【Abstract】Objective To investigate the impact of indoxyl sulfate (IS) on cardiovascular events and hospitalizations in patients undergoing maintenance hemodialysis (MHD). Methods Patients receiving MHD at the First Affiliated Hospital of Dalian Medical University between January 1 and May 31, 2022 were enrolled. Based on the median IS level of 43.00 mg/L (interquartile range 29.98～60.72mg/L), participants were divided into a low-IS group (＜43 mg/L) and a high-IS group (≥43 mg/L). Inter-group differences were compared. Patients were followed up until May 31, 2025, during which cardiovascular events and hospitalizations were recorded. Logistic regression analysis was performed to identify associated factors. Results A total of 137 patients were included, with 68 in the low-IS group and 69 in the high-IS group. Significant inter-group differences were observed in urea clearance index (Z=2.547, P=0.011), diabetes prevalence (χ2 =6.635, P= 0.010), residual renal function (χ2 =4.109, P=0.043), systolic blood pressure (Z=2.565, P=0.010), body mass index (t=3.311, P=0.001), high-density lipoprotein cholesterol (Z=1.929, P=0.05), fasting glucose (Z=3.859, P＜0.001), triglyceride-glucose index (Z=2.680, P=0.007), N-terminal pro-brain natriuretic peptide (Z=2.833, P=0.005), IS level (Z=10.100, P＜0.001), left ventricular end-diastolic diameter (t=3.585, P＜0.001), left atrial diameter (Z=3.585, P=0.021), interventricular septal thickness (Z=4.092, P＜0.001), left ventricular posterior wall thickness (Z=4.122, P＜0.001), left ventricular mass index (t=5.480, P＜0.001), left ventricular ejection fraction (Z=2.517, P=0.012), and global longitudinal strain of the left ventricle (t=-7.470, P＜0.001). Multivariate logistic regression analysis identified age (OR=1.060, 95% CI: 1.004～1.118, P=0.036), hypertension (OR=3.877, 95% CI:1.180～12.737, P=0.026), triglyceride-glucose index (OR=6.359, 95% CI: 1.312～ 30.815, P=0.022), and IS level (OR=1.066, 95% CI: 1.025～1.108, P=0.001) as independent risk factors for cardiovascular events in MHD patients; while diabetes (OR=6.520, 95% CI:1.673～25.408, P=0.007) and IS level (OR=1.059, 95% CI: 1.021～1.097, P=0.002) were identified as independent risk factors for hospitalization. Conclusion IS level is an independent risk factor for both cardiovascular events and hospitalization in MHD patients. 

Objective To analyze the relationship between the modified creatinine index (mCI) level and prognosis in maintenance hemodialysis (MHD) patients, and to explore the effect of longitudinal changes of mCI on all-cause mortality in MHD patients. Methods The study was a retrospective cohort study. Patients who underwent hemodialysis at Hangzhou Hospital of Traditional Chinese Medicine between March 2017 and June 2017 were enrolled. Base on longitudinal changes in mCI over one year from baseline, patients were divided into an mCI decline group and an mCI non-decline group. The outcome was all-cause mortality, with follow-up ending on June 30, 2023. The Kaplan-Meier method and Cox proportional hazards model were used to analyze the effect of longitudinal changes in mCI on all-cause death. Results A total of 211 patients were included, with an mean age of (61.17±13.74) years. There were 91 patients in the mCI decline group and 120 in the non-decline group. The median follow-up time was 72 (QR: 43, 75) months. Kaplan-Meier curve analysis showed that the risk of death was higher in the mCI decline group than that in the non-decline group (Log rank χ2=5.991, P=0.014). After adjusting for confounding factors using the Cox proportional hazards model, the trend of mCI change remained an independent risk factor for all-cause death, even after adjustment for baseline mCI. The risk of all- cause death in the decline group was 2.149 times that in the non- decline group (95% CI: 1.236～3.734, P=0.007). Conclusions In MHD patients, a decline in mCI is associated with an increased risk of all-cause mortality. The longitudinal trend of mCI should be monitored dynamically, and timely interventions should be  implemented to improve prognosis.

