Chinese Journal of Blood Purification

12 June 2025, Volume 24 Issue 06 Previous Issue   

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Analysis of the correlation between body cell mass index and mortality in maintenance hemodialysis patients YU Xian, WANG Mei, HUANG Yi-bin, WANG Yao 2025, 24 (06):  441-446.  doi: 10.3969/j.issn.1671-4091.2025.06.001 Abstract ( 43 )   Objective  This study investigates the correlation between the body cell mass index (BCMI), measured using bioelectrical impedance analysis (BIA), and mortality in patients undergoing maintenance hemodialysis (MHD).  Methods  Ninety-two MHD patients from Xishan People's Hospital were selected for this study between October 2020 and April 2021 and were followed for 34 months. The cohort included 27 patients who died and 64 who survived. Clinical data were compared between thetwo groups to identify factors influencing mortality and to evaluate the predictive value of BCMI in predicting death among MHD patients. Results   Multivariate COX regression analysis identified BCMI (HR=0.700, 95% CI:0.508～0.965, P=0.029) and prealbumin (HR=0.993, 95% CI:0.988～0.998, P=0.008) as independent predictors of mortality. The receiver operating characteristic (ROC) curve indicated that BCMI has predictive value for mortality in MHD patients, with an area under the curve (AUC= 0.654, P=0.020) and an optimal cutoff value of 9.95 kg/m2. Compared with the BCMI＞9.95 group, the proportion of female patients was significantly higher in the BCMI≤9.95 group (χ2=23.391, P＜0.001), and the proportion of patients with sarcopenia was as high as 47.5% (χ2=14.368, P＜0.001). Survival curves showed that the survival rate of patients in the BCMI ＞ 9.95 group was much higher than that in the BCMI ≤ 9.95 group (log rank  P = 0.022).  Conclusion  A low BCMI is significantly associated with increased mortality in MHD patients. Low BCMI indicates comorbid sarcopenia and heightened mortality risk. BIA-measured BCMI values can aid in identifying patients with sarcopenia, enabling timely interventions to improve patient prognosis.  Metrics

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Predictive value of plasma lipoprotein-associated phospholipase A2 in major adverse cardiovascular events among patients with chronic kidney disease LAI Yan-hong, ZHONG Hao-wen, XIE Na, WU Song-zhao, LIANG Xiang, SU Xiao-yan 2025, 24 (06):  447-451.  doi: 10.3969/j.issn.1671-4091.2025.06.002 Abstract ( 39 )   Objective  To assess the risk factors associated with major adverse cardiovascular events (MACE) in patients diagnosed with stages 3-5 chronic kidney disease (CKD), and to evaluate the predictive value of plasma lipoprotein-associated phospholipase A2 (Lp-PLA2) for MACE within this specific patient population.  Methods  In this retrospective study, we enrolled a total of 212 patients diagnosed with CKD stages 3-5 at Dongguan Tungwah Hospital between November 2017 and December 2022. Among the two groups: 106 patients with confirmed MACE and an equal number of patients without MACE. We compared the differences in Lp-PLA2 levels and various clinical indicators between the two groups, employing logistic regression analysis to identify the risk factors associated with MACE. Additionally, we utilized ROC curve analysis to evaluate the predictive accuracy of Lp-PLA2 for MACE events.  Results  The Lp-PLA2 levels were significantly elevated in the MACE group compared to the non-MACE group (252.769±138.053 vs. 128.984±37.499，t=8.909，F=81.964，Z=-8.331， P＜0.001) among CKD stages 3-5 patients. Logistic regression analysis revealed that, besides age and sex, Lp-PLA2 independently contributed as a risk factor for MACE in CKD stages 3-5 patients with an odds ratio of 1.026. The analysis of age subgroups (elderly OR=1.027，95% CI:(1.009～1.045), P=0.003; non-elderly OR=1.025, 95% CI:(1.013～1.037), P＜0.001), gender subgroups [male OR=1.019, 95% CI: (1.009～1.029), P＜0.001; female OR=1.052, 95% CI:(1.021～1.084), P=0.001], and diabetes subgroup [diabetes OR=1.027, 95% CI: (1.012～1.043), P＜0.001; non-diabetes OR=1.025, 95% CI:(1.012～1.037), P＜0.001] revealed that Lp-PLA2 served as an independent risk factor for MACE. ROC curve analysis demonstrated that a cutoff value of 189 ng/ml for Lp-PLA2 predicted MACE with a sensitivity of 60.4% and specificity of 95.3%. Conclusions  The Lp-PLA2 enzyme is an independent risk factor for MACE in CKD stages 3-5 patients, and it holds significant clinical value in predicting the occurrence of MACE in this patient population. Metrics

