The industry standard YY/T 1274-2025 "Peritoneal Dialysis Equipment" was released in 2025 and is scheduled for implementation in 2027. This standard will replace YY/T 1493-2016, "Gravity-Controlled Peritoneal Dialysis Equipment" and YY/T 1274-2016, "Pressure-Controlled Peritoneal Dialysis Equipment". By comparing the main technical differences between the new edition and the previous editions, this paper interprets the key clauses of the new standard, aiming to provide references for the industry to understand and implement the standard, so as to improve the safety of peritoneal dialysis equipment and promote the high-quality development of the industry.

Objective  To measure serum levels of secreted frizzled-related protein 5 (SFRP5) and histone deacetylase 4 (HDAC4) in maintenance hemodialysis (MHD) patients, and to investigate their relationship with major adverse cardiovascular events (MACE).  Methods  From September 2021 to September 2023, 167 MHD patients admitted to our hospital were enrolled. According to the occurrence of MACE during follow-up, they were divided into a MACE group (n=57) and a non-MACE group (n=110). ELISA method was used to measure serum SFRP5 and HDAC4. The influencing factors of MACE in MHD patients were analyzed. To evaluate the predictive value of serum SFRP5 and HDAC4 levels for MACE in MHD patients  Results  In the MACE group, dialysis duration (47.65±10.25) months, low-density lipoprotein cholesterol (3.11±0.35) mmol/L, parathyroid hormone (321.89±47.88) ng/L, systolic blood pressure (145.26±15.28) mmHg, and diastolic blood pressure (95.21±11.27) mmHg were all significantly higher than those in the non-MACE group (33.49±6.52) months, (2.85±0.33) mmol/L, (298.54±49.53)ng/L, (122.08±13.15) mmHg, (81.25±9.03) mmHg, respectively. Conversely, residual kidney glomerular filtration rate (5.49±1.36 ml/min/1.73 m2), residual kidney creatinine clearance rate (25.72±3.98)L/week, urea clearance index (0.54±0.13), and hemoglobin (108.32±12.29) g/L in the MACE group were significantly lower than those in the non-MACE group (6.43±1.85)mL/min/1.73 m², (28.36±4.57)L/week, 0.65±0.18, and (116.07±14.75)g/L, respectively; all t-values from 3.389 to 10.868, P＜0.001). Serum levels of SFRP5 (32.68±7.45)μg/L and HDAC4 (29.56±4.85) pg/mL in the MACE group were significantly lower than those in the non-MACE group (42.95 ±8.16)μg/L and (38.92±6.48)pg/mL, respectively; t=7.939, 7.547, P＜0.001]. Multivariate analysis identified the following as independent factors influencing MACE (all P＜0.05): dialysis duration (OR=1.723, 95% CI:1.047～2.835), low-density lipoprotein cholesterol (OR=1.835, 95%CI: 1.151～2.926), parathyroid hormone (OR=2.175, 95%CI: 1.103～4.281), residual kidney GFR (OR=0.523, 95%CI: 0.317～0.864), residual kidney Ccr (OR=0.512, 95%CI: 0.277～0.948), urea clearance index (OR=0.379, 95%CI: 0.166～0.865), systolic blood pressure (OR=1.946, 95%CI: 1.035～3.658), diastolic blood pressure (OR=2.135, 95%CI: 1.079～4.223), hemoglobin (OR=0.297, 95%CI: 0.107～0.821), serum SFRP5 (OR=0.479, 95% CI: 0.277～0.828), and HDAC4 (OR=0.435, 95%CI: 0.238～0.796). The area under the curve (AUC) for the combination of serum SFRP5 and HDAC4 in predicting MACE was 0.914, which was superior to the predictive value of either marker alone (Z combined vs. SFRP5 alone = 3.043, P=0.002; Z combined vs. HDAC4 alone = 2.770, P=0.006).  Conclusion  Serum levels of SFRP5 and HDAC4 in MHD patients are both decreased. The combined detection has a higher predictive value for the occurrence of MACE in MHD patients.