Objective This study aimed to evaluate the predictive value of combining the Prognostic Nutritional Index (PNI) and the Systemic Immune-Inflammation Index (SII) for all-cause mortality in patients undergoing peritoneal dialysis (PD). Methods PD patients diagnosed and treated in the Department of Nephrology at the Second Xiangya Hospital of Central South University between June 1, 2014, and May 31, 2024, were enrolled. Receiver operating characteristic (ROC) curve analysis determined optimal cut-off values for PNI and SII. Patients were divided into four groups based on these cut-offs: Group A (High PNI / Low SII), Group B (High PNI / High SII), Group C (Low PNI / Low SII), and Group D (Low PNI / High SII). Baseline characteristics were compared across groups. Kaplan-Meier (K-M) analysis was performed to assess differences in survival rates. Cox proportional hazards regression models evaluated the impact of PNI, SII, and PNI-SII on all-cause mortality. ROC curves and decision curve analysis were used to evaluate predictive performance and clinical utility. Results A total of 955 patients were included. The cut- off values for PNI and SII were 40.875 and 691.954, respectively. Groups A, B, C, and D comprised 275, 282, 199, and 199 patients, respectively. Kaplan-Meier curves demonstrated a statistically significant difference in the cumulative all-cause mortality risk among groups (log-rank test χ2 =116.000, P＜0.001). After adjusting for key confounding factors, Group D had a 7.6- fold increased risk of all-cause mortality compared to Group A (95% Confidence Interval [CI]: 2.08～27.64, P=0.002). The area under the curve (AUC) for PNI- SII in predicting allcause mortality was 0.822 (95% CI: 0.780～0.864), surpassing that of PNI alone (0.777, 95% CI: 0.732～0.821; DeLong test Z= 4.755, corrected P＜0.001) and SII alone (0.692, 95% CI: 0.639～0.745; DeLong test Z=14.277, corrected P＜0.001). Conclusion The combination of PNI and SII offers superior predictive accuracy and greater clinical utility for all-cause mortality risk stratification in PD patients compared to either in dex used alone.

Objective To evaluate the effects of glucose-containing dialysate versus glucose-free dialysate on glycemic variability (GV) and blood pressure variability (BPV) in patients with type 2 diabetes mellitus (T2DM) undergoing maintenance hemodialysis (MHD). Methods Using a prospective self-crossover controlled design, T2DM patients on MHD at Peking Tsinghua Chang Geng Hospital were enrolled. They sequentially used glucose-containing and glucose-free dialysate. Changes in blood glucose and blood pressure during dialysis were compared between the two conditions. The effects of glucose-containing dialysate on GV and BPV in patients with different baseline glycosylated hemoglobin (HbA1c) ranges were also explored. Results No statistically significant differences were observed in pre-dialysis baseline blood pressure or blood glucose between the two groups (systolic blood pressure [SBP]: t=-0.023, P=0.982; diastolic blood pressure [DBP]: t=-0.414, P=0.154; blood glucose: t=0.301, P=0.764). During the use of glucose-free dialysate, SBP was higher at 2 hours (t=2.162, P=0.033) and 4 hours (t=2.372, P=0.020) compared to during glucose-containing dialysate use; DBP was higher at 1 hour compared to during glucose-containing dialysate use (t=-2.086, P=0.004). Blood glucose during dialysis was lower from 1 to 4 hours with glucose-free dialysate than with glucose-containing dialysate (1 h: t = 2.745, P=0.007; 2 h: t= 3.950, P＜0.001; 3 h: t= 6.070, P＜0.001; 4 h: t=6.890, P＜0.001). Both GV (t=39.442, P＜0.001) and systolic blood pressure variability (SBPV, t=6.366, P=0.012) were lower with glucose-containing dialysate than with glucose-free dialysate. Hypoglycemic events during dialysis were reduced with glucose-containing dialysate (χ²=17.370, P＜0.001). For patients with different baseline HbA1c levels, both GV and SBPV were lower with glucose-containing dialysate than with glucose-free dialysate (P＜0.05). Regardless of dialysate type, the group with HbA1c 7%～8% exhibited the lowest SBPV and GV during dialysis, showing a statistically significant difference compared to the other two groups (F=13.183, P=0.001). Conclusions For T2DM patients on MHD, the use of glucose-containing dialysate can effectively reduce SBPV, GV, and the risk of hypoglycemia during dialysis. Patients with HbA1c levels between 7% and 8% demonstrated the smallest fluctuations in blood glucose and blood pressure during hemodialysis, highlighting the importance of glycemic control.