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Hemodynamic characteristics before and after hemodialysis and their clinical significances HUANG Hong, QIU Qiang, LIU Qiang, YAN Dong-mei 2025, 24 (06):  452-456.  doi: 10.3969/j.issn.1671-4091.2025.06.003 Abstract ( 48 )   Objective  To observe the changes of hemodynamic parameters before and after hemodialysis in maintenance hemodialysis (MHD) patients, and to explore the clinical value of hemodynamic monitoring in MHD patients by comparison of clinical indicators between patients with improved and those with unimproved hemodynamics.  Methods  Patients undergoing stable MHD at the Department of Nephrology, Beijing Shunyi District Hospital were selected as study subjects. General clinical data were collected, venous blood samples were obtained before and after hemodialysis, and non-invasive hemodynamic monitoring using thoracic electrical bioimpedance was performed. Changes in hemodynamic parameters before and after dialysis and their correlations with clinical indicators were analyzed.  Results  A total of 41 patients were included.  ① Significant differences in heart rate, heart rate variability, cardiac index, thoracic fluid conductivity, pulmonary capillary wedge pressure, and systemic vascular resistance were observed before and after hemodialysis (t=0.056, 2.932, 0.998, 0.022, 0.637 and 2.653 respectively; P=0.023, 0.021, 0.015, 0.005, 0.006 and 0.030 respectively).  ② In the 27 patients with improved hemodynamic status after dialysis, mean arterial pressure, systemic vascular resistance, systolic blood pressure, and diastolic blood pressure decreased significantly post-dialysis (t=0.924, 2.136, 2.453 and 0.092 respectively; P=0.009, 0.013, 0.004 and 0.047 respectively).  ③ In the patients with improved hemodynamic status after dialysis, lower total cholesterol levels and the better control of intact parathyroid hormone (iPTH) were found, as compared those in the unimproved group (t=4.705 and 5.327; P=0.036 and 0.026).  Conclusion  Hemodynamic parameters undergo significant changes after dialysis in MHD patients. Patients demonstrating improved hemodynamic after dialysis exhibit relatively stable blood pressure profiles and better controls of total cholesterol and iPTH. Metrics

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Risk factors for fracture occurrence in maintenance hemodialysis (MHD) patients LIU Rong-li, LU Jin-hua, HUO Yuan-yuan 2025, 24 (06):  457-462.  doi: 10.3969/j.issn.1671-4091.2025.06.004 Abstract ( 29 )   Objective  To investigate the influencing factors of fracture occurrence in maintenance hemodialysis (MHD) patients.  Methods  A prospective cohort of MHD patients admitted to Xi'an Hospital of Traditional Chinese Medicine from August 2020 to December 2022 was selected and randomly divided into a modeling group and a validation group in a 7:3 ratio. The modeling group was further categorized into fracture and non-fracture subgroups based on fracture occurrence. Multivariate logistic regression was used to analyze risk factors for fractures in MHD patients. A nomogram model for predicting fracture risk was constructed using R software. Receiver operating characteristic (ROC) curves were plotted to evaluate the discriminative ability of the nomogram, and calibration curves were generated to assess model consistency.  Results  A total of 358 patients were included, with 251 in the modeling group and 107 in the validation group. In the modeling group, 38 patients (15.14%) experienced fractures. The fracture group had higher proportions of patients aged ≥65 years, females, and those with intact parathyroid hormone (iPTH) ≥300 ng/L compared to the non-fracture group (χ²=13.014, 11.765, 10.158; P＜0.001, 0.001, 0.001, respectively). The fracture group also showed lower rates of active vitamin D supplementation and lower skeletal muscle mass index (χ²/t = 13.553, 6.138; both P＜0.001). The most common fracture type was vertebral compression fractures (31.58%), followed by hip fractures (23.68%). Multivariate logistic regression identified that the risk factors were age ≥65 years (OR=11.150, 95% CI: 3.790～32.086; P＜0.001), female sex (OR=5.443, 95% CI: 1.977～14.985; P=0.001), and iPTH ≥300 ng/L (OR=31.784, 95% CI: 9.457～106.826; P＜0.001); while higher skeletal muscle mass index (OR=0.421, 95% CI: 0.200～0.885; P=0.022) and active vitamin D supplementation (OR=0.055, 95% CI: 0.014～0.206; P＜0.001) were protective factors. The area under the ROC curve (AUC) was 0.872 for the modeling group (Hosmer-Lemeshow test: χ²=7.124, P=0.704) and 0.924 for the validation group (Hosmer-Lemeshow test: χ²=6.353, P=0.687), indicating good discrimination and calibration.  Conclusion  Age, female sex, and elevated iPTH are independent risk factors for fractures in MHD patients, while higher skeletal muscle mass index and active vitamin D supplementation serve as protective factors. The constructed nomogram model demonstrated good predictive performance for fracture risk in this population. Metrics

