Chinese Journal of Blood Purification

12 May 2026, Volume 25 Issue 05 Previous Issue   

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Chinese expert consensus on the clinical management of renal anemia in patients undergoing maintenance hemodialysis (2026 edition) Work Group of Chinese Expert Consensus on the Clinical Management of Renal Anemia in Patients Undergoing Maintenance Hemodialysis ( edition) 2026, 25 (05):  353-369.  doi: 10.3969/j.issn.1671-4091.2026.05.001 Abstract ( 125 )   Renal anemia is one of the most common complications in patients undergoing maintenance hemodialysis (MHD), profoundly impacting on their quality of life and long-term prognosis. With the steadily growing number of MHD patients in China, standardized management of renal anemia is essential for improving their clinical outcomes. However, there is currently no specific clinical management guidance for renal anemia in MHD patients, both domestically and internationally. To address this unmet need, the Blood Purification Committee of the Chinese Research Hospital Association organized a panel of national experts to develop this consensus based on evidence-based medicine and clinical experience. This consensus covers definition, assessment, monitoring, treatment, and patient education of renal anemia in MHD patients, aiming to further standardize the management of renal anemia, improve anemia control, and enhance patients' quality of life and long-term prognosis in MHD patients. Metrics

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Construction and validation of a prediction model for moderate to severe pruritus in hemodialysis patients based on different machine learning algorithms SONG Xu-ran, QIN Jin-xue, CAO Ti, GAO Hong-hua 2026, 25 (05):  370-374.  doi: 10.3969/j.issn.1671-4091.2026.05.002 Abstract ( 15 )   Objective  To construct a risk prediction model for moderate to severe pruritus in hemodialysis patients based on machine learning algorithms, and to screen and verify the optimal model.  Methods  A total of 510 patients who underwent maintenance hemodialysis in the blood purification center of our hospital from January 2020 to June 2025 were studied. Logistic regression (LR), random forest (RF), lightweight gradient boosting machine (LightGBM), extreme gradient boosting (XGBoost) and support vector machine (SVM) were used to establish the prediction models. The performance of the models was evaluated by comparing the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, accuracy, calibration curve and decision curve.  Results  Finally, six factors including intact parathyroid hormone (iPTH), blood phosphorus, dry skin, sleep quality score, anxiety score and depression score were included to construct a risk prediction model. The XGBoost prediction model had the highest AUC in the modeling group and the validation set, which were 0.894 (95% CI: 0.828～0.961) and 0.887 (95% CI: 0.801～0.973), respectively; the accuracies were 0.837 and 0.823, respectively, the sensitivities were 0.508 and 0.492, respectively, the specificities were 0.951 and 0.945, respectively, and the F1 scores were 0.614 and 0.591, respectively. The calibration curve was close to the ideal curve, and the decision curve analysis (DCA) showed that the model had a high net benefit in 8%～78% threshold probability range, indicating high clinical applicability.  Conclusion  The XGBoost model can effectively predict the risk of moderate to severe pruritus in hemodialysis patients, which is expected to provide a basis for early clinical warning and individualized intervention. Metrics