Objective  To compare the clinical efficacy and safety of intravenous iron isomaltoside and iron sucrose in maintenance hemodialysis (MHD) patients with iron deficiency anemia (IDA).  Methods  A total of 82 MHD patients with IDA treated at the People’s Hospital of Xinjiang Uygur Autonomous Region between March 2022 and January 2025 were retrospectively analyzed. Patients were divided into an iron isomaltoside group (n=54) and an iron sucrose group (n=28). Changes in hemoglobin (Hb), serum ferritin (SF), transferrin saturation (TSAT), and adverse events were compared between the groups during a 6-month follow-up period. Results  The mean age of the patients was 54 years (range 19～83), with 56.1% males. At 1 month after treatment, the increase in Hb was significantly greater in the iron isomaltoside group than in the iron sucrose group (18 g/L vs. 11 g/L; P=0.030, Z=-2.164). The hematological response rate (40.7% vs. 17.9%; P=0.011, χ2=6.413) and target Hb achievement rate (22.2% vs. 0%; P =0.004, χ2=8.472) were also higher in the iron isomaltoside group, and this advantage persisted at 2 months. No significant differences were observed in SF or TSAT between the groups (P＞0.05). One patient in the iron isomaltoside group experienced transient fever, while no adverse events occurred in the iron sucrose group. Conclusion  Compared with iron sucrose, iron isomaltoside provides a faster correction of anemia and a superior short-term hematologic response in MHD patients, with a comparable safety profile. Its single high-dose infusion regimen may also enhance patient compliance and convenience.

Objective: To investigate the association between plasma glial cell line-derived neurotrophic factor (GDNF) levels and insomnia in patients undergoing maintenance hemodialysis (HD). Methods: This single-center cross-sectional study enrolled 29 stage 1-3 chronic kidney disease (CKD) patients without insomnia (mean age: 59.93?±?15.03 years) and 103 HD patients (mean age: 59.89?±?11.64 years). Based on Pittsburgh Sleep Quality Index (PSQI) scores, HD patients were categorized into three groups: HD without insomnia (PSQI ≤ 5, n=41), mild insomnia (6 ≤ PSQI ≤ 10, n=37), and moderate to severe insomnia (PSQI ≥ 11, n=25). Plasma GDNF concentrations were measured and sleep quality was assessed using the PSQI. Results: The median GDNF level differed significantly between the non-insomnia CKD group and the non-insomnia HD group (Z=2.754, P=0.006). Among HD patients, age (F=8.238, P=<0.001), dialysis duration (X2=6.094, P=0.047), and GDNF levels (X2 =8.370, P=0.015) showed significant differences across insomnia groups. Pairwise comparisons revealed that both age and GDNF levels were significantly different between the non-insomnia and mild insomnia groups (t=2.263，P=0.026；Z =2.517，P=0.012), as well as between the non-insomnia and moderate-to-severe insomnia groups (t=4.011，P<0.001；Z =2.360，P=0.018). Spearman correlation analysis indicated that plasma GDNF levels were positively correlated with PSQI total score (ρ = 0.290, t=3.045，P=0.003), as well as with components including subjective sleep quality (ρ= 0.334，t=3.561，P<0.001), sleep latency(ρ= 0.311，t=3.289，P=0.001), sleep duration(ρ= 0.217，t=2.234，P=0.027), sleep efficiency(ρ= 0.241，t=2.496，P=0.014), and sleep disturbances (ρ= 0.227，t=2.342，P=0.021). Conclusion: GDNF level was associated with insomnia in HD patients. GDNF may serve as a novel biomarker for insomnia in HD patients.