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The efficacy of roxadustat combined with iron therapy in treating renal anemia in maintenance dialysis patients and its impact on the proline hydroxylase 2/hypoxia-inducible factor-2 α pathway ZHAO Jian-ping, YUAN Yi 2025, 24 (06):  463-468.  doi: 10.3969/j.issn.1671-4091.2025.06.005 Abstract ( 24 )   Objective  To investigate the efficacy of roxadustat combined with iron supplements in treating renal anemia in maintenance dialysis patients and its effects on the proline hydroxylase 2 (PHD2)/hypoxia-inducible factor (HIF)-2α pathway.  Methods  A total of 111 patients with renal anemia undergoing maintenance dialysis at Dazhou Dachuan District People’s Hospital from June 2021 to June 2023 were selected and divided into three groups using the random number table method. Control group 1 received roxadustat alone, control group 2 received iron supplements alone, and the combined group received roxadustat plus iron supplements. Anemia symptoms, hematological parameters, iron metabolism indices, PHD2/HIF-2α pathway markers, and adverse reactions were compared across the three groups.  Results  The total effective rate of the combined group was higher than that of the control group 1 (χ2=5.046, P=0.025) and the control group 2 (χ2=14.131, P＜0.001). Post-treatment scores for pallor, dizziness, chest tightness, and memory decline in the combined group were significantly lower than those in control groups 1 and 2 (F=52.085, 81.722, 81.208, 111.818; all P＜0.001). The combined group also showed higher post-treatment hemoglobin (Hb), hematocrit (Hct), red blood cell count (RBC), ferritin, transferrin, transferrin saturation (TSAT), and total iron-binding capacity (TIBC) compared to both control groups (F=44.763, 70.279, 37.997, 64.326, 24.704, 48.965, 52.505; all  P＜0.001). Conversely, unsaturated iron-binding capacity (UIBC), PHD2, HIF-1α, and HIF-2α levels were significantly lower in the combined group (F=49.801, 39.901, 62.073, 51.449; all P＜0.001). Conclusion  Roxadustat combined with iron therapy effectively improves anemia symptoms, hematological parameters, and iron metabolism in maintenance dialysis patients with renal anemia, potentially through modulation of the PHD2/HIF-2α pathway. Metrics

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Risk factor assessment for peritoneal dialysis catheter exit-site infections WANG Yi-xuan , ZHANG Xiao-lan , LIU Shi-jian , ZHAO Yao, BAO Yun-xia, LIU Guo-jian, JI Tian-rong, KONG Fan-wu 2025, 24 (06):  469-473.  doi: 10.3969/j.issn.1671-4091.2025.06.006 Abstract ( 22 )   Objective  To investigate risk factors for exit site infection (ESI) in peritoneal dialysis (PD) patients, develop a predictive model for early identification of high-risk individuals, and guide personalized preventive strategies. Methods PD patients regularly followed at the peritoneal dialysis clinic of the Second Affiliated Hospital of Harbin Medical University from October 2023 to November 2024 were enrolled. Based on the 2023 International Society for Peritoneal Dialysis (ISPD) diagnostic criteria for ESI, patients were categorized into ESI and non-ESI groups. Binary logistic regression was used to identify ESI risk factors, followed by the construction of a nomogram model. Model performance was evaluated through predictive accuracy and clinical applicability. Results  Among 245 patients, 37 were classified into the ESI group and 208 into the non-ESI group. Significant differences were observed between groups in age (Z =-4.199, P ＜0.001), dialysis vintage (Z =-4.908, P ＜0.001), hemoglobin (Z =-4.445, P ＜0.001), serum albumin (Z =-5.271, P ＜0.001), external cuff extrusion (χ²=27.038, P ＜0.001), and history of catheter traction (χ²=24.797, P ＜0.001). Binary logistic regression identified. Based on binary logistic regression analysis, age (OR=0.796, 95% CI: 0.705～0.899, P＜0.001), dialysis vintage (OR=1.036, 95% CI: 1.010～1.064, P=0.007), hemoglobin (OR=0.951, 95% CI:0.914～0.990, P=0.013), serum albumin (OR=0.796, 95% CI: 0.705～0.899, P＜0.001), external cuff extrusion (OR=6.636, 95% CI:1.156～38.114, P=0.034), and history of catheter traction (OR=6.530, 95% CI: 1.275～33.454, P=0.024) were identified as independent risk factors for peritoneal dialysis catheter exit-site infection. The nomogram model demonstrated excellent predictive performance (AUC= 0.935, 95% CI: 0.8916～0.978). Hosmer-Lemeshow goodness-of-fit test (χ²=12.712, P=0.122) and decision curve analysis confirmed robust calibration and clinical utility.  Conclusion Age, dialysis vintage, hemoglobin, serum albumin, external cuff distance, external cuff extrusion, and catheter traction are independent risk factors for ESI. The developed predictive model effectively stratifies ESI risk in PD patients, providing a scientific basis for early intervention and personalized management. Metrics

