.002 Abstract ( 6 )   Objective  To explore the effect of atrial fibrillation (AF) on the mortality of hemodialysis (HD) patients.  Methods  HD patients in the Nephrology Department of Beijing Chaoyang Hospital from September 2019 to August 2022 were collected. According to the presence of AF, they were divided into the AF group and non-AF group, and followed up to September 2024 to record the treatment, complications and outcome. Kaplan-Meier survival curve and landmark analysis were used to analyze the survival rate between different groups. Cox regression was used to analyze the effect of AF on the prognosis of HD patients.  Results  A total of 172 patients were included, 37 patients (21.5%) were in the AF group, and the median follow-up time was 61 (32, 61) months. The proportion of cardiovascular and cerebrovascular complications in the AF group was significantly higher than that in the non-AF group (78.4% vs. 51.9%，χ2=8.365，P=0.005). During the follow-up period, 46 cases died, and there were no significant differences in all-cause and cardiovascular mortality between the AF group and non-AF group between 0 to 36 months (χ2=1.436, P=0.231; χ2=0.580, P=0.446), but all-cause and cardiovascular mortality were significantly higher in AF group than those in non-AF group after 36 months (χ2=5.908, P=0.015; χ2=3.951, P=0.047). Univariate COX regression analysis suggested that AF was an influencing factor for all-cause mortality (HR=2.984, 95%CI: 1.178～7.562, P=0.021) and cardiovascular mortality (HR=3.127, 95%CI: 1.954～10.249, P=0.041) in HD patients.  Conclusions  In this preliminary study, the incidence of AF in HD patients is high, and therefore attention should be paid to it in clinical practice. Further studies are needed to provide clinical basis for the treatment guidelines of AF in HD patients. Metrics

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The predictive value of the g-I/GFRABS for acute kidney injury following contrast agent injection in patients with chronic kidney disease MAIERZIYA Wu-siaman, WANG Ke-ke, SULIER Mai-mai-ti, ZHANG Ding-fan, WANG Shun 2026, 25 (06):  452-457.  doi: 10.3969/j.issn.1671-4091.2026.06.003 Abstract ( 8 )   Objective  To investigate the predictive value of the gram-iodine/absolute glomerular filtration rate ratio (g-I/GFRABS) for contrast-induced acute kidney injury (CI-AKI) in patients with chronic kidney disease (CKD) undergoing intravenous contrast medium administration.  Methods  This retrospective study enrolled CKD patients who underwent intravenous contrast medium examinations administration at the First Affiliated Hospital of Xinjiang Medical University from January to March 2023. Clinical data were collected, and the g-I/GFRABS was calculated. Patients were divided into CI-AKI group and non-CI-AKI group based on the occurrence of CI-AKI within 7 days post-procedure. Multivariate Logistic regression analysis was used to identify independent risk factors for CI-AKI. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of relevant ratios for CI-AKI.  Results  A total of 221 CKD patients were included, with 28 in the CI-AKI group and 193 in the non-CI-AKI group. Compared with the non-CI-AKI group, the CI-AKI group had significantly higher baseline levels of serum creatinine, blood urea nitrogen, and uric acid, as well as higher values of the ratio of contrast medium volume to estimated glomerular filtration rate ratio (CMV/eGFR), g-I/GFRABS, and g-I/eGFR (t=-4.212, -4.028, -2.984, -3.821, -4.816, -3.709, respectively; all P ＜ 0.001 except for uric acid, where P=0.003). Conversely, levels of eGFR, GFRABS, hemoglobin, and hematocrit were significantly lower in the CI-AKI group (t=5.644, 5.233, 2.826, 2.966, respectively; all P＜0.001 except for hemoglobin, P=0.005 and hematocrit, P=0.003). Multivariate Logistic regression analysis revealed that high CMV/eGFR (OR=4.574, 95% CI:2.197～9.520, P＜0.001), high g-I/GFRABS (OR=23.671, 95% CI:3.287～170.449, P=0.002), and high g-I/eGFR (OR=22.345, 95% CI: 4.617～108.134, P＜0.001) were independent risk factors for CI-AKI in CKD patients. The influence of baseline serum creatinine, blood urea nitrogen, and uric acid on CI-AKI varied depending on the model. ROC curve analysis showed that the area under the curve for g-I/GFRABS in predicting CI-AKI was 0.781 (95% CI: 0.668～0.893), with an optimal cut-off value of 0.926, yielding a sensitivity of 60.7% and a specificity of 96.4%.  Conclusion  The g-I/GFRABS is an independent predictor of CI-AKI in CKD patients and may serve as a useful indicator for identifying high-risk individuals. Metrics