Objective  To explore the predictive value of novel inflammatory markers for cardiovascular and cerebrovascular events in maintenance hemodialysis  (MHD) patients. Methods  A retrospective analysis was performed on patients who received MHD in Beijing Friendship Hospital, Capital Medical University from January 1 2019 to January 1 2024. Patients were divided into a cardiovascular and cerebrovascular event group and a non-event group based on the occurrence of such events. General data and laboratory indicators were compared between the two groups. The Mann-Whitney U test and Cox proportional hazards regression model were used to assess the relationship between inflammatory indicators and the occurrence of cardiovascular and cerebrovascular events in MHD patients. The predictive value of baseline platelet-to-lymphocyte ratio (PLR) and systemic immune-inflammation index (SII) for these events was evaluated using receiver operating characteristic (ROC) curve analysis.  Results  A total of 157 patients were enrolled, among whom 42 cases (26.75%) experienced cardiovascular and cerebrovascular events. The event group had higher age (U=1905.500, P=0.043), body mass index (BMI) (t=-7.965, P＜0.001), hemoglobin (U=1744.000, P=0.008), platelet count (t=-9.416, P＜0.001), neutrophil count (U=443.500, P＜0.001), high-sensitivity C-reactive protein (hs-CRP) (U=691.000, P＜0.001), calcium (U=1872.000, P=0.031), SII (U=343.000, P＜0.001), PLR (U=721.500, P＜0.001), and neutrophil-to-lymphocyte ratio (NLR) (U=679.000, P＜0.001), but lower lymphocyte count (t=3.173, P=0.002) compared to the non-event group. SII (HR=1.001, 95% CI: 1.001～1.002, P＜0.001) and PLR (HR=1.005, 95% CI: 1.001～1.009, P=0.009) were identified as independent risk factors for cardiovascular and cerebrovascular events in MHD patients. The predictive value of SII was superior to that of PLR, with area under the curve (AUC) values of 0.837, 0.869, and 0.865 at 1-year, 3-year, and 5-year time points, respectively. The corresponding AUC values for PLR were 0.725, 0.752, and 0.784.  Conclusion  Both SII and PLR levels are associated with cardiovascular and cerebrovascular events in MHD patients, and SII has a better predictive value, which can serve as a reference indicator for early evaluation of cardiovascular and cerebrovascular events in MHD patients.

Objective This study aims to investigate the prevalence of depressive symptoms and their influencing factors in patients undergoing maintenance hemodialysis (MHD). Methods A multicenter design was adopted, and a total of 397 MHD patients were included. Data on sociodemographic characteristics, laboratory test indicators, and scores from the Patient Health Questionnaire-9 (PHQ-9) were collected. Univariate analysis, logistic regression, and Chi-squared Automatic Interaction Detector (CHAID) decision tree analysis were used to determine the influencing factors.  Results The prevalence of depressive symptoms in MHD patients was 21.91%. Logistic regression analysis indicated that insomnia (OR=2.583，95%CI: 1.472～4.533，P＜0.001), diabetes (OR=1.796，95%CI: 1.026～3.144，P = 0.040), and hepatitis B (OR=3.996，95%CI: 1.786～8.942, P＜0.001) were independent influencing factors of depressive symptoms in MHD patients. CHAID decision tree analysis showed that insomnia (χ2=20.046, P＜0.001), diabetes (χ2=5.543, P=0.019), hypoproteinemia (χ2=19.198, P＜0.001), and β2-microglobulin (β2-MG) (χ2 =10.969, P=0.008) were the main factors affecting depressive symptoms.  Conclusion  Insomnia, diabetes, hepatitis B, hypoalbuminemia, and β2-MG are closely associated with depressive symptoms in MHD patients. This study provides a scientific basis for the early identification and intervention of depressive symptoms in MHD patients.