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Construction and verification of hemodialysis-related headache prediction model base on Logistic-Nomogram ZOU Han, LIU Xia, HU Xiao-xia, LI Jie, ZHANG Yan-fang, LI Zi-han 2025, 24 (06):  474-478.  doi: 10.3969/j.issn.1671-4091.2025.06.007 Abstract ( 25 )   Objective  To investigate risk factors for hemodialysis-related headache (HRH) and develop and validate a predictive model using logistic-nomogram analysis. Methods  Clinical data of hemodialysis patients at the Second Hospital of Lanzhou University from March 2021 to March 2024 were retrospectively analyzed. Patients treated from March 2021 to May 2023 were assigned to the training set (n=229), and those from June 2023 to March 2024 were included in the validation set (n=98). The influencing factors of HRH were analyzed by Logistic regression models. A nomogram model was constructed using the rms package in R, with calibration evaluated via the calibrate function. Receiver operating characteristic (ROC) curves assessed the model’s predictive performance. Results  There was no significant difference in clinical data between the training set and the validation set (P＞0.05). Logistic regression analysis showed that elevated pre-dialysis systolic blood pressure (SBP, OR =1.124, 95% CI: 1.051～1.203, P=0.001), diastolic blood pressure (DBP, OR=1.128, 95% CI: 1.066～1.194, P=0.001), and serum sodium (OR=1.119, 95% CI:1.076～1.338, P＜0.001) were independent risk factors for HRH in hemodialysis patients, while higher platelet count (PLT) was a protective factor for HRH (OR=0.932, 95% CI:0.895～0.971, P=0.001). The prediction model of HRH risk in hemodialysis patients was constructed with SBP, DBP, serum sodium and PLT as variables. The nomogram model demonstrated strong predictive performance, Dxy=0.831, C-index=0.916, mean absolute error (MAE) =0.017 in the training set, and Dxy=0.804, C-index=0.902, MAE=0.029 in the validation set. Calibration curves closely aligned with ideal curves in both sets.  ROC curve analysis showed that the area under the curve (AUC) =0.916 (95% CI: 0.872～0.948), Youden index=0.720, sensitivity=81.13%, specificity=90.91% in the training set, and AUC=0.903 (95% CI: 0.826～0.954), Youden index=0.756, sensitivity=92%, specificity= 83.56% in the validation set.  Conclusion  Elevated pre-dialysis SBP, DBP, and serum sodium are independent risk factors for HRH, while higher PLT is protective. The nomogram model based on these variables provides robust predictive value for HRH risk in hemodialysis patients. Metrics