Objective To analyze the latent classes of family resilience among young and middle-aged (18-59 years) patients on maintenance hemodialysis (MHD) and to explore their influencing factors. Methods This cross-sectional study recruited 412 eligible young and middle-aged MHD patients from multiple centers, including the First and Second Departments of Blood Purification at Hunan Provincial People's Hospital, the Hemodialysis Unit of Changsha First Hospital, and the Chenzhou Second People's Hospital, between October 2024 and March 2025. A general information questionnaire and the Chinese version of the Family Resilience Assessment Scale (C-FRAS) were used for the survey. Latent class analysis was applied to identify different categories of family resilience among the young and middle-aged MHD patients, and multivariate logistic regression was employed to analyze the influencing factors. Results Family resilience in this population could be classified into three latent classes: low resilience (208 cases, 50.5% ), moderate resilience (178 cases, 43.2%), and good resilience (26 cases, 6.3%). Using the good resilience group as the reference, multivariate logistic regression identified several protective factors: a higher education level (using college or above as reference; junior high school or below: moderate vs. high OR=1.132, 95% CI: 1.019～1.825, P=0.026; low vs. high OR=1.587, 95% CI: 1.120～8.195, P=0.023), lighter economic burden (using no burden as reference; lighter burden: moderate vs. high OR=4.392, 95% CI: 2.364～6.825, P=0.035), enrollment in employee medical insurance (using resident medical insurance as reference; moderate vs. high OR=3.654, 95% CI: 1.165～7.521, P=0.012; low vs. high OR=3.654, 95% CI: 1.123～4.574, P＜0.001), extroverted personality (using introverted as reference; moderate vs. high OR=0.245, 95% CI: 0.321～0.936, P=0.039), and shorter dialysis vintage (using ＜1 year as reference; 1～3 years: moderate vs. high OR=3.245, 95% CI: 2.962～4.954, P= 0.015; low vs. high OR=1.326, 95% CI: 1.121～7.829, P＜0.001). Conversely, a heavy economic burden (using no burden as reference; heavier burden: low vs. high OR=0.126, 95% CI: 0.012～0.687, P=0.049) was identified as a risk factor. Conclusion Family resilience among young and middle-aged MHD patients can be categorized into three latent classes. Clinical healthcare professionals should pay attention to the family resilience status of these patients and implement targeted intervention strategies to enhance their treatment adherence.

【Abstract】bjective Erythropoietin (EPO) hypo-responsiveness is not rare in maintenance hemodialysis (MHD) patients, leading to refractory anemia. Identifying its influencing factors is crucial for guiding clinical intervention. Methods Patients undergoing maintenance hemodialysis at the Hemodialysis Center of Beijing Friendship Hospital from September 2022 to September 2023 were enrolled. Based on the median erythropoietin resistance index (ERI), they were divided into an ideal response group (ERI-T1 group) and a suboptimal response group (ERI-T2 group). The impact of demographic and laboratory indicators on ERI was further analyzed. Results A total of 236 patients were included, with 117 in the ERI-T1 group and 119 in the ERI-T2 group. The proportion of females was higher in the ERI-T2 group compared to the ERI-T1 group (t=-0.396, P＜0.001). Body mass index (Z=-2.088, P=0.037), hemoglobin (Z=-4.067, P＜0.001), serum iron (Z=-3.087, P=0.002), transferrin saturation (Z=- 2.216, P=0.027), and albumin (Z=- 3.226, P=0.001) were lower in the ERI-T2 group than in the ERI-T1 group. Correlation analysis showed that serum iron (r=-0.231, P=0.012) and albumin (r=-0.186, P=0.043) were negatively correlated with ERI. Multivariate linear regression analysis revealed that serum iron (β=-0.269, P=0.003) and albumin (β=-0.218, P=0.017) were independently and negatively correlated with ERI. Logistic regression analysis indicated that albumin was an independent protective factor against EPO hypo- responsiveness in maintenance hemodialysis patients (OR=0.881, 95% CI: 0.809～ 0.959, P=0.004). Conclusions Low serum iron and low albumin are modifiable risk factors for EPO hypo-responsiveness in MHD patients. Albumin can serve as a clinical practical predictive marker for EPO hypo-responsiveness. Clinical attention to patients' nutritional status is necessary to optimize anemia management.