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Elevated eosinophil count is a risk factor for exit-site infection in peritoneal dialysis YANG Zai-hong, FENG Sheng, LU Ying, CONG Qi-fei, SONG Kai 2026, 25 (05):  375-380.  doi: 10.3969/j.issn.1671-4091.2026.05.003 Abstract ( 12 )   Objective  Exit-site infection (ESI) can increase the risk of peritonitis and technical failure. This study analyzes the correlation between peripheral blood eosinophil count(EC) and ESI. Methods Clinical data of 345 PD patients was retrospectively collected from January 2016 to December 2021. Patients were groups  by tertiles of the EC at 3 months of peritoneal dialysis catheter: low EC3M group (EC＜130cells/μL, n=110), mid EC3M group (EC=130-240cells/μL, n=115), and high EC3M group (EC≥240cells/μL, n=120). The relationship between eosinophil count and ESI, all-cause mortality, technique failure, and PD-related peritonitis was analyzed using a multifactorial COX model after adjusting for confounding factors.  Results  The age of the patients was (56.1±15.8) years old. The median follow-up duration was 38(29,46) months. The Kaplan-Meier survival curves with the log-rank test showed that there were significant differences in the risk of ESI incidence among the high, medium, and low EC3M groups (χ²=11.648, P=0.003). Post-hoc pairwise comparisons revealed that the medium EC3M group (χ²=4.313, P=0.038) and the high EC3M group (χ²=11.939, P＜0.001) had significantly higher ESI risks compared to the low EC3M group. Multivariate COX analysis revealed that after adjusting for confounding factors, the EC at three months after the operation was independently associated with ESI (HR=2.028, 95%CI 1.060-3.881, P=0.033).  Conclusion  Elevated peripheral eosinophil counts at 3 months post-PD catheterization are independently associated with ESI. Monitoring EC may aid in early identification of high-risk ESI patients. Metrics

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A cross-sectional survey on clinical characteristics and renal anemia of maintenance hemodialysis patients in Yushu Tibetan Autonomous Prefecture BAO Shu-min, Dairanwenmao, FEI Bi-yan, Dejiyangzong, ZHANG Guo-juan 2026, 25 (05):  381-385.  doi: 10.3969/j.issn.1671-4091.2026.05.004 Abstract ( 18 )   Objective  To conduct a cross-sectional survey on maintenance hemodialysis (MHD) patients in the Yushu Prefecture Hemodialysis Center, and to investigate the demographic characteristics, primary diseases, and control status of renal anemia in dialysis patients in this region. Methods Patients receiving regular hemodialysis from January 1 to June 30, 2024, in 3 hemodialysis centers in Yushu Prefecture were selected as the research subjects. General patient information, primary diseases, comorbidities/complications were collected by reviewing medical records and conducting questionnaires. Laboratory test results of the patients were recorded to analyze their clinical characteristics. Patients were divided into a hemoglobin (Hb)-target-achieving group and a Hb-non-target-achieving group based on Hb levels. Differences in clinical characteristics and laboratory test results between the two groups were compared, and risk factors affecting Hb target achievement were analyzed. Results A total of 70 dialysis patients were included, with a mean age of (54.54±13.60) years. Among them, 52 were male (74.29%) and 69 were Tibetan (98.57%). The average medical treatment radius of the patients was 156.7 kilometers, and 85.71% had an education level of junior high school or below. Primary diseases were mainly primary glomerulonephritis(30.0%) and diabetic nephropathy(22.9%). The control rate of hemoglobin (Hb) reaches 52.9%,the average Hb level was (110.21±24.21) g/L.Compared with the hemoglobin (Hb)-target-achieving group, the Hb-non-target-achieving group had significantly lower serum albumin (ALB) levels (t=-2.924, p=0.003) and significantly higher low-density lipoprotein cholesterol (LDL-C) levels (t=-3.497, p=0.001).Multivariate Logistic regression analysis showed that after adjusting for other confounding factors, ALB was a protective factor, and its increased level could reduce the risk of Hb inadequacy (OR=0.851, 95%CI 0.745～0.973, P=0.018); LDL-C was a risk factor, and its increased level could increase the risk of Hb inadequacy (OR=3.386, 95%CI 1.332～8.607, P=0.010). Conclusion The clinical characteristics of maintenance hemodialysis (MHD) patients in Yushu Tibetan Autonomous Prefecture are different from those in plain areas. Their Hb compliance rate is affected by the levels of ALB and LDL-C, among which ALB is a protective factor and LDL-C is a risk factor. Clinically, individualized treatment plans can be formulated for the above influencing factors to improve the anemia status of patients. In the future, further studies can be carried out to explore the specific reasons for the differences in clinical characteristics between MHD patients in this area and those in plain areas. Metrics