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Construction of a frailty diagnostic model based on iron metabolism in elderly maintenance hemodialysis patients FENG Ling-xiao, ZHANG Sheng-lei, HU Chun-yan, LIU Lan, ZHANG Dong-xue 2026, 25 (06):  458-462.  doi: 10.3969/j.issn.1671-4091.2026.06.004 Abstract ( 13 )   Objective  To analyze the correlation between iron metabolism level and frailty in elderly patients undergoing maintenance hemodialysis (MHD), and to evaluate its diagnostic value for frailty.  Methods A convenience sampling method was used to select 130 elderly MHD patients (aged≥60 years). Clinical data and biochemical indicators were collected. Frailty was assessed using a frailty symptom scale, and patients were divided into non-frailty group (57 cases) and frailty group (73 cases). Differences between the two groups were compared. Logistic regression was used to analyze risk factors for frailty, and receiver operating characteristic (ROC) curves were used to evaluate diagnostic performance. Results  Compared with the non-frailty group, the frailty group had significantly lower levels of hemoglobin, albumin, uric acid, and transferrin saturation (TSAT) (t=1.997, 2.214, 2.455, 4.271; P=0.048, 0.029, 0.015, ＜0.001, respectively), and significantly higher serum ferritin (SF) levels (t=-3.244, P=0.002). Multivariate logistic regression showed that SF (OR=1.004, 95% CI: 1.001～1.007, P=0.009) and TSAT (OR=0.846, 95% CI: 0.777～0.922, P＜0.001) were independent risk factors for frailty. ROC curve analysis showed an AUC of 0.747 (95% CI: 0.663～0.819) for TSAT and 0.631 (95% CI: 0.542～0.714) for SF. The cut-off value for SF was 495.5 ng/ml, and for TSAT was 21.7%. The combination of the two improved diagnostic performance (AUC = 0.794, 95% CI: 0.710～0.860). Conclusion  Iron metabolism levels are influencing factors for frailty in elderly MHD patients. The regression model combining SF and TSAT can improve the diagnostic performance for frailty and has high clinical application value. Metrics

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Predictive value of early serum potassium level combined with hypersensitive C-reactive protein to albumin ratio for all-cause mortality in patients on continuous ambulatory peritoneal dialysis: a single-center retrospective cohort study CHEN Mo, SUN Bin-bin, ZHAO Bian-jie, WANG Ling 2026, 25 (06):  463-468.  doi: 10.3969/j.issn.1671-4091.2026.06.005 Abstract ( 4 )   Objective  To investigate the predictive value of early serum potassium (sK) level combined with the hypersensitive C-reactive protein to albumin ratio (CAR) for all-cause mortality in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Methods  A single-center retrospective cohort study was conducted. Data were collected from CAPD patients who underwent catheterization at the Peritoneal Dialysis Center of Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University from January 2016 to January 2024. Early sK was defined as the mean value of sK within the first three months after initiating peritoneal dialysis. Patients were divided into three groups according to sK level: hypokalemia group (sK＜3.5 mmol/L), normokalemia group (3.5≤sK≤5.5 mmol/L), and hyperkalemia group (sK>5.5 mmol/L). General characteristics and laboratory indicators were compared among the groups. Multivariate Cox proportional hazards regression model was used to analyze factors associated with all-cause mortality. Restricted cubic spline (RCS) analysis was applied to examine the relationship between early sK, CAR and all-cause mortality. Receiver operating characteristic (ROC) curves were used to evaluate the predictive value of early sK combined with CAR for all-cause mortality.  Results  A total of 462 CAPD patients were enrolled, including 93(20.1%) in the hypokalemia group, 345(74.7%) in the normokalemia group, and 24(5.2%) in the hyperkalemia group. The median follow-up time was 40.0(22.0,63.0) months, and 96 patients (20.8%) died. Multivariate Cox regression analysis showed that age (HR=1.059, 95% CI: 1.037～1.082, P＜0.001), hemoglobin (HR=0.987, 95% CI: 0.974～1.000, P=0.046), sK(HR=0.718, 95% CI: 0.523～0.985, P=0.040), and CAR (HR=2.867, 95% CI: 1.742～4.720, P＜0.001) were independent factors influencing all-cause mortality in CAPD patients. RCS analysis revealed a U-shaped association between early sK level and the risk of all-cause mortality, with the