Objective To analyze the risk factors for cognitive impairment (CI) in middle-aged and elderly peritoneal dialysis (PD) patients and to develop a risk prediction model. Methods Middle-aged and elderly PD patients from the Peritoneal Dialysis Center of Beijing Luhe Hospital, Capital Medical University between October 1, 2024 and December 31, 2024 were enrolled for group analysis and prediction model construction. Results A total of 138 PD patients were included in this study, with 96 in the training set. Univariate analysis revealed that the CI group had significantly lower serum potassium levels (t=2.150, P=0.034), lower albumin levels (t=2.310, P=0.023), lower Activities of Daily Living (ADL) scores [90.00 (60.00, 100.00) vs. 100.00 (100.00, 100.00), Z=-4.170, P＜0.010), higher prevalence of diabetes (71.19% vs. 48.65%, χ²=4.930, P=0.026), greater proportion of alcohol drinkers (67.80% vs. 35.14%, χ²=9.810, P=0.002), poorer health literacy (88.14% vs. 54.05%, χ² =4.930, P=0.026), and higher proportion of low income (67.80% vs. 32.43%, χ²=11.460, P＜0.001), as compared those with the non-CI group. Binary logistic regression identified decreased ADL score (OR=0.960, 95% CI: 0.930～0.990, P=0.003), history of alcohol consumption (OR= 16.310, 95% CI: 3.740～71.080, P＜0.001), annual family income ＜100,000 yuan (OR=9.620, 95% CI: 2.450～37.750, P=0.001), and poor medication adherence (OR=0.050, 95% CI:0.010～0.430, P=0.005) as the independent risk factors for CI in middle-aged and elderly PD patients. A prediction model was constructed based on these factors, and a nomogram was drawn. The model demonstrated an area under the curve (AUC) of 0.884 (95% CI: 0.819～0.948) in the training set, with an accuracy of 0.781 (95% CI:0.685～0.859) and a sensitivity of 0.973 (95%CI: 0.921～1.000). The validation set showed a predictive accuracy of 0.839 (95% CI: 0.716～0.961), a precision of 0.762 (95% CI: 0.605～0.879), and a F1 score of 84.2% (95% CI: 67.8～ 100.0%), which indicated that the model had higher predictability, accuracy and stability, and a better generalization ability. Conclusion The risk prediction model developed in this study demonstrates excellent performance for early identification of CI in middle-aged and elderly PD patients, having potential value for clinical application and promotion.

【Abstract】Objective To analyze the effect of hydrogen and oxygen inhalation on nutrition and microinflammation in maintenance hemodialysis (MHD) patients. Methods The stable MHD patients who underwent regular hemodialysis in the Hemodialysis Center of Beijing Taikang Yanyuan Rehabilitation Hospital were enrolled in this study. Every subject inhaled hydrogen and oxygen gases (3L/min, hydrogen: oxygen=2: 1) for 120 min during hemodialysis session for one month, and the subjects were observed and followed up for 6 months. Results A total of 37 patients were enrolled in this study, and 32 patients (25 males and 7 females) completed the trial. Their mean age was 64.4±12.2 years, and mean dialysis age was 60.1±49.5 months. In the first month after the start of treatment, serum albumin increased significantly compared to the baseline value (t=2.362, P=0.025). Serum albumin increased further in the second month (t=6.813, P＜0.001). Platelet/albumin (PAR) began to decline in the first month after treatment (t=0.252, P=0.802), and decreased further in the second month (t=2.906, P=0.007). Conclusion Inhalation of hydrogen and oxygen may improve nutrition and microinflammation status in MHD patients.