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A study on the impact of family members' psychological status on patients undergoing maintenance hemodialysis SUN Chao, WANG Xin-xin, CHEN Di, SHI Ying, CHENG Jun, MA Ying-chun 2026, 25 (05):  386-390,396.  doi: 10.3969/j.issn.1671-4091.2026.05.005 Abstract ( 23 )   Objective  To explore the influence of the psychological status of family members on patients undergoing maintenance hemodialysis (MHD).  Methods  MHD patients who had undergone hemodialysis for more than three months at the China Rehabilitation Research Center and their family members were enrolled. The correlation between their psychological status, quality of life, and other indicators was assessed.  Results  A total of 140 patients and their corresponding family members were enrolled. Family members' anxiety scores were positively correlated with patients' anxiety scores (r=0.190, P =0.025), and negatively correlated with patients' health-related quality of life subscores, including symptom score, kidney disease impact score, kidney disease burden score, physical function score, and psychological status score (r=−0.183,−0.208, −0.189, −0.216, −0.188; P=0.030, 0.014, 0.026, 0.011, 0.026). Family members' depression scores were positively correlated with patients' anxiety and depression scores (r=0.192, 0.359;P=0.023,<0.001,respectively), and negatively correlated with patients' symptom score, kidney disease impact score, and psychological status score (r =−0.173, −0.215, −0.185; P =0.041, 0.011, 0.029). When family members were free of anxiety (n=116) or depression (n=53), MHD patients had lower serum β2-microglobulin levels (t=−2.364, −2.100; P=0.019, 0.038). When family members were free of depression, MHD patients had higher serum albumin levels (t =2.078, P=0.040).  Conclusion  The psychological status of family members is correlated with patients' anxiety and depression levels, quality of life, serum β2-microglobulin levels, and serum albumin levels. Metrics

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The relationship between serum FABP4, CTRP3 and major adverse cardiovascular events in maintenance hemodialysis patients ZHANG Xiao-min, GUO Ya-juan, CHEN Xiao-zhen 2026, 25 (05):  391-396.  doi: 10.3969/j.issn.1671-4091.2026.05.006 Abstract ( 19 )   Objective   To investigate the relationship between serum fatty acid binding protein 4 (FABP4), C1q/tumor necrosis factor related protein 3 (CTRP3), and major adverse cardiovascular events (MACE) in patients undergoing maintenance hemodialysis (MHD).  Methods  A total of 140 patients with MHD treated at Handan First Hospital between June 2020 and December 2022 were enrolled. Pearson correlation analysis was used to assess correlations. Relative risk (RR) was applied to analyze the impact on MACE occurrence. Multivariate logistic regression was used to identify factors associated with MACE, and receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of serum FABP4 and CTRP3 for MACE.  Results  A total of 132 patients completed the 2-year follow-up period, including 47 patients (35.61%) in the MACE group and 85 patients (64.39%) in the non-MACE group. Serum FABP4 was positively correlated with hs-CRP (r=0.487,P <0.001) and TG (r=0.452,P<0.001), and negatively correlated with CTRP3 (r=−0.503,P<0.001). Serum CTRP3 was negatively correlated with hs-CRP (r=−0.495,P<0.001) and TG (r = −0.416,P=0.005). Among MHD patients, those with high serum FABP4 levels had an approximately 1.4-fold increased risk of MACE (RR=1.437,95%CI:1.130～1.919,P=0.003), while those with low CTRP3 levels had an approximately 1.6-fold increased risk (RR=1.559,95%CI: 1.183～2.054,P=0.001). FABP4 (OR=3.178, 95%CI:1.783～5.666,P<0.001), hs-CRP (OR=2.532, 95%CI:1.401～4.576,P=0.002), and iPTH (OR=2.484, 95%CI:1.283～4.809,P=0.007) were risk factors for MACE in MHD patients, while CTRP3 was a protective factor (OR=0.392, 95%CI: 0.244～0.630, P<0.001). The area under the curve (AUC) of the combination of serum FABP4 and CTRP3 for predicting MACE in MHD patients was higher than that of either indicator alone (Z=2.517,2.055;P=0.008,0.023).  Conclusion  Elevated serum FABP4 levels and reduced CTRP3 levels are associated with the occurrence of MACE in  MHD patients. The combination of these two markers may serve as a serum indicator for predicting MACE. Metrics