Objective o investigate the influencing factors for major adverse cardiovascular events (MACE) in patients undergoing maintenance hemodialysis (MHD) and to analyze the predictive value of combined detection of serum asymmetric dimethylarginine (ADMA), nuclear factor erythroid 2-related factor 2 (NRF2), and gasdermin D (GSDMD) for the occurrence of MACE.  Methods  MHD patients admitted to Shaanxi Provincial Hospital of Traditional Chinese Medicine from February 2019 to February 2024 were selected as the case group and divided into a MACE group and a non-MACE group based on whether MACE occurred. Healthy volunteers undergoing physical examinations during the same period were selected as the control group. Serum levels of ADMA, NRF2, and GSDMD were measured by ELISA. The predictive value of combined serum ADMA, NRF2, and GSDMD for MACE was evaluated using ROC curve analysis. Multivariate logistic regression was used to analyze related risk factors affecting MACE occurrence.  Results  The case group included 238 patients, with 81 in the MACE group and 157 in the non-MACE group; the control group included 119 individuals. Compared with the control group, serum levels of ADMA, NRF2, and GSDMD were elevated in the case group (t=44.339, 41.996, 42.793, all P＜0.001). Compared with the non-MACE group, the MACE group showed increased serum levels of ADMA (t=8.241, P＜0.001), NRF2 (t=8.997, P＜0.001), GSDMD (t=8.323, P＜0.001), as well as longer dialysis vintage (t=7.209, P＜0.001), and higher levels of hypersensitive C-reactive protein (hs-CRP) (t=5.661, P＜0.001), serum phosphorus (t=4.896, P＜0.001), serum calcium (t=12.623, P＜0.001), and intact parathyroid hormone (iPTH) (t=4.454, P＜0.001). The area under the curve (AUC) for the combined prediction of MACE in MHD patients by serum ADMA, NRF2, and GSDMD was 0.934, which was higher than that of individual markers (Z=4.631, 3.553, 3.691, all P＜0.001). Serum calcium (OR=2.661, 95% CI: 1.301～5.442, P=0.007), iPTH (OR=3.136, 95% CI: 1.477～6.656, P=0.003), ADMA (OR=3.628, 95% CI: 1.802～7.304, P＜0.001), NRF2 (OR=4.129, 95% CI: 1.882～9.061, P＜0.001), and GSDMD (OR=3.284, 95% CI: 1.901～5.67, P＜0.001) were identified as risk factors for MACE in MHD patients.  Conclusion  ADMA, NRF2, GSDMD, dialysis vintage, serum calcium, and iPTH are all risk factors for MACE in MHD patients. Combined detection of serum ADMA, NRF2, and GSDMD has high predictive value for the occurrence of MACE in MHD patients.

Objective To explore the influencing factors of pulmonary arterial hypertension (PAH) in maintenance hemodialysis patients (MHD) and provide scientific recommendations for clinical diagnosis and treatment. Methods  End-stage renal disease (ESRD) patients receiving MHD treatment at the First Affiliated Hospital of Henan University of Science and Technology from January 2022 to April 2025 were selected. Patients were divided into a PAH group (defined as pulmonary artery systolic pressure > 35 mmHg) and a non-PAH group based on PAH occurrence. Demographic data, laboratory test indicators, and echocardiographic findings of the two groups were collected, organized, and compared to analyze their correlation with PAH occurrence.  Result A total of 159 subjects were included, of which 66 (41.51%) developed PAH. Statistically significant differences were observed between the PAH and non-PAH groups in serum calcium (t=2.173, P=0.031), albumin (t=3.526, P=0.001), hemoglobin (t=4.357, P＜0.001), platelet count (Z=-2.866, P=0.004), D-dimer (Z=-2.188, P=0.029), dialysis vintage ≥3 years (χ²=4.781, P=0.029), percutaneous transluminal angioplasty (PTA) and catheter-directed thrombolysis ≥2 times (χ²=5.710, P=0.017), history of cuffed catheter placement (χ²=5.695, P=0.017), left atrial anterior-posterior diameter (t=-2.255, P=0.026), left ventricular anterior-posterior diameter (Z=-2.022, P=0.043), right atrial transverse diameter (t=-2.335,P=0.022), right ventricular anterior-posterior diameter (Z=-2.496, P=0.013), pulmonary artery diameter (Z=-2.270, P=0.023), and left ventricular ejection fraction (Z=-2.224, P=0.026). Multivariate binary logistic regression analysis revealed that decreased albumin (OR=0.893, 95% CI: 0.817～0.976, P=0.013), decreased hemoglobin (OR=0.954, 95% CI: 0.931～0.978, P＜0.001), elevated D-dimer (OR=1.156, 95% CI: 1.057～1.263, P=0.001), dialysis vintage≥3 years (OR=2.861, 95% CI: 1.174～6.975, P=0.021), PTA and catheter-directed thrombolysis≥2 times (OR=2.572, 95% CI: 1.120～5.907, P=0.026), and history of cuffed catheter placement (OR=4.057, 95% CI: 1.290～12.755, P=0.017) were independent risk factors for PAH.  Conclusion  The incidence of PAH in MHD patients was 41.51%. Decreased hemoglobin and albumin, elevated D-dimer, dialysis vintage≥3 years, PTA and catheter-directed thrombolysis≥2 times, and history of cuffed catheter placement are independent risk factors for PAH in MHD patients, suggesting that targeted treatment may reduce the incidence of PAH and improve patients' quality of life