lowest risk at a sK level of 4.397 mmol/L. The association between CAR and all-cause mortality was L-shaped, with an optimal cut-off value of 0.323 mg/g. Combined analysis of sK and CAR showed significantly increased mortality risk in the hypokalemia + high CAR group (HR=2.361, 95% CI:1.214～4.591, P=0.011), hypokalemia+low CAR group (HR=1.808, 95%CI:1.059～3.085,P=0.030), and hyperkalemia + high CAR group (HR=3.191, 95% CI: 1.149～8.465, P=0.026). The area under the ROC curve (AUC) for sK combined with CAR (AUC=0.737, 95% CI:0.678～0.797, P＜0.001) was superior to that of sK alone (AUC=0.694, 95% CI:0.626～0.761,P＜0.001) or CAR alone (AUC=0.709, 95% CI:0.654～0.765, P＜0.001) in predicting all‑cause mortality. Conclusion Early sK level and CAR are influencing factors for all-cause mortality in CAPD patients. The combination of sK and CAR further improves the predictive value for mortality risk. Metrics

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Analysis of the relationship between plasma C-terminal agrin fragment, myostatin and sarcopenia in elderly patients with diabetic kidney disease on maintenance hemodialysis CAO Wen-qiong, MA Xiao, YANG Jin-hui, ZHU Xue-xin 2026, 25 (06):  469-473.  doi: 10.3969/j.issn.1671-4091.2026.06.006 Abstract ( 4 )   Objective To investigate the relationship between plasma C-terminal agrin fragment (CAF), myostatin (MSTN), and sarcopenia in elderly patients with diabetic kidney disease (DKD) undergoing maintenance hemodialysis (MHD). Methods  Elderly DKD patients (≥60 years) receiving MHD at the Department of Nephrology, Lanzhou First People's Hospital from January 2021 to March 2025 were selected as the DKD-MHD group. Elderly non-dialysis DKD patients admitted during the same period served as the control group (n=200). Factors associated with sarcopenia in DKD-MHD patients and the predictive performance of plasma CAF and MSTN levels were analyzed.  Results  Compared with the control group [CAF: 42.57(22.34, 52.16) pg/ml, MSTN: 60.03(29.77, 83.79) ng/ml], the DKD-MHD group had significantly higher plasma levels of CAF [96.37(58.99, 135.08) pg/ml] and MSTN [145.43(100.19, 259.30) ng/ml] (Z=-13.039, -13.224, both P＜0.001). Increased age (OR=1.412, 95%CI: 1.171～1.703, P＜0.001), elevated CAF (OR=1.059, 95%CI:1.034～1.084, P＜0.001), and elevated MSTN (OR=1.027, 95%CI:1.017～1.038, P＜0.001) were independent risk factors for sarcopenia in elderly DKD-MHD patients, while increased body mass index (OR=0.736, 95% CI:0.567～0.954, P=0.021) was an independent protective factor. The area under the curve (AUC) for predicting sarcopenia in elderly DKD-MHD patients was 0.839 for plasma CAF, 0.843 for MSTN, and 0.930 for the combination of both, with the combined detection being superior to either alone (Z=3.692, 3.434, both P＜0.001).  Conclusion  Elevated plasma CAF and MSTN levels are independent risk factors for sarcopenia in elderly DKD-MHD patients and are correlated with sarcopenia parameters. The combination of plasma CAF and MSTN levels has high predictive efficacy for sarcopenia. Metrics

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Efficacy of cardiac resynchronization therapy in patients with maintenance hemodialysis with advanced heart failure WEI Gui-ling, LUO Yuan, ZHUANG Bing, YE Hong, ZHANG Bo-qing, HE Wei-chun 2026, 25 (06):  474-478.  doi: 10.3969/j.issn.1671-4091.2026.06.007 Abstract ( 9 )   Objective  To observe the efficacy and safety of cardiac resynchronization therapy (CRT)  in patients on maintenance hemodialysis (MHD) with advanced heart failure (HF).  Methods  A prospective observational study was conducted. Patients with MHD and advanced HF who met CRT indications and were admitted to the Second Affiliated Hospital of Nanjing Medical University from January 2021 to June 2022 were enrolled. Changes in cardiac function, electrocardiographic parameters, and echocardiographic parameters were observed after CRT implantation, and adverse events were recorded.  