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Astragaloside IV alleviates renal fibrosis in unilateral ureteral obstruction rats by inhibiting ferroptosis through the regulation of the cAMP/PKA signaling pathway HE Xiao-dan, ZHANG Zi-yuan, HU Ya-ling, FANG Jing-ai 2025, 24 (06):  479-484.  doi: 10.3969/j.issn.1671-4091.2025.06.008 Abstract ( 23 )   Objective   To investigate the mechanism by which astragaloside IV alleviates renal fibrosis in unilateral ureteral obstruction (UUO) rats by inhibiting ferroptosis through modulation of the cyclic adenosine monophosphate (cAMP)/protein kinase A (PKA) signaling pathway.  Methods   Specific pathogen-free (SPF) male Sprague-Dawley (SD) rats were used to establish UUO models and randomly divided into four groups (n=6 per group): sham operation group, model group, AS-IV group [40 mg/(kg·d)], and losartan group [10.3 mg/(kg·d)]. Intragastric administration began one day post-surgery and continued for 14 days. Serum creatinine (Scr), blood urea nitrogen (BUN), and cAMP levels were measured. Renal histopathology was assessed via hematoxylin-eosin (HE) and Masson staining. Immunohistochemistry evaluated fibrosis markers [α-smooth muscle actin (α-SMA), fibronectin (FN), collagen type I (COL-I)], while Western blotting analyzed PKA and ferroptosis-related markers [glutathione peroxidase 4 (GPX4), heme oxygenase-1 (HO-1), solute carrier family 7 member 11 (xCT)].  Results  No significant differences in Scr were observed among groups (F=2.815, P=0.065). Compared to the sham group, the model group exhibited elevated BUN (t=26.306, P＜0.001), which was reduced in the astragaloside IV and losartan potassium groups (t=−5.241, −3.469; P＜0.001, P=0.002, respectively). HE and Masson staining revealed severe renal fibrosis in the obstructed kidneys of rats in the model group, while fibrosis was attenuated in the astragaloside IV and losartan potassium groups. Compared with the sham operation group, the model group exhibited increased expression of α-SMA, FN, COL-I (t =17.728, 9.202, 13.710, all  P＜0.001), cAMP levels (t =9.601, P＜0.001), and PKA (t =32.321, P＜0.001). In the astragaloside IV and losartan potassium groups, the expression of α-SMA (t =-11.457, -5.519, P＜0.001, P =0.001), FN (t =-6.301, -4.725, P＜0.001, P =0.001), COL-I (t =-6.087, -3.243, P＜0.001, P=0.012), cAMP levels (t =-6.629,-5.809, both P＜0.001), and PKA (t =-22.754, -23.294, both  P＜0.001) was decreased compared with the model group. Compared with the sham operation group, the model group showed decreased expression of GPX4, HO-1, and xCT (t =-38.397, -41.713, -56.779, all  P＜0.001). In the astragaloside IV and losartan potassium groups, the expression of GPX4 (t =25.504, 16.786, both P＜0.001), HO-1 (t=10.611, 42.007, both P＜0.001), and xCT (t=7.192, 3.181, P＜0.001, P =0.013) was increased compared with the model group.   Conclusions  Astragaloside IV improves renal function and mitigates fibrosis in UUO rats, potentially by suppressing ferroptosis through regulation of the cAMP/PKA signaling pathway. Metrics

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Current research status in mortality risk prediction models in hemodialysis patients FAN Ji-xiang, LI Jing 2025, 24 (06):  485-488.  doi: 10.3969/j.issn.1671-4091.2025.06.009 Abstract ( 39 )   In the context of escalating prevalence of chronic kidney disease (CKD) globally, the mortality rate among patients with end-stage renal disease (ESRD) has remained a concern point in the field of nephrology. Maintenance hemodialysis (MHD) is the predominant renal replacement therapy for ESRD. However, mortality risk in MHD patients is still higher with significant inter-patient variability. Accurate prediction of mortality risk in MHD patients is critical for clinical decision-making, resource allocation, and patient management. This review aims to discuss and outline the mortality risk prediction models developed for hemodialysis patients, both domestically and internationally. By comparing the modeling methods, predictive capabilities, generalizability and clinical utility of the models, this review provides a reference for constructing an appropriate predictive model. Metrics

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The effect of structured exercise on maturity of arteriovenous fistula in patients with chronic kidney disease: a meta-analysis LONG Xiao-lian, DU Juan 2025, 24 (06):  489-494.  doi: 10.3969/j.issn.1671-4091.2025.06.010 Abstract ( 20 )   Objective  To explore the effects of structured exercise on blood flow in arteriovenous fistula (AVF), internal diameter of AVF vein, forearm depth of AVF vein, ultrasonic maturity rate and clinical maturity rate in patients with chronic kidney disease.  Methods  Relevant literatures from CNKI, Wanfang Database, VIP database, Chinese Biomedical Literature database, Embase, Medline, Web of Science and Cochrane Library were systematically searched until August 2024. Two researchers conducted data extraction and meta-analysis of the included references.  Results  A total of 10,736 literatures were retrieved, and 11 literatures with a total of 941 subjects were extracted. The meta-combined results showed that in patients after AVF surgery treated with structured exercise compared those treated with routine nursing/exercise, the blood flow in AVF was greater (SMD=1.39, 95% CI: 0.74～2.03, P＜0.01), the internal diameter of AVF vein was larger (SMD=0.95, 95% CI: 0.35～1.51, P＜0.01), the forearm depth of AVF vein was smaller (SMD=-1.49, 95% CI: -2.57～0.40, P＜0.01), the ultrasonic maturity rate was 1.43 times higher (95% CI: 1.28~1.59, P＜0.01), and the clinical maturity rate was 1.58 times higher (95% CI: 1.23～2.43, P＜0.01). Subgroup analysis showed that in patients beginning structured exercise after surgery for one week compared those beginning structured exercise after surgery within a week, the changes of blood flow in AVF was greater (structured exercise after surgery for one week: SMD=2.44, 95% CI: 1.16～3.72, P＜0.01; structured exercise after surgery within a week: SMD=0.62, 95% CI: 0.30～0.95, P＜0.01); in patients with structured exercise after surgery for one week compared those with conventional nursing exercise after surgery for one week, the forearm depth of AVF vein was smaller (SMD=-2.38, 95% CI: -3.89～-0.86, P＜0.01).  Conclusion  Structured exercise after AVF surgery can promote AVF maturation, increase blood flow in AVF and AVF vein diameter, reduce forearm depth of AVF vein, and improve ultrasonic maturity rate and clinical maturity rate of AVF. We recommend that medical staff should develop individualized and structured exercise program for patients after AVF surgery. Metrics