Objective  To study the application value of exercise rehabilitation model based on the Internet of Things in elderly peritoneal dialysis (PD) patients with sarcopenia.  Methods  A total of 60 elderly PD patients with sarcopenia treated in our hospital from June 2020 year to June 2023 year were retrospectively studied. They were divided into group A and group B with 30 cases in each group. Conventional rehabilitation was applied in group A, while the exercise rehabilitation model based on the Internet of Things was adopted in group B. Muscle mass, muscle function, left and right grip strength, time for 6m walk, and blood indexes were compared between the two groups.  Results Muscle mass, skeletal muscle relative mass index, left and right grip strength and serum albumin increased, time for 6m walk shortened, and C-reactive protein decreased in both groups after intervention (group B: t=-10.637, -5.317, -6.381, -6.060, -10.143, 8.948 and 7.701 respectively; group A: t=-5.083, -4.744, -4.255, -7.588, -6.805, 6.048 and 7.076 respectively; all P＜0.001). The improved ranges of the above indicators were higher in group B than in group A (t=2.153, 2.480, 2.123, 2.240, 0.209, 2.247 and 2.503 respectively; P=0.036, 0.016, 0.029, 0.038, 0.013, 0.028 and 0.015 respectively).  Conclusion The exercise rehabilitation model based on the Internet of Things can improve muscle function, walking speed and inflammation indicators in elderly PD patients with sarcopenia.

Objective  To explore the potential categories and influencing factors of social frailty in elderly maintenance hemodialysis (MHD) patients.  Methods  A total of 248 elderly patients undergoing MHD from two tertiary hospitals in Wuhan were enrolled in this study. General information questionnaire, Social Vulnerability Index, Geriatric Depression Scale 5, Personal Mastery Scale, and Social Network Scale were used for the investigation. Latent profile analysis was used to test the heterogeneity. Multivariate logistic regression analysis was used to assess the influencing factors for potential types of social frailty.  Results  The social frailty of elderly MHD patients could be categorized as mild social frailty-comprehensive type (62.10%), moderate social frailty-information acquisition type (11.29%), and severe social frailty type (26.61%). Regression analysis showed that marriage (OR=5.074, 95% CI: 1.082～23.797, P=0.039), depression (OR=0.546, 95% CI: 0.356～0.941, P=0.028), education of junior high school or below (OR=0.042,  95% CI: 0.002～0.862, P=0.040), and sense of personal mastery (OR=1.522, 95% CI: 1.183～1.958, P=0.001), dialysis duration ＜1 year (OR=25.286, 95% CI: 1.347～43.652, P=0.022) and social network (OR=1.247, 95% CI: 1.071～S1.451, P=0.004) were the influencing factors for potential categories of social frailty in elderly MHD patients.  Conclusion   Significant heterogeneity exists in social frailty among elderly MHD patients. Medical staff should implement target interventions tailored to distinct frailty categories and clinical characteristics.