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Prediction of progression to end-stage renal disease in patients with stage 3-4 chronic kidney disease with diabetic kidney disease by serum 4-HNE combined with ApoB HAN Xiao-li, ZHAO Qi, DONG Juan, ZHAO Jin-wen, JIANG Xiu-feng, WEI Zhi-feng, LIU Cui-lan 2026, 25 (05):  397-410.  doi: 0.3969/j.issn.1671-4091.2026.05.007 Abstract ( 5 )   Objective  To investigate the predictive value of serum 4-hydroxynonenal (4-HNE) combined with apolipoprotein B (ApoB) for the progression to end-stage renal disease (ESRD) in chronic kidney disease (CKD) stage 3-4 patients with diabetic kidney disease (DKD).  Methods  A total of 126 CKD3-4 patients with DKD admitted from January 2021 to March 2023 were selected. They were divided into an ESRD group (n=46) and a control group (Con group, n=80) based on whether they progressed to ESRD within two years. The general data, biochemical indicators and serum 4-HNE were compared between the two groups. Binary Logistic regression model was used to analyze the influencing factors for the progression of CKD3～4 DKD to ESRD, and the receiver operating characteristic (ROC) curve was used to analyze the predictive value of clinical indicators.  Results  The levels of serum creatinine, blood urea nitrogen, apolipoprotein B (ApoB) and 4-HNE in the ESRD group were higher than those in the Con group (t/Z/F/χ²=2.594,3.313,5.945,8.539;P=0.011,0.001, <0.001, <0.001). Logistic regression analysis showed that ApoB (OR=2813.365, 95%CI: 13.184～600349.625) and 4-HNE (OR=23.923, 95%CI:6.236～91.777) were factors influencing the progression to ESRD within two years in patients with CKD G3～4 DKD. The area under the curve (AUC) of ApoB, 4-HNE, and their combination for predicting progression to ESRD was 0.866, 0.796, and 0.902, respectively, with the combined prediction showing a higher AUC than either indicator alone (Z=4.723,5.691;P=0.021,0.013).  Conclusion  Elevated serum 4-HNE and ApoB levels are influencing factors for the progression from CKD G3～4 DKD to ESRD. Combined detection of serum 4-HNE and ApoB has good predictive value for progression to ESRD within two years in patients with CKD G3～4 DKD. Metrics