Results  A total of 4 patients were included (2 males, 2 females), with a mean age of (62.3±7.9) years, median dialysis vintage of 76.2 (27.3, 179.0) months, and mean follow-up time of (19.7±9.9) months. Compared with preoperative values, the QRS duration shortened from (183.3±26.3) ms to (150.0±13.0) ms; left ventricular end-diastolic diameter decreased from (70.3±10.3) mm to (64.0±11.1) mm; left ventricular end-systolic diameter decreased from (57.8±13.2) mm to (48.8±15.7) mm; E/e‘ ratio decreased from (27.5±9.9) to (20.6±6.5); and median N-terminal pro brain natriuretic peptide (NT-proBNP) level decreased from 167,459.5 (59,645.8, 231,789.0) ng/ml to 81,773.0 (26,151.3, 134,313.0) ng/ml, representing reductions of 18.2%, 9.0%, 15.6%, 25.1%, and 51.2%, respectively. Left ventricular ejection fraction increased from (32.8±7.4)% to (42.3±15.3)%, an increase of 30.0%. According to the New York Heart Association (NYHA) functional classification, 2 patients improved to NYHA class I and 2 to class II. None of the 4 patients could complete the 6-minute walk test preoperatively; among them, 3 achieved an average walking distance of (328.3±138.2) m at 1 year post-surgery. One patient developed bacteremia after surgery.  Conclusion  CRT may help improve cardiac function in MHD patients with advanced HF and has potential to improve quality of life. Its short-term safety in this specific population is acceptable. However, the impact on long-term prognosis requires further validation with larger sample sizes. Metrics

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The associated factors of intradialytic hypotension and its impact on 3-year survival in patients on maintenance hemodialysis LIAN Xiao-ying, KUANG Ze-min, MA Ye-ping, SHAO Feng, LI Zhong-xin 2026, 25 (06):  479-783,528.  doi: 10.3969/j.issn.1671-4091.2026.06.008 Abstract ( 14 )   Objective  To investigate the independent factors associated with intradialytic hypotension (IDH) in maintenance hemodialysis (MHD) patients and to analyze its impact on 3-year all-cause mortality risk.  Methods  A retrospective cohort study was conducted, which included 191 MHD patients treated at the Blood Purification Center of Beijing Lu-he Hospital, Capital Medical University, from October to December 2021. According to the occurrence of IDH, the patients were divided into an IDH group (n=50) and a non-IDH group (n=141). Clinical data were collected. Univariate and multivariate logistic regression analyses were performed to identify the independent factors associated with IDH. Kaplan-Meier curve was used, and multivariate Cox proportional hazards regression model was applied to analyze the relationship between IDH and survival prognosis.  Results  Multivariate logistic regression analysis showed that pre-dialysis systolic blood pressure (OR=0.958, 95% CI: 0.936～0.981, P＜0.001), pre-dialysis creatinine (OR=0.998, 95% CI: 0.997～1.000, P=0.037), and serum albumin (OR=0.769, 95% CI: 0.652～0.907, P=0.002) were the independent factors associated with IDH in MHD patients. Survival analysis revealed that the 3-year cumulative survival rate was significantly lower in the IDH group than in the non-IDH group (42% vs. 72%, log-rank χ²=9.450, P=0.003). To further clarify the independent association between IDH and mortality, multivariate COX regression after adjustment for age, hemoglobin, albumin, pre-dialysis creatinine, diabetes history, and ultrafiltration volume indicated that IDH was not an independent risk factor for 3-year all-cause mortality (HR=1.423, 95% CI: 0.771～2.626, P=0.259). In the adjusted model, age (HR=1.088, P＜0.001) was a risk factor for death, while hemoglobin(HR=0.971,P=0.015) served as a protective factor.  Conclusion  Lower pre-dialysis systolic blood pressure, serum albumin, and pre-dialysis creatinine levels are the independent factors associated with IDH in MHD patients. IDH is significantly correlated with reduced patient survival, but it primarily reflects the underlying frail state of the patients rather than acting as an independent risk factor for mortality. Metrics

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Clinical application of Metagenomic next-generation sequencing in peritoneal dialysis related peritonitis with antibiotic treatment ZHANG Qing-yan, LIU Ying, FENG Yuan, LIU Xu-meng, JIANG Chun-ming, TANG Ri-ning 2026, 25 (06):  484-489.  doi: 10.3969/j.issn.1671-4091.2026.06.009 Abstract ( 13 )   Objective  To investigate the diagnostic value of metagenomic next-generation sequencing (mNGS) for pathogens of peritoneal dialysis (PD)-associated peritonitis following antibiotic treatment.  Methods  We retrospectively analyzed clinical data of the patients with PD-associated peritonitis treated in Nanjing Drum Tower Hospital between June 2020 and May 2024. PD effluents were collected from the patients for mNGS and microbial culture. They were categorized into two groups based on antibiotic use within two weeks: antibiotic exposure group and no antibiotic exposure group. Pathogen detection rates of mNGS and microbial culture were compared between the two groups.  