Objective To develop and validate a predictive model for renal anemia hyporesponsive to erythropoiesis- stimulating agents (ESA) in patients with chronic kidney disease not dependent on dialysis (NDD-CKD). Methods A retrospective study was conducted on 208 NDD-CKD patients with renal anemia in our hospital from January 2020 to January 2024. They were treated with ESA, and the responsiveness to ESA was assessed. Their clinical data were collected. Multivariate logistic regression was applied to analyze the influencing factors for low ESA reactivity in these patients. A nomogram prediction model for low ESA reactivity was constructed based on the regression results, and value of the nomogram was validated. Results Low ESA reactivity was observed in 45 cases (21.63%). Multivariate logistic regression showed that high neutrophil/lymphocyte ratio (NLR) (OR=1.614, 95% CI:1.063～2.451, P＜0.001) and high parathyroid hormone (PTH) (OR=1.457, 95%CI: 1.074～1.979, P＜0.001) were the risk factors, and higher estimated glomerular filtration rate (eGFR) (OR=0.547, 95% CI: 0.314～0.953, P=0.002) and higher hemoglobin (OR=0.598, 95% CI: 0.365～0.977, P=0.006) were the protective factors for low ESA reactivity in NDD-CKD patients with renal anemia. The nomogram prediction model for low ESA reactivity exhibited higher calibration (average absolute error=0.006), prediction accuracy (area under the curve=0.922) and clinical practicability. Conclusion The levels of eGFR, hemoglobin, NLR, and PTH are correlated with low ESA reactivity in NDD-CKD with renal anemia. The nomogram prediction model constructed based on the risk factors can effectively predict risk of low ESA reactivity in these patients.

Objective To explore the trajectory change of volume load management, and to discuss the correlation between different trajectories and physical activity in peritoneal dialysis (PD) patients. Methods A total of 155 patients undergoing PD were selected by convenience sampling. A questionnaire was used to conduct surveys on them within one week of the initial dialysis (T1), and after regular dialysis for one month (T2), 3 months (T3), and 6 months (T4). Result Three volume load management trajectories were identified, namely the low-level upward group (C1, n=50), the medium-level upward group (C2, n=56), and the low-tomedium-level fluctuation group (C3, n=41). There were significant differences among the 3 trajectory categories in terms of educational level (χ2 =13.570, P=0.035), diabetic nephropathy (χ2 =11.640, P=0.003), concurrent peritonitis during the period (χ2 =18.677, P＜0.001), and hypoproteinemia (χ2 =6.947, P=0.031). Within the initial 6 months of PD (T1-T4), physical activity scores of the patients showed an upward trend in every group (C1: F=109.134, P＜0.001; C2: F=46.537, P＜0.001; C3: F=33.361, P＜0.001); during T1-T4 stages, there were significant differences in distribution of physical activity scores among the three groups (T1: F= 5.364, P=0.005; T2: F=9.015, P＜0.01; T3: F=27.156, P＜0.001; T4: F=40.333, P＜0.001). Conclusion Educational level, diabetic nephropathy, concurrent peritonitis and hypoproteinemia have impacts on trajectory change of volume load management in PD patients. Moreover, volume load management at different stages have impacts on physical activity of the patients.

Patient-reported outcomes (PROs) with regarding to health situation and treatment responses
directly collected from the patients are valuable in nephrology and particularly in hemodialysis (HD), reflecting physical and mental status and helping reform treatment strategies. The comparison of high-dose hemodiafiltration (HDF) with high-flux hemodialysis trial (2018) (CONVINCE) compared high-dose HDF with highflux HD and incorporated PROs for the first time. This review summarizes PRO applications in HDF research
and discusses future clinical implementation.

【Abstract】Organ donation serves as the fundamental approach for treatment of the patients with endstage organ failure, and the success rate relies heavily on the quality of donor maintenance. Severe traumatic
brain injury is a primary source of donors, but is often complicated with severe internal environment disturbances, hemodynamic collapse, and multiple organ dysfunction syndrome (MODS). Blood purification technology is an important procedure for critical care. Among these techniques, continuous blood purification
(CBP) has emerged as a key intervention for donor maintenance, by clearing inflammatory mediators, stabilizing internal environment and hemodynamics, and providing renal support. This article systematically reviews the esential value of CBP in donor maintenance, including regulating internal environment (e.g., correcting hypernatremia), maintaining circulatory stability, implementing renal replacement therapy, and removing inflammatory mediators and toxins. This review also provides the values and evidences in protecting target organs (heart, lungs and kidneys) and managing special donors (e.g., those with poisoning or heat stroke). Current studies have confirmed the clinical benefits of CBP. However, high-quality evidence-based medical evidence (such as randomized controlled trial) is insufficient, especially in mode optimization, standardized protocols, and long-term outcome evaluation. Future research is needed to refine the strategies and to improve the survival rate of transplanted organs.