Objective  Indoxyl sulfate (IS) is a typical uremic toxin accumulated in chronic kidney disease (CKD) patients, and higher IS level is closely associated with cardiovascular complications. Accurate evaluation of IS adsorption performance of hemoperfusion devices is essential for their clinical effectiveness. This study systematically compares the applicability of ultra-performance liquid chromatography-tandem mass spectrometry (LC-MS/MS) and ultraviolet-visible spectrophotometry (UV-Vis) in evaluating IS adsorption by hemoperfusion devices, and clarifies the impact of IS concentration on adsorption efficiency.  Method  LC-MS/MS: bovine plasma containing IS was treated with acetonitrile for protein precipitation. IS concentrations pre-/post-adsorption were quantified, establishing a linear model of 0.0850～1.3080μg/mL (Y=36045.242X + 763.841, R²=0.9987). UV-Vis: IS in bovine serum albumin solution was detected, demonstrating dual linear relationships of 3.75～120μg/mL (Y=77.337X - 0.5316, R²=0.9977; Y=93.014X - 0.4991, R²=0.9996). Both methods showed precision of RSD ＜5% and recovery rates of 86～110% (LC-MS/MS) and 91～110% (UV-Vis).  Result  LC-MS/MS has the advantages of high sensitivity (LOQ=0.0212μg/mL), strong anti-matrix interference, and suitability for batch plasma testing. UV-Vis is applicable for rapid screening of high-concentration IS (＞3.75μg/mL) but is significantly interfered by protein binding. For adsorption dynamics: at low IS concentrations (＜30μg/mL), insufficient molecular diffusion kinetics reduced efficiency; at high concentrations (＞100μg/mL), saturation of active sites decreased binding efficiency per molecule. Peak efficiency occurred at ～60μg/mL, balancing diffusion kinetics and site competition.  Conclusion LC-MS/MS serves as the core method for evaluating IS adsorption performance in hemoperfusion devices, providing a basis for quality standards. UV-Vis is limited to preliminary high-concentration screening during adsorbent development. This study offers critical technical support for optimizing clinical protocols and establishing industry standards.

Objective To evaluate the effects of different non-pharmacological interventions on thirst in patients undergoing maintenance hemodialysis (MHD) via a network meta-analysis, and to provide evidence for clinical nursing.  Methods  Randomized controlled trials about the impact of non-pharmacological interventions on thirst in MHD patients were searched across eight databases: PubMed, Web of Science, the Cochrane Library, Embase, CNKI, Wanfang, VIP, and CBM. The search period was from database inception to July 25, 2025. Two researchers independently conducted literature screening, quality assessment, and data extraction. Network meta-analysis was performed using RevMan 5.4 and Stata 14.0 software.  Results  A total of 14 studies were included, involving 937 MHD patients and 10 non-pharmacological interventions. There was a statistically significant difference between routine care and the following interventions: chewing sugar-free gum (SMD=-3.69, 95% CI: -4.51～-2.86, P＜0.001), rinsing mouth with compound mouthwash (SMD=  -1.48, 95% CI: -2.77～-0.20, P=0.024), comprehensive sodium management (SMD=-3.3, 95% CI: -6.56～     -0.04, P=0.047), and sucking lemon ice cubes (SMD=-1.69, 95% CI: -3.21～-0.17, P=0.029).  Conclusion Chewing sugar-free gum is the most effective intervention for alleviating thirst symptoms. Clinical healthcare providers can develop relevant interventions following patients’ preferences.

Electrolyte disorders in chronic kidney disease patients are critical issues in nephrology research, with hyperkalemia being one of the most life-threatening electrolyte disturbances. This review examines the risk factors for hyperkalemia in chronic kidney disease patients, compares the differences in predictive models constructed by traditional statistical methods and machine learning approaches, and analyzes the predictive performance of various models in depth, aiming to provide a theoretical basis for the development of more precise risk prediction tools for clinical applications.

Micro-inflammatory state is prevalent in patients undergoing maintenance hemodialysis (MHD) and is associated with adverse clinical outcomes. Cardiovascular complications are the leading cause of death in MHD patients, in which cardiovascular calcification (CVC) plays an important role. The progression of CVC is closely linked to the micro-inflammatory state. This review aims to summarize the role of micro-inflammatory state in the occurrence and development of CVC in MHD patients.