Results  A total of 69 patients were recruited in this study, including 25 patients in the antibiotic exposure group. The pathogen detection rate of microbial culture was significantly lower in the antibiotic exposure group than in the no antibiotic exposure group (χ2=20.707, P＜0.001), while the rate of mNGS remained unaffected (χ2=0.000, P=1.000). Based on the duration of antibiotic use prior to PD effluent collection, patients in the antibiotic exposure group were further divided into three groups: ≤1 day (n=5), 2～7 days (n=14), and ≥8 days (n=6) groups. There was no significant difference in pathogen detection rate of mNGS among the three groups (χ2=1.182, P=1.000), whereas the rate of microbial culture decreased along with the duration of antibiotic use (χ2=7.123, P=0.025). Both mNGS and microbial culture were found to be positive in 47 patients, of which 44 patients (93.6%) had the consistently positive results between the two detection methods, including identical results in 28 cases and partial identical results in 16 cases.  Conclusion  For patients with PD-associated peritonitis following antibiotic treatment, mNGS has the advantages of higher pathogen detection rate and stronger consistency with the pathogens identified by microbial culture. Metrics

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The relationship between serum serum SGK3, OPG, SLC7A11 and malnutrition - inflammation - atherosclerosis syndrome in maintenance hemodialysis and the value of their joint detection YANG Qing, ZHENG Qi-gang, FENG Ting-ting, GONG Zheng-tang, LI Huan, DU Ling-li 2026, 25 (06):  490-494.  doi: 10.3969/j.issn.1671-4091.2026.06.010 Abstract ( 2 )   Objective  To investigate the relationship between serum levels of osteoprotegerin (OPG), serum and glucocorticoid inducible kinase 3 (SGK3), solute carrier family 7 member 11 (SLC7A11) and malnutrition-inflammation-atherosclerosis syndrome (MIAS) in patients undergoing maintenance hemodialysis (MHD), and to evaluate the value of their combined detection.  Methods  A total of 172 MHD patients admitted to Jingmen People's Hospital from June 2022 to June 2024 were enrolled and divided into MIAS group (55 cases) and non-MIAS group (117 cases). The analysis was conducted using Lasso regression, multivariate logistic regression and receiver operating characteristic (ROC) curves.  Results  Lasso analysis identified high-sensitivity C reactive protein (hs-CRP), intimal-medial thickness (IMT), OPG, SGK3, and SLC7A11 as predictors of MIAS. IMT (OR=2.951, 95%CI:1.179～7.385, P=0.021), OPG (OR=3.272, 95% CI:1.339～7.998, P=0.009), and SGK3 (OR = 3.189, 95% CI:1.362～7.466, P=0.008) were risk factors for MIAS in MHD patients, while SLC7A11 (OR = 0.294, 95% CI:0.122～0.706, P=0.006) was a protective factor. The area under the curve (AUC) of serum OPG, SGK3, and SLC7A11 alone and in combination for predicting MIAS in MHD patients was 0.839, 0.822, 0.806, and 0.940, respectively, with the combined efficacy being superior to that of each individual indicator (Z=4.088,3.558,3.947,all P＜0.001).  Conclusion  Serum OPG and SGK3 levels are elevated and SLC7A11 level is decreased in MHD patients with MIAS. The combined detection of these three indicators may serve as a serum biomarker for predicting MIAS in MHD patients. Metrics

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Logistic regression model and artificial neural network model for predicting the risk factors of frequent intradialytic hypotension in maintenance hemodialysis patients HOU Hui, LI Hong-shao, CAI Ling-li, ZHANG Fei-jin, ZHU Feng 2026, 25 (06):  495-500.  doi: 10.3969/j.issn.1671-4091.2026.06.011 Abstract ( 7 )   Objective  To investigate the risk factors of frequent intradialytic hypotension (IDH) in patients undergoing maintenance hemodialysis (MHD), and to compare the predictive performance between logistic regression model and artificial neural network (ANN) model.  Methods  A retrospective analysis was conducted on the clinical data of 232 MHD patients treated from January 2022 to June 2024. They were randomly divided into a training set (n=162) and a testing set (n=70) with a ratio of 7:3. Based on the presence of IDH ≥20% as frequent IDH, patients in the training set were categorized into a frequent IDH group (n=43) and a non-frequent IDH group (n=119). Univariate analysis was performed to compare the differences between the two groups. Multifactorial logistic regression model and ANN model were used to analyze the risk factors for frequent IDH. The area under the curve (AUC) of receiver operating characteristic (ROC) was used to assess model performance.  