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Meta-analysis of long-acting and short-acting erythropoiesis-stimulating agents for the treatment of renal anemia in maintenance hemodialysis patients ZHANG Yuan, ZHANG Dong-xue, JIN Jing-jing, CHENG Mei-juan, LIU Lan, ZHANG Sheng-lei 2026, 25 (05):  402-406,419.  doi: 10.3969/j.issn.1671-4091.2026.05.008 Abstract ( 10 )   Objective  To systematically evaluate the efficacy and safety of long-acting and short-acting erythropoiesis-stimulating agents (ESAs) for the treatment of renal anemia in patients with maintenance hemodialysis (MHD).  Methods  We searched the Cochrane Library, Web of Science, Embase, PubMed, China Journal Full-Text Database, VIP Information Chinese Journal Service Platform, and WanFang Data Knowledge Service Platform to obtain literature on ESAs. The search period was up to June 30, 2025. RevMan 5.4 software was used to screen and analyze the randomized controlled trials.  Results  A total of 16 studies involving 3,961 patients were included in the meta-analysis. Meta-analysis showed that no significant differences were found between long-acting and short-acting ESAs in terms of hemoglobin increase range [MD=-0.05, 95% CI：(-0.19, -0.09), P=0.480], hemoglobin response rate [RR=0.97, 95% CI：(0.92, 1.02), P=0.280], ferritin level [MD=7.90, 95% CI：(-14.81, 30.61), P=0.500], and transferrin saturation level [MD=0.16, 95% CI：  (-1.08, 1.40), P=0.800] in MHD patients. Subgroup analysis based on treatment interval of long-acting ESAs indicated that patients receiving Darbepoetin alfa once every 1～2 weeks had a greater increase in hemoglobin level than those receiving short-acting ESAs [MD=0.13, 95% CI：(0.11, 0.15), P＜0.001]. In contrast, patients receiving Methoxy Polyethylene Glycol-Epoetin beta once a month had a lower increase in hemoglobin level than those receiving short-acting ESAs [MD=- 0.29, 95% CI：(-0.42, -0.16), P＜0.001]. The risk of cardiovascular and cerebrovascular thromboembolism was lower in patients receiving long-acting ESAs than those receiving short-acting ESAs [RR=0.85, 95% CI：(0.75,0.97), P=0.020]. There were no statistically significant differences between the two groups in terms of respiratory tract infection [RR=1.13, 95% CI：(0.89,1.43),P=0.330], gastrointestinal diseases [RR=0.98, 95% CI：(0.89,1.07), P=0.600], hypertension [RR=1.06, 95% CI：(0.91, 1.23),P=0.470], mortality [RR=0.98, 95% CI：(0.78,1.24), P=0.880], and the incidence of total adverse events [RR=0.96, 95% CI：(0.91,1.02), P=0.220].  Conclusion  There are no significant differences in improving hemoglobin indicators between long-acting and short-acting ESAs for MHD patients. However, long-acting ESAs are better in increase of hemoglobin level with a lower risk of cardiovascular and cerebrovascular thromboembolism. Metrics

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Research progress in the relationship between remnant cholesterol and cardiovascular disease in patients with chronic kidney disease WANG Zhi-gang, WANG Jing-fu 2026, 25 (05):  407-410.  doi: 10.3969/j.issn.1671-4091.2026.05.009 Abstract ( 12 )   Remnant cholesterol (RC) is the cholesterol component of triglyceride-rich lipoproteins, existing in the form of intermediate-density lipoprotein (IDL) and very low-density lipoprotein (vLDL) in the fasting state, and as chylomicron remnants in the non-fasting state. Currently, the primary method  to obtain RC content is through the calculation of RC=total cholesterol (TC) - high-density lipoprotein cholesterol (HDL-C) - low-density lipoprotein cholesterol (LDL-C). RC is a significant risk factor for cardiovascular diseases, while cardiovascular disease is the leading cause of death in patients with chronic kidney disease (CKD). This article reviews the characteristics of blood lipids and the relationship between RC level and cardiovascular complications in CKD patients under various disease conditions, aiming to provide new insights into early identification and precise intervention of cardiovascular complications in CKD patients. Metrics

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Research progress in shared decision-making through entire life cycle management of vascular access in patients with chronic kidney disease YE Xue-ping, YU Wei-ping, QIAN Yu-meng 2026, 25 (05):  411-414.  doi: 10.3969/j.issn.1671-4091.2026.05.010 Abstract ( 9 )   Management of vascular access is a key step in maintaining hemodialysis efficacy. Appropriate selection and long-term maintenance of vascular access directly impact on quality of life of the patients. The lifelong management of vascular access encompasses the entire process from planning and establishment to utilization and removal, which involves multifactorial clinical evaluations and requires integration of evidence-based guidelines, patient preference, and healthcare resources. Shared decision-making is a patient-centered model emphasizing joint participation of physician and patient in treatment decisions, and is a valuable method of vascular access management. This paper systematically reviews current application of shared decision-making in lifelong management of vascular access, analyzes key challenges in clinical practice, and proposes targeted promotion strategies, aiming to provide theoretical references and practical guidelines for establishing a scientific and systematic decision-making framework for vascular access in patients with chronic kidney disease. Metrics