Therapeutic plasma exchange (TPE) has been proven effective for various diseases, but some conditions may require concurrent continuous renal replacement therapy (CRRT). The TPE-CRRT combination technique enables both forms of extracorporeal blood purification to be performed simultaneously. However, the feasibility, safety, therapeutic efficacy, and application prospects of the TPE-CRRT combination technique remain unclear. In light of this, our team reviewed the literature, introduced the forms of TPE, summarized the forms of TPE combined with CRRT, and outlined advantages and disadvantages of the combined therapy, as well as our clinical experience, to facilitate future research on combined therapy.

Peritoneal dialysis (PD) patients often have the risks of unfavorable outcomes due to longer treatment period and complicated disease conditions, presenting many challenges to disease management. The risk prediction model of outcomes based on the application of artificial intelligence (AI) can help PD medical team early and precisely manage the high risk PD patients, being valuable to increase the technological survival rate of PD patients. This paper reviews AI-based risk prediction models for clinical outcomes of PD patients from a PD medical care team perspective. Meanwhile, this paper also analyzes the existed challenges and prospects, aiming to provide a reference for precise management of PD with the aid of AI.

Uremic tumoral calcinosis (UTC) is a rare complication of end-stage renal disease, characterized by painless calcium salt deposits around large joints. Its core driving factor is elevated serum phosphate and calcium-phosphate product. Diagnosis requires a combination of dialysis history, clinical manifestations, imaging examinations, and laboratory indicators including serum calcium, phosphate, parathyroid hormone, and alkaline phosphatase. The therapeutic goal is to jointly control serum phosphate, serum calcium, and mineral-bone metabolism. Major approaches include non-calcium-based phosphate binders, low-calcium dialysis, parathyroidectomy, kidney transplantation, and lesion excision. Due to the lack of large-scale controlled studies, the optimal management strategy for UTC remains to be further validated

Objective To investigate the clinical efficacy, safety, and economic benefits of two vascular
accesses: autologous arteriovenous fistula (AVF) and temporary central venous catheter (CVC), in prolonged
intermittent renal replacement therapy (PIRRT) for critically ill maintenance hemodialysis (MHD) patients.
Methods Sixty critically ill MHD patients requiring PIRRT and admitted to the Fifth People's Hospital of
Chengdu between January and May 2025 were enrolled in this study. Using a random number table, they were
randomly assigned to AVF group (undergoing plastic trocar puncture, n=30) or CVC group (n=30). The two
groups were compared in terms of dialysis adequacy (Kt/V value), incidence of access- related complications
(infection, thrombosis and bleeding), length of hospital stay, total treatment expenses, and prognosis. Results
The average Kt/V value in the AVF group was higher than that in the CVC group (1.39±0.17 vs. 1.29±0.17, t=
2.146, P=0.036). The incidence of access-related complications was significantly lower in the AVF group than
in the CVC group (3.33% vs. 36.67%, χ² =8.440, P＜0.001). In particular, the incidence of catheter- related
complications (catheter-related infection, central venous thrombosis, and bleeding) was as high as 36.67% in
the CVC group. The length of hospital stay in the AVF group was shorter than that in the CVC group (10.83±
3.84 vs. 12.93±3.56 days, t=-2.308, P=0.025), and the total treatment expenses in the AVF group was lower
than that in the CVC group (24 394.48±11 953.48 yuan vs. 32 339.92±17 950.68 yuan, t=-2.018, P=0.048).
There was no significant difference in the 28-day survival rate between the two groups (93.33% vs. 90.00%,
χ²=0.209, P=0.648). Conclusion For critically ill MHD patients undergoing PIRRT, selecting AVF as the vascular access can improve treatment efficacy, reduce access- related complications (e.g., infection) and lower
medical expenses, being worthy of further clinical application and exploration.