Results  The frequent IDH group had significantly older age (t=4.486, P＜0.001), longer dialysis duration (t=4.813, P＜0.001), higher average ultrafiltration volume (UFV) (t=4.802, P＜0.001) and higher UFV to dry body weight ratio (UFV/W) (t=6.218, P＜0.001) but had significantly lower levels of high-density lipoprotein (HDL) (t=4.389, P＜0.001) and hemoglobin (t=4.253, P＜0.001), as compared with those in the non-frequent IDH group. Logistic regression showed that dialysis duration (OR=1.031, 95%CI:1.002～1.061, P=0.033), average UFV (OR=3.865, 95%CI:1.498～9.974, P=0.005) and average UFV/W (OR=2.355, 95% CI:1.582～3.506, P＜0.001) were the risk factors for frequent IDH, while hemoglobin (OR=0.956, 95% CI:0.932～0.981, P＜0.001) and HDL (OR=0.120, 95% CI:0.022～0.475, P=0.004) were the protective factors for frequent IDH. The AUC was 0.906 for logistic regression model and was 0.907 for ANN model, showing no statistically significant difference (Z=0.238, P=0.812). The results of testing set validation were robust (logistic AUC=0.892, ANN AUC=0.885; Z=0.152, P=0.879).  Conclusion  Dialysis duration and ultrafiltration load (UFV/W＞3.5%) are the risk factors, while hemoglobin and HDL are the protective factors for frequent IDH. The predictive performance of logistic regression model and ANN model is comparable; logistic regression model offers stronger interpretation ability, while ANN model can capture complex nonlinear relationships. Metrics

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Establishment and evaluation of a clinical prediction model for acute renal injury related to anti-tumor drugs using artificial intelligence LI Ze-wei, ZHANG Y, PU Li-tian, LI Li, YANGXIONG Li-yan, CUI Jian-chen, SHEN Ying, WANG Xin-yu, DENG Qin-yuan, XU Jian 2026, 25 (06):  501-507.  doi: 10.3969/j.issn.1671-4091.2026.06.012 Abstract ( 8 )   Objective  This study aimed to investigate the risk factors for acute kidney injury (AKI) associated with antineoplastic drugs and to develop an artificial intelligence (AI)-based prediction model.  Methods A cohort of 272 cancer patients diagnosed and treated at the First People's Hospital of Yunnan Province between January 1, 2015, and August 1, 2023 were enrolled. These patients were divided into the AKI group (n=89) and the non-AKI group (n=183) based on the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Both univariate and multivariate logistic regression analyses were employed to identify independent risk factors, and machine learning models, such as decision trees and random forests algorithms, were constructed. The performance of these models was assessed using metrics including the area under the receiver operating characteristic curve (AUC). Results Of the 272 patients included, 89 (32.7%) developed AKI. Univariate analysis showed that patients with normal body mass index (BMI) (OR=0.533, 95%CI：0.295～0.964，P=0.037), previous radiotherapy (OR=0.369, 95%CI：0.147～0.922，P=0.033), or surgery (OR=0.142, 95%CI：0.065～0.311，P＜0.001) were associated with a lower risk of AKI. However, multivariate analysis identified respiratory system cancer (OR=2.162, 95%CI：1.172～3.991, P=0.014), the use of cisplatin (OR=2.135, 95% CI: 1.178～3.869, P=0.012), and non-platinum chemotherapy drugs (OR=9.247, 95% CI：4.271～20.017, P＜0.001) as independent risk factors. The decision tree model achieved an AUC of 0.660, the LASSO regression model an AUC of 0.864, and the neural network model an AUC of 0.833. Among all models, the random forest model exhibited the optimal predictive performance, with an AUC of 0.870 and a recall of 0.919.  Conclusions The AI model utilizing the random forest algorithm enables early identification of high-risk patients for AKI associated with antineoplastic drugs, thereby providing valuable decision support for clinical intervention. Metrics