Objective  To investigate the relationship between serum levels of residual lipoprotein cholesterol (RLP-C), nuclear factor kappa B (NF-κB), and stromal interaction molecule 1 (STIM1) and arteriovenous fistula (AVF) thrombosis in maintenance hemodialysis (MHD) patients.  Methods  A total of 209 MHD patients undergoing autologous AVF surgery at our Hospital was selected. During the 12-month follow-up study, 71 patients developed thrombosis and 138 did not. In addition, 243 healthy individuals were recruited  as the control group. Serum samples were collected to measure serum levels of RLP-C, NF-κB, and STIM1.  Results  Serum levels of RLP-C, NF-κB, STIM1, C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) were higher in the MHD patients than in the control group (t=35.664, 54.133, 34.955, 59.703, 97.831 and 32.253 respectively; all P＜0.001). The thrombosis group exhibited higher levels of all aforementioned indicators and low-density lipoprotein cholesterol (LDL-C) compared to the non-thrombosis group (t=7.848, 8.662, 7.761, 9.161, 12.541, 6.076 and 59.703 respectively; all P＜0.001). LDL-C (OR=4.725, 95% CI: 2.640～8.457, P＜0.001), IL-6 (OR=3.782, 95% CI: 1.491～9.595, P=0.005), and CRP (OR=5.019, 95% CI: 1.083～3.766, P=0.027), TNF-α (OR=4.396, 95% CI: 2.741～7.050, P＜0.001), RLP-C (OR=5.627, 95% CI: 3.586～5.970, P＜0.001), NF-κB (OR=6.250, 95% CI: 4.281～9.124, P＜0.001), and STIM1 (OR=6.468, 95% CI: 3.356～8.908, P＜0.001) were identified as the risk factors for AVF thrombosis. Serum RLP-C, NF-κB, and STIM1 were positively correlated with IL-6 (r=0.533, 0.614 and 0.504; P＜0.001), CRP (r=0.714, 0.568 and 0.672; P＜0.001) and TNF-α (r=0.635, 0.527 and 0.493; P＜0.001). The area under the curve of combined use of RLP-C, NF-κB and  STIM1 was superior to that of individual use of RLP-C (Z=2.630, P=0.009), NF-κB (Z=2.539, P=0.011), and STIM1 (Z=3.013, P=0.003) for the prediction of AVF thrombosis.  Conclusion Serum RLP-C, NF-κB and STIM1 in MHD patients correlate with micro-inflammatory state and AVF thrombosis. Combined use of serum RLP-C, NF-κB and STIM1 may predict the risk  of AVF thrombosis in MD patients.

Objective  To evaluate the efficacy and safety of ultrasound-guided percutaneous liposuction for easy puncture and cannulation of the autogenous arteriovenous fistula (AVF) in patients with excessive subcutaneous fat around the AVF.  Methods  Patients who underwent forearm percutaneous liposuction at the First Hospital of Hebei Medical University between September 2023 and May 2025 due to difficult dialysis cannulation resulting from thick forearm subcutaneous fat were retrospectively enrolled. Ultrasound measurements were performed to assess the skin-to-target vein depth for arteriovenous fistula (AVF) puncture and brachial artery flow before the procedure, at 3 days, and at 1 month postoperatively. The cephalic vein internal diameter was measured before and 1 month after surgery. Successful cannulation time and perioperative complications were also recorded.  Results  A total of 9 patients were enrolled in this study, with a mean age of 46.44±14.23 years and a mean body mass index (BMI) of (31.90±2.76)kg/m². All patients successfully utilized the AVF for hemodialysis after liposuction. Compared to preoperative assessments, the depth of the cannulation vein decreased significantly after the operation for 3 days (t=8.903, P＜0.001) and one month (t=13.910, P＜0.001); and diameter of the target cannulation vein increased significantly after the operation for one month (t=3.786, P=0.007). In the 5 patients without percutaneous transluminal angioplasty (PTA) within one month, flow volume in brachial artery showed no significant change after the operation for 3 days (t=0.653, P=0.550) and one month (t=0.922, P=0.409), as compared to the preoperative levels. In the 4 of the 9 patients with preoperative brachial artery flow ＞500 ml/min, successful cannulation achieved after liposuction for 22±12 days with a primary patency rate of 100% in one month; in the 5 of the 9 patients with preoperative brachial artery flow ＜500 ml/min, all required PTA treatment within 20-36 days after liposuction. The primary and secondary patency rates in one month were 100% in all patients. During the 6-month follow-up period (including one patient less than 6 months), the primary and secondary patency rates were 75% and 100%, respectively. One patient developed a hematoma at the liposuction site, which was partially resolved allowing for successful cannulation after the operation for 28 days.  Conclusion  Ultrasound-guided percutaneous liposuction is a safe, effective, and minimally invasive technique for AVF in patients with deep cannulation veins due to excessive subcutaneous fat.