nfection is the second leading cause of hospitalization and death, and ranks only behind cardiovascular diseases in hemodialysis patients owing to impaired immunity and the dialysis involving frequent extracorporeal circulation. Multi-drug resistant bacteria (MDROs) are microorganisms resistant to most antibacterial drugs and have higher survival ability and transmissibility. MDROs are easily colonized in human body but are difficult to be eliminated. Maintenance hemodialysis patients are susceptible to MDROs, resulting in serious consequences that threaten medical safety of the patients and consume more medical resources. Blood purification centers are the key places that spread MDROs and require strictly preventive strategies. In addition to the standard preventive measures, effective system support, personnel training, appropriate use of antibiotics, microbiological monitoring, etc are critical to the control of MDRO infections. This paper reviews the prevalence and control measures of MDROs, the impact of preventive measures on patients, current situation and obstructions in blood purification centers, in order to provide references for effective prevention and control of MDRO infections in different levels of blood purification centers. In view of current fact that most blood purification centers do not have the environment to strictly isolate MDRO infected hemodialysis patients, future investigations should be focused on the standardized MDRO preventive protocols.

Objective To understand the current nursing status of continuous renal replacement therapy (CRRT) in hospitals, and provide a reference for further improving the quality of specialized nursing. Methods A convenience sampling method was used. From August to December 2023, a self- designed questionnaire was used to investigate the nursing status of CRRT in 101 hospitals. Results A total of 115 questionnaires were distributed and 106 valid responses from 106 nursing units in 101 hospitals were collected, with an effective recovery rate of 92.17%. In terms of infection prevention and control management, 91 (85.85%) nursing units used disposable ready-made hemodialysis kits, 74 (69.81%) nursing units used disposable sterile rubber gloves for operations, 89 (83.96%) nursing units used ready-made replacement fluid, and 80 (75.47%) nursing units used disposable dedicated waste fluid collection bags. In terms of nursing operations, 57
(53.77%) nursing units directly connected the circuit after priming, 60 (56.6%) nursing units used a medical three-way stopcock to connect 5% sodium bicarbonate injection to the venous end of the extracorporeal circulation circuit during treatment, and 103 (97.17%) nursing units used closed blood return technology when disconnecting the machine. In terms of nursing management, 78 (73.58%) nursing units regularly conducted theoretical and operational assessments, 51 (48.11% ) nursing units have already carried out related in- hospital nursing consultations, and 36 (33.96%) nursing units have already used information-based specialized nursing record sheets. Conclusion There are several differences in the nursing care of CRRT among hospitals. It is recommended to further standardize and unify the clinical nursing standards for CRRT to promote the improvement of specialized nursing quality. 

Objective Hemodialysis combined with hemoperfusion is a commonly adopted clinical treatment mode, and hemoperfusion cartridge coagulation occurs frequently during treatment. Closed static heparin priming of hemoperfusion cartridge is a widely used method. This study aimed to explore the feasibility of closed dynamic circulation heparin priming for hemoperfusion cartridge and to observe its effect on cartridge coagulation, as compared those with closed static heparin priming. Methods A total of 32 patients undergoing maintenance hemodialysis in the Dialysis Unit of Peking University International Hospital were enrolled. They received hemodialysis 3 times a week, including 1 session of hemodialysis combined with hemoperfusion. A self-controlled before-and-after design was adopted. Every patient underwent 8 sessions of hemodialysis combined with hemoperfusion using closed dynamic circulation heparin priming and 8 sessions using closed static heparin priming. The heparin dosage was recorded for each session of hemodialysis combined with hemoperfusion, and the coagulation status of the hemoperfusion cartridge was evaluated. Results There was no significant difference in heparin dosage during treatment between closed dynamic circulation heparin method and closed static heparin method (58.41±7.23mg vs. 59.24±6.96mg, t=-1.730, P=0.094). The incidence of hemofilter coagulation during priming in closed dynamic circulation heparin method was lower than that in closed static heparin method (χ²=11.633, P=0.009). Specifically, the incidence of grade 2 hemofilter coagulation during priming in closed dynamic circulation heparin method was significantly lower than that in closed static heparin method (χ²=4.552, P=0.033), and the incidence of grade 3 hemofilter coagulation was also significantly lower in closed dynamic circulation heparin method (χ²=4.129, P=0.042). Conclusion In the absence of a difference in heparin dosage, closed dynamic circulation heparin priming for hemoperfusion cartridges is superior to closed static heparin priming in preventing hemoperfusion cartridge coagulation during hemodialysis combined with hemoperfusion. It is worthy of clinical promotion and application.