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Mechanism of EZH2-mediated ERK/HIF-1α signaling pathway in promoting peritoneal dialysis-associated peritoneal fibrosis FU Bi-ling, XIE Ting-fei, XU Yun-peng, ZHANG Yan-zi, CHEN Ji-hong 2026, 25 (06):  508-513.  doi: 10.3969/j.issn.1671-4091.2026.06.013 Abstract ( 5 )   Objective   To investigate the role of enhancer of zeste homolog 2 (EZH2) through regulating the extracellular signal-regulated kinase (ERK)/hypoxia inducible factor-1α (HIF-1α) signaling pathway in the pathogenesis of peritoneal dialysis-associated peritoneal fibrosis.  Methods  Cell studies: human peritoneal mesothelial cells were divided into 3 groups, control group, TGF-β group, and TGF-β+siEZH2 (TGF-β+small interference RNA targeting EZH2) group. Animal studies: the mouse peritoneal fibrosis model was divided into 3 groups, control group, model group, and model+EZH2 knockdown group. The expressions of EZH2, ERK, HIF-1α, α-SMA (α-smooth muscle actin), MMP2 (matrix metallo proteinase 2), IL-6 (interleukin-6), and MCP-1 (monocyte chemoattractant protein-1) were detected by qPCR and western blot. Peritoneal tissues were stained by HE and Masson method.  Results  Cell studies: TGF-β induced the transformation of human peritoneal mesothelial cells to fibroblasts, which was attenuated by knockdown of EZH2. Compared with those in the control group, the TGF-β group showed the increase of mRNAs and proteins of EZH2 (t=4.473 and 22.39, P=0.001 and ＜0.001), HIF-1α (t=5.873 and 3.763, P=0.004 and 0.019), α-SMA (t=20.71 and 4.587, P＜0.001 and =0.010), and MMP2 (t=47.500 and 3.994, P＜0.001 and =0.016), as well as the increase of p-ERK (t=3.355, P=0.028)； IL-6 and MCP-1 were also upregulated (P＜0.05). Compared with those in the TGF-β group, the TGF-β+siEZH2 group exhibited the reduction of mRNAs and proteins of EZH2 (t=32.430 and 4.886, P＜0.001 and=0.008), HIF-1α (t=6.732 and 0.019, P=0.003 and 0.001), α-SMA (t=25.760 and 2.809, P＜0.001 and =0.048), and MMP2 (t=45.30 and 3.119, P＜0.001 and =0.035), as well as the reduction of p-ERK (t=2.851, P=0.046)； IL-6 and MCP-1 were also downregulated (P＜0.05). No intergroup differences were observed in ERK mRNA (P＞0.05). Animal studies: the model group exhibited thickening of peritoneal mesothelial layer, fibrosis and inflammatory infiltration, which were ameliorated in the model+EZH2 knockdown group. Compared with the control group, the model group showed the increase of mRNAs and proteins of EZH2 (t=12.340 and 93.560, P＜0.001), HIF-1α (t=3.891 and 35.250, P=0.017 and ＜0.001), α-SMA (t=17.540 and 15.020, P＜0.001), and MMP2 (t=47.330 and 61.120, P＜0.001), as well as the increase of p-ERK (t=102.800, P＜0.001). Compared with the model group, the model+EZH2 knockdown group exhibited the reduction of mRNAs and proteins of EZH2 (t=3.313 and 29.040, P=0.029 and ＜0.001), HIF-1α (t=3.928 and 38.520, P=0.017 and ＜0.001), α-SMA (t=6.617 and 5.570, P=0.002 and 0.005), and MMP2 (t=5.406 and 10.150, P=0.005 and ＜0.001), as well as the reduction of p-ERK (t=59.460, P＜0.001). No intergroup differences were observed in ERK mRNA (P＞0.05).  Conclusion   EZH2 promotes peritoneal fibrosis by activating the ERK/HIF-1α pathway to upregulate the expressions of HIF-1α, α-SMA, MMP2 and inflammatory factors. Knockdown of EZH2 inhibits this pathway and attenuates fibrosis. Targeting the EZH2/ERK/HIF-1α pathway may represent a novel therapeutic strategy. Metrics

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Recent advances in gut microbiome mechanisms underlying the sleep disorders and its intervention study in maintenance hemodialysis patients DING Bing-tian, SUN Yan-yan 2026, 25 (06):  514-517.  doi: 10.3969/j.issn.1671-4091.2026.06.014 Abstract ( 13 )   Sleep disorders are highly prevalent in maintenance hemodialysis (MHD) patients, which significantly impair the quality of life and clinical outcomes. Recent studies have indicated that the gut microbiota participates in sleep regulation via the "gut-brain axis", and MHD patients are more prone to present gut microbiota dysbiosis, which subsequently affects sleep through metabolic, neuroendocrine and other pathways. This review summarizes the epidemiology and microbiome mechanisms of sleep disorders in MHD patients, and evaluates the effectiveness of emerging intervention strategies, aiming to provide insights into individualized treatment. Metrics