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Analysis of the factors correlating to restenosis after autologous arteriovenous fistula percutaneous transluminal angioplasty LI Zong-yang, NING Yong, WANG Zhi-xiang, HE Xi-fei, YAN jian-jun, PAN Hao 2025, 24 (06):  495-498，507.  doi: 10.3969/j.issn.1671-4091.2025.06.011 Abstract ( 41 )   Objective To explore the risk factors for restenosis after percutaneous transluminal angioplasty (PTA) in autologous arteriovenous fistulas (AVF) of hemodialysis patients.  Methods  A total of 65 patients on hemodialysis after PTA for the first time were selected as the research subjects. They were followed up for 12 months. For patients who developed restenosis within 12 months, the relevant data at the time of restenosis were collected. For those without restenosis, the relevant data at the end of the follow-up were also recruited. The differences in relevant indicators of the patients were analyzed. Cox univariate and multivariate regression analysis was used to analyze the risk factors for restenosis after PTA. Kaplan-Meier and log rank tests were used for univariate survival analysis.  Results  ①Among the 65 patients followed-up for 12 months, 27 developed restenosis within 12 months. The patency rates at one month, 3, 6, 9 and 12 months after surgery were 100%, 93.85%, 73.85%, 63.08% and 58.46%, respectively.  ②Patients who developed restenosis after the first PTA had shorter AVF usage time (t=2.832, P=0.006), higher calcium-phosphorus product (t=2.240, P=0.029), lower blood magnesium (t=2.090, P=0.041), lower PTH (t=2.587, P=0.012), higher β2-microglobulin (t=3.024, P=0.003), and hypotension during dialysis (χ2=4.260, P=0.039). ③COX univariate and multivariate regression analysis revealed that AVF usage time (HR=0.980, 95% CI:0.963～0.997, P=0.020), calcium-phosphorus product (HR=1.045, 95% CI:1.009～1.082, P=0.013), β2-microglobulin (HR=1.080, 95% CI:1.006～1.158, P=0.033), and hypotension during dialysis (HR=3.354, 95% CI:1.548～7.269, P=0.002) were the main risk factors  for restenosis after the first PTA.  Conclusion  For hemodialysis patients undergoing the first PTA in AVF, the occurrence of AVF restenosis can be reduced by controlling chronic kidney disease-mineral and bone disorder (CKD-MBD), strengthening the clearance of middle and large molecular toxins, and preventing hypotension during dialysis.  Metrics

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The relationship between the occurrence of vascular access complications and the risk of all-cause mortality in hemodialysis patients LIU Fan, FENG Ya, HUANG Ai-jing, HU Zai-cheng, XIAO Xiang 2025, 24 (06):  499-503.  doi: 10.3969/j.issn.1671-4091.2025.06.012 Abstract ( 21 )   Objective This study evaluated the impact of vascular access complications on outcomes in maintenance hemodialysis (MHD) patients.  Methods  We retrospectively analyzed the data of a vascular access cohort from Jan 2009 to Oct 2022 in our institution. Demographic, clinical, vascular access, vascular access complication, and survival data were collected. Patients were grouped based on complication status: no complication group (n=324) and complication group (n=176). All-cause mortality was the primary endpoint. Multivariate logistic regression and subgroup analyses were used to assess the relationship between vascular access complications and mortality.  Results  Among 500 MHD patients, 176 (35.5%) developed vascular access complications. During the follow-up period, 82 (16.4%) died. Multivariate logistic regression found that the all-cause mortality risk in complication group increased to 117.8% of the risk in no complication group (HR=2.178, 95% CI: 1.232～3.860, P=0.007). Subgroup analyses demonstrated that age (Z=-1.689, P=0.091), BMI (Z=-1.357, P=0.175), vascular access type (Z=0.863, P=0.172), female (Z=2.834, P=0.005) and non-diabetic were the factors significant influencing the prediction of all-cause mortality by vascular access complications in MHD patients.  Conclusion Vascular access complications may be used to identify the MHD patients at a high risk of mortality that warrants intensive surveillance. Metrics