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Research progress in artificial intelligence in acute kidney injury prediction models CHEN Peng-wei, LI Yue-hong 2026, 25 (05):  415-419.  doi: 0.3969/j.issn.1671-4091.2026.05.011 Abstract ( 3 )   Acute kidney injury (AKI) is a common and severe syndrome with poor prognosis. Artificial intelligence (AI) is a promising tool for early AKI prediction. This review summarizes recent advances in AI-based AKI prediction models including different modeling approaches, key predictors, validation strategies and clinical challenges, aiming to provide references for AKI risk prediction and translational medicine. Metrics

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Research progress on decision-making aids for patients with chronic kidney disease in the peridialysis period LIU Yuan, WAN Li-hong, WANG Rao-ping, WEN Sui-qin, WANG Lu-ying 2026, 25 (05):  420-423.  doi: 10.3969/j.issn.1671-4091.2026.05.012 Abstract ( 12 )   The choice of treatment mode for patients with chronic kidney disease (CKD) during the peridialysis period involves multiple complex decisions, and patients often face difficulties such as lack of knowledge and decision-making conflicts. The use of patient decision-making aids (PDA) can assist them in actively participating in treatment decisions, making important choices suitable for their own preferences and achieving the goal of sharing decisions with medical staff. This article reviews the types and current application status of PDA for CKD patients during peridialysis period, aiming to provide a reference for promoting shared decision-making among CKD patients during peridialysis period and developing our own decision-making aids in China. Metrics

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Machine learning-based prediction of mortality risk in patients with chronic kidney disease: a systematic review SHEN Si-si, HE Li, ZHANG Ying-jun, CHEN Lin 2026, 25 (05):  424-429.  doi: 10.3969/j.issn.1671-4091.2026.05.013 Abstract ( 14 )   Objective  The purpose of this article was to analyze the existing evidence on the application of machine learning-based chronic kidney disease mortality risk prediction models in chronic kidney disease-related fields.  Methods  Literature search was conducted using subject words combined with free words in six databases: Wanfang Medicine, China National Knowledge Infrastructure, VIP, Pubmed, Embase, and Web of Science. The included articles contain one or more prediction models based on artificial intelligence.  Result  A total of 918 articles were retrieved, and ultimately 15 articles were included in the analysis. The usage rate of artificial intelligence-based risk prediction models (random forest, support vector machine, and extreme gradient boosting) was the highest (n=11, 73.3%), and the performance of this type of risk prediction model was better. Among them, the AUCs of the extreme gradient boosting models were all greater than 0.8 (95% CI: 0.768～0.832).  Conclusion Prediction models based on machine learning are generally better than traditional prediction methods in predicting death risk in patients with chronic kidney disease. Metrics