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Studies on the distribution of coagulase-negative staphylococcus strains in maintenance hemodialysis patients with tunnel cuffed catheters, the consistency of multiple detection methods, and the clinical intervention XU Zhuo-jia, LIANG Guo-yu, YANG Wei-na, WANG Kai 2026, 25 (06):  518-522.  doi: 10.3969/j.issn.1671-4091.2026.06.015 Abstract ( 4 )   Objective  To clarify the distribution and drug resistance characteristics of coagulase-negative staphylococcus floras in patients with long-term indwelling tunnel cuffed catheters in a single dialysis center, to verify the consistency of the multiple detection methods including bacterial culture, automated testing for bacteria (ATB), and pulsed field gel electrophoresis (PFGE) for the same specimen, and to distinguish the clinical significance of colonization, pre-infection and infection period of the strains, in order to provide references for precise prevention, control and stratified intervention.  Methods  A total of 216 hemodialysis patients with tunnel cuffed catheters admitted to the Dialysis Center of Civil Aviation General Hospital from January 2020 to January 2025 were recruited for this study. Specimens from their catheter-related areas and nasal cavities were collected, and were subjected to bacterial culture, ATB, drug sensitivity test, and PFGE for gene homology analysis. The significance of the identified strains was evaluated in conjunction with clinical symptoms.  Results  A total of 109 coagulase-negative staphylococcus strains (12.62%) were isolated, mainly from external neck skins covered with dressings (53 strains, 48.62%). Staphylococcus epidermidis accounted for 51.38% of the strains (56 strains). These coagulase-negative staphylococci were resistant to penicillin (91/109, 83.49%), but sensitive to tigecycline and vancomycin (109/109, 100%). The consistency of the detection methods was satisfied, with Kappa=0.89 for bacterial culture/ATB and Kappa=0.78 for culture/PFGE typing (Kappa≥0.75 was defined as good consistency). Among the 109 strains, 75.23% (82/109) were considered to be colonization, 22.02% (24/109) were attributed to the pathogens of pre-infection stage, and 2.75% (3/109) to the pathogens of infection stage. PFGE indicated the existence of cross-patient clonal transmission (homology rate 18.67%, 28/150) and self-cross-site colonization (homology rate 66.67%, 16/24).  Conclusion  Patients with tunnel cuffed catheters have a higher rate of coagulase-negative staphylococcal colonization. Multiple detection methods are helpful to check accuracy each other. Clinically, regular screening and stratified intervention can reduce the risk of infection. PFGE is suitable for routine homology characterization. Metrics

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The influence of sarcopenia on major adverse cardiovascular events in maintenance hemodialysis patients ZHONG Zhi-cong, CAO Yan-fei, LUO Shi-miao, WEI Lin 2026, 25 (06):  523-528.  doi: 10.3969/j.issn.1671-4091.2026.06.016 Abstract ( 9 )   Objective  To investigate the impact of sarcopenia on major adverse cardiovascular events (MACE) in patients undergoing maintenance hemodialysis (MHD).  Methods  A convenience sampling method was used to select MHD patients as the research subjects from Department of Dialysis, The Second Hospital Affiliated to Guangzhou University of Chinese Medicine between December 2021 to July 2025. These patients were divided into the sarcopenia group and the non-sarcopenia group based on the presence or absence of sarcopenia. The follow-up period was 36 months, and the occurrence of MACE and survival status were recorded. Kaplan-Meier curve, Cox regression model, and Fine-Gray competing risk model were used to analyze the relationship between sarcopenia and the occurrence of MACE, all-cause death, and cardiovascular disease death in these MHD patients.  Results   A total of 177 MHD patients were included. The MACE rate was 74.89% in the sarcopenia group (n=65), and was 41.69% in the non-sarcopenia group (n=112). The mortality rate was 53.36% in the sarcopenia group, and was 22.26% in the non-sarcopenia group. Kaplan-Meier analysis showed that the rates of MACE and mortality in the sarcopenia group were higher than those in the non-sarcopenia group (log-rank χ2=17.596 and 18.977, P＜0.001). Multivariate Cox regression revealed that sarcopenia (HR=2.011, 95% CI:1.214～3.333, P=0.008) and low muscle strength (HR=1.818, 95% CI:1.075～3.074, P=0.026) were the independent influencing factors for the occurrence of MACE in MHD patients, and sarcopenia was the independent influencing factor for all-cause death in MHD patients (HR=2.133, 95% CI:1.015～4.486, P=0.046). Fine-Gray competing risk model analysis found that the risk of cardiovascular disease death in the sarcopenia group was 7.696 times higher than that in the non-sarcopenia group (HR=7.696, 95% CI:2.077～28.524, P=0.002).  Conclusion  The rates of sarcopenia and MACE are higher in MHD patients. Sarcopenia and low muscle strength increase the risk of MACE. Metrics