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Application of small inner diameter cephalic vein in construction of autogenous arteriovenous fistula FANG Fan, YU Wen-hong, CHEN Liang-jing 2025, 24 (06):  504-507.  doi: 10.3969/j.issn.1671-4091.2025.06.013 Abstract ( 28 )   Objective  To explore the application of small inner diameter cephalic vein in construction of autogenous arteriovenous fistula (AVF).   Methods  A retrospective study was conducted on patients undergoing AVF construction at the Department of Nephrology, Chongqing Songshan Hospital from January 1, 2022 to December 31, 2023. According to the inner diameter of the cephalic vein at the preoperative surgical site, they were divided into a small inner diameter group and a conventional inner diameter group. The operation was performed by one surgeon. Brachial artery flow rate at 8 weeks after operation, maximum pump-controlled blood flow during dialysis, and urea clearance rate were compared between the two groups. Statistical analysis was performed using SPSS 22.0 software, and P＜0.05 was considered to be statistically significant.  Results  By comparing maturity and use of AVF between the small inner diameter group and the conventional inner diameter group, we found that there were no significant differences in brachial artery flow rate (χ2=2.009, P=0.156), dialysis maximum pump-controlled blood flow rate (χ2=2.509, P=0.113), and urea clearance rate (χ2=2.979, P=0.084) after 8 weeks between the two groups.  Conclusion  There were no statistical differences in maturity and use of AVF between the small inner diameter group and the conventional inner diameter group. For patients with preoperative cephalic vein diameter less than 2.0 mm, but greater than or equal to 1.5 mm, the success rate of AVF construction is still high, warranting to be tried surgically. Metrics

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Symptom clusters in maintenance hemodialysis patients: a scoping review XIAO Yu, XING Xin-yue, HU Wan-yue, WANG Chen-qi, WU Ya-xuan, XIAO Hong-ling 2025, 24 (06):  508-512.  doi: 10.3969/j.issn.1671-4091.2025.06.014 Abstract ( 39 )   Objective To conduct a scoping review of the studies relating to symptom clusters in maintenance hemodialysis (MHD) patients, so as to provide references for symptom management by healthcare professionals.  Methods  This study strictly followed the scoping review method reported by Arksey and O'Malley. We systematically searched PubMed, Embase, WOS, CINAHL, Medline, SinoMed, CKNI, WanFang and VIP, with a timeframe from the establishment of the database to September 26, 2024. The searched references were screened, and the useful data and graphics were extracted.  Results   A total of 16 articles were included, and 31 symptom clusters were extracted. The common types of symptom clusters included gastrointestinal symptom clusters, affective symptom clusters, water and electrolyte symptom clusters, and others. Eight assessment tools were involved, all of which were multi-symptom assessment scales. Symptom clusters were extracted mainly by using exploratory factor analysis and principal component analysis. The influencing factors of the symptom clusters included gender, age, dialysis age, urine output, hemoglobin, and others.  Conclusion  Various types of symptom clusters are present in MHD patients. It is necessary to explore a symptom assessment tool suitable for the MHD patients in China, the optimal nomenclature of symptom clusters, the mechanism underlying the symptom clusters, the methods appropriate for the identification of core, bridge and sentinel symptoms, and the factors influencing symptom clusters, in order for healthcare professionals to establish a targeted symptom intervention program. Metrics