Objective  To clarify the overall prevalence of sarcopenic obesity (SO) in patients undergoing maintenance hemodialysis (MHD) by means of systematic review and meta-analysis, so as to provide evidence-based support for clinical screening and intervention.  Methods   A systematic search was conducted in databases including PubMed, Web of Science, Medline, Scopus, Embase, CBM, Cochrane Library, CNKI, VIP, and WanFang, with the search period ranging from the establishment of the database to January 2025. Study screening, data extraction, and quality assessment were independently carried out by two researchers respectively. In case of judgment discrepancies during the process, a unified conclusion was reached through joint discussion and negotiation between the two researchers. Stata 18.0 software was used for meta-analysis.  Results  A total of 9 studies were finally included, among which 3 were cohort studies and 6 were cross-sectional studies, with a total sample size of 9 946 cases. The overall prevalence of SO in MHD patients was 20% (95% CI: 17%～23%). High heterogeneity occurred among the studies (I²=90.52%, P＜0.001). Subgroup analysis showed that there was no significant difference in prevalence between cohort studies (21.5%, 95% CI: 14.9%～28.2%) and cross-sectional studies (19.1%, 95% CI: 15.3%～22.9%) (P=0.536); there was no significant difference in prevalence between the group with mean age ＜60 years (22.1%, 95% CI: 19.3%～24.9%) and the group with mean age ≥60 years (17.7%, 95% CI: 9.0%～26.4%) (P=0.342); the prevalence corresponding to different diagnostic criteria for sarcopenia ranged from 15.4% to 21.7%, and the difference between subgroups did not reach statistical significance (P=0.178); in terms of obesity diagnosis, there were significant differences in prevalence corresponding to different diagnostic methods (P=0.002). Among them, the studies using body fat percentage (BFP%) combined with body mass index (BMI) to diagnose obesity had the highest prevalence, reaching 24.7% (95% CI: 20.2%～29.2%), followed by studies using visceral fat area (VFA) for diagnosis (19.8%, 95% CI: 14.4%～25.2%), studies using BFP alone for diagnosis (17.7%, 95% CI: 10.5%～24.9%), and studies using BMI alone for diagnosis (16.9%, 95% CI: 12.6%～21.2%).  Conclusions  The prevalence of SO is higher among MHD patients. Although most subgroup differences were not statistically significant, the higher overall prevalence suggests that routine SO screening and intervention should be implemented as part of the standard care protocol for all MHD patients.

This report presents a case of hypothyroidism induced by roxadustat, a hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI), for the treatment of renal anemia. The patient was a 93-year-old female undergoing maintenance hemodialysis, and was admitted due to “recurrent dizziness for more than 10 years, chronic kidney disease stage 5 (CKD stage 5), and renal anemia”. She had received regular hemodialysis for over one year and was treated with oral roxadustat for renal anemia. On the third day after roxadustat therapy, the patient developed symptoms of hypothyroidism, accompanied by abnormal laboratory test results. Following consultation with the Department of Endocrinology and comprehensive differential diagnosis, she was confirmed to have central hypothyroidism. Despite treatment with levothyroxine sodium (Euthyrox), her thyroid function failed to improve; however, it gradually returned to normal after discontinuing roxadustat. In view of this case, we recommended that thyroid function should be regularly monitored when the patients receive roxadustat therapy. When necessary, thyroid hormone replacement therapy is initiated or roxadustat is temporarily suspended.