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Hemodialysis quality analysis in Nanning city in 2018─2023: focusing on urban-rural differences ZENG Qiao, SU He-ping, LIAO Bing, SHI Hong-bin 2026, 25 (05):  430-435.  doi: 10.3969/j.issn.1671-4091.2026.05.014 Abstract ( 6 )   Objective To analyze the quality of hemodialysis services in 2018 to 2023 in Nanning city, Guangxi Zhuang Autonomous Region. The hemodialysis units were classified into urban group and county group based on their geographical location. Comparisons of hemodialysis service quality between the two groups demonstrate the current status of developmental differences across urban and county regions, from which strategies targeting the differences can then be organized to enhance the overall hemodialysis quality throughout the city.  Methods  Baseline data, quality control indicators including blood pressure, hemoglobin (Hb), intact parathyroid hormone (iPTH), blood calcium (Ca), blood phosphorus (P), albumin (Alb), vascular access type and common complications, and compliance rates assessed according to the "Standard Operating Procedures for Blood Purification, 2021 Edition" during 2018-2023 were recruited from the hemodialysis units in Nanning city. The differences in hemodialysis service quality were compared between the hemodialysis units in urban and county regions.  Results  ①From 2018 to 2023, the number of hemodialysis units in Nanning city increased from 19 to 35, dialysis machines from 358 to 1,015, qualified physicians from 65 to 146, qualified nurses from 155 to 464, and qualified technicians from 19 to 39. The number of maintenance hemodialysis patients rose from 2,231 to 5,148, and treatment sessions increased from 200,801 to 569,935.    ②Since 2019, the number of dialysis machines, patient number and treatment sessions were higher in the county group than those in the urban group. For resource allocation and workload, the ratios of patients per physician (Z=-6.570, P<0.001), patients per nurse (Z=-2.286, P=0.022), treatment sessions per physician (Z=   -6.270, P<0.001) and treatment sessions per nurse (Z=-3.084, P=0.002) were higher in the county group than those in the urban group. ③For management of quality control indicators, the monitoring  rates of blood pressure (t=-0.339, P=0.704), Hb (t=-1.662, P=0.158), Alb (t=-0.975, P=0.373), blood Ca (t=0.750, P=0.485 ) and blood P (t=-0.440, P=0.676), and the compliance rates of blood pressure (t=-1.221, P=0.227), Hb (t=-0.406, P=0.699) and Alb (t=1.017, P=0.356) had no differences between urban group and county group; but the monitoring rate of iPTH (t=3.384, P=0.019) and the compliance rates of iPTH (t=3.547, P=0.016), blood Ca (t=3.048, P=0.029) and blood P (t=3.836, P=0.012) were higher in urban group than those in county group; the use rate of autogenous arteriovenous fistula (t=-5.077, P=0.004) was higher in county group than that in urban group.  Conclusion  During 2018 to 2023, hemodialysis quality increased significantly in Nanning city, in which hemodialysis quality developed faster in the county regions than urban regions, but the medical staff working in county regions bore more working burdens. Therefore, the number of medical staff should be increased and the management of chronic kidney disease-mineral and bone disorder should be improved in county regions. Metrics

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Analysis of the influencing factors and inflection point age of life space constriction among elderly maintenance hemodialysis patients LU Cheng-qian, LI Ya, LU Qin-yi, JIN Xue-qin 2026, 25 (05):  436-440.  doi: 10.3969/j.issn.1671-4091.2026.05.015 Abstract ( 10 )   Objective  To identify the inflection point age of life space constriction in elderly maintenance hemodialysis (MHD) patients and to explore its influencing factors.  Methods  A total of 412 elderly MHD patients treated in the Hemodialysis Centers of Kunshan First People's Hospital, Kunshan Hospital of Traditional Chinese Medicine and Kunshan Third People's Hospital from November 2024 to June 2025 and selected by convenience sample method were enrolled as the research subjects. Receiver operating characteristic (ROC) curve was used to determine the inflection point age of life space constriction. Additionally, the effects of general demographic data and disease-related information on life space constriction in these patients were analyzed.  Results  The prevalence of life space constriction among elderly MHD patients was 49.03%. ROC curve analysis revealed that age had a high predictive value for life space constriction, with an area under the curve (AUC) of 0.966 (95% CI: 0.949～0.982). The overall inflection point age for life space constriction in this population was 68.5 years. Influencing factors included advanced age (OR=1.429, 95% CI: 1.236～1.653, P＜0.001), type of vascular access (OR=5.190, 95% CI: 1.389～19.394, P=0.014), sedentary behavior (OR=4.784, 95% CI: 1.265～18.097, P=0.021), post-dialysis fatigue (OR=1.123, 95% CI: 1.051～1.201, P＜0.001), learned helplessness (OR=1.122, 95% CI: 1.057～1.191, P＜0.001), sarcopenia (OR=10.081, 95% CI: 0.015～0.436, P=0.003), and fall down efficacy (OR=0.944, 95% CI: 0.905～0.984, P=0.007).   Conclusion   Age is a strong predictor of life space constriction in elderly MHD patients. Special attention should be paid to elderly MHD patients with advanced age, central venous catheter placement, sedentary behavior, post-dialysis fatigue, learned helplessness, sarcopenia, and fall down efficacy. Metrics