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The status and influencing factors of medical service experiences in maintenance hemodialysis patients LIU Qun, YAN Li, LIU Jin-jin, ZHANG Li, HU Dan, YAO Ying 2025, 24 (06):  513-517.  doi: 10.3969/j.issn.1671-4091.2025.06.015 Abstract ( 36 )   Objective To investigate the status and influencing factors of medical service experiences among maintenance hemodialysis (MHD) patients.  Methods  A single-center cross-sectional study was conducted on outpatient MHD patients treated in the Hemodialysis Center of Fuxing Hospital, Capital Medical University from December 2023 to March 2024. A self-developed questionnaire was used to evaluate the medical service experiences in the MHD patients. Demographic and clinical data were also collected. The correlations between medical service experiences of the patients and factors including sociological characteristics, psychological factors, comorbidities, dialysis duration, dialysis-related complications, and health education were analyzed.  Results  A total of 127 patients were included in this study. The medical service experience questionnaire found that the dimension of respect for patient preferences had the lowest rate of problems (average 10.6%). In contrast, higher rates of problems were obtained in the dimensions of emotional support (44.1%), trust (48.0%), and continuity of care (37.8%). In the patients with better medical service experiences (n=69), the proportions of having diet education (85.5% vs. 46.6%, χ2=21.874, P＜0.001) and vascular access education (85.5% vs. 53.4%, χ2=15.687, P＜0.001) were higher, as compared those with bad medical service experiences (n=58).  Conclusion  The medical service experiences in MHD patients needs to be improved, especially in the dimensions of emotional support, trust, and continuity of treatment. Health education plays an important role in improving patient's experiences in hemodialysis center. Metrics

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Hands-on operation of hemodialysis treatment by autologous arteriovenous fistula puncture (video demonstration): a cross-sectional survey of 30 provinces and cities in China Working Group for the Preparation of Standards for Dialysis Special Standardized Skills Competition, Capacity Building and Continuing Education Center, National Health Commission 2025, 24 (06):  518-523.  doi: 10.3969/j.issn.1671-4091.2025.06.016 Abstract ( 40 )   Objective  To investigate the current status of standardized operation of maintenance hemodialysis by autologous arteriovenous fistula puncture in hemodialysis nurses.  Methods  In July to August 2023, the videos of hemodialysis operation by autologous arteriovenous fistula puncture were collected nationwide through the platform of “Comprehensive Dialysis Management Capacity Building Project, National Health Commission”. Two experts reviewed the videos by using a self-made scoring scale that contains  five dimensions: instrument and occupational protection, hand hygiene timing and method, pre-operation assessment and inspection, vascular puncture and drug injection, and safety verification, and the reasons for point deduction were recorded. Differences of scores were compared among hospital levels, whether or not from a blood purification teaching base, and by different professional titles.  Results  A total of 419 valid videos were collected. The scoring rates of the five dimensions were as follows: instrument and occupational protection (85.232%), hand hygiene timing and method (84.417%), pre-operation assessment and inspection (74.213%), vascular puncture and drug injection (77.513%), and safety verification (68.702%). Total scores were higher from tertiary hospitals and above than from other hospitals (t=3.466, P=0.015); total scores were higher from blood purification teaching bases than from non-teaching bases (t=5.062, P=0.004); total scores had no significant difference from nurses of different professional titles (F=0.292, P=0.747).  Conclusion  The scoring rates of the five dimensions ordered from low to high are as follows: safety verification, pre-operation assessment and inspection, vascular puncture and drug injection, hand hygiene timing and method, and instrument and occupational protection, suggesting the key points of hemodialysis operation training in the future. The operation quality is relatively lower in the hospitals below the tertiary level and non-teaching bases, highlighting the hemodialysis units we should concern with and pay assistance to. Metrics

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A systematic review of the models for predicting frailty risk in maintenance hemodialysis patients ZHOU Jin-feng, ZHAO Li, LUO Wen-yu, QIU Ling-yu, FAN Yi-xi, ZENG Hao-jie 2025, 24 (06):  524-528.  doi: 10.3969/j.issn.1671-4091.2025.06.017 Abstract ( 41 )   Objective  To systematically search and evaluate the frailty risk prediction models for maintenance hemodialysis (MHD) patients.  Methods  The relevant literatures on frailty risk prediction models for MHD patients published on Web of Science, PubMed, CINAHL, Cochrane Library, Embase, CNKI, Wipnet, Wanfang and Chinese Biomedical Literature Database were systematically searched. The search period is up to May 1, 2024. Two researchers independently screened the literatures according to the inclusion and exclusion criteria, extracted data, evaluated model performance and quality of the literatures.  Results  A total of 16 studies with 18 models were included. Six studies conducted internal validation, one conducted external validation, and one conducted a combination of internal and external validation. The differentiation of 15 studies was ＞0.7. Models applicability is generally good, but the risk of overall bias is high, and mainly concentrated in the field of statistical analysis. The predictors of frequency ≥5 were age, comorbidities, albumin, sex, nutrition and sports training.  Conclusion  Most of the existing frailty risk prediction models for MHD patients have methodological defects and higher bias. In the future, frailty risk prediction models should be constructed and verified internally and externally on the basis of standardized research design and reporting procedures. Metrics