Objective   To explore the effect of the interaction between red blood cell distribution width (RDW) and high-sensitivity C-reactive protein (hsCRP) on cardiovascular events in  maintenance hemodialysis (MHD) patients.  Methods   Patients who received MHD at the Second Affiliated Hospital of Kunming Medical University from January 2020 to June 2022 were enrolled. Based on median RDW levels, patients were divided into a high-RDW (RDW≥4.75%, n=102) and a low-RDW group (RDW＜14.75%, n=102). According to hsCRP level, patients were divided into a high-hsCRP (hsCRP＞3 mg/L, n=127) and a low-hsCRP group (hsCRP≤3 mg/L, n=77). Kaplan-Meier survival curves and COX regression models were used to explore correlations between RDW and cardiovascular events across hsCRP strata and their interaction effect. A restricted cubic spline regression model was used to analyze the dose-response relationship between RDW levels and cardiovascular events.  Results   A total of 204 MHD patients were included in this study, and there were 76 cases (37.3%) of cardiovascular events during the follow-up period. Kaplan-Meier analysis revealed a significantly higher cardiovascular event incidence in the high-RDW versus low-RDW group within the high-hsCRP stratum (χ²=12.831, P＜0.001), but not in the low-hsCRP group (χ²=0.072, P=0.788).  Multivariate Cox regression analysis revealed a significant interaction between RDW and hsCRP on cardiovascular events (HR=1.001, 95% CI:1.000～1.001, P=0.014). Compared with the low-hsCRP-low RDW group，the high-hsCRP-high RDW group had a significantly higher risk of cardiovascular events (HR=2.215, 95% CI: 1.108～4.427, P=0.024). The restricted cubic spline plot showed a linear dose-response relationship between RDW levels and the risk of cardiovascular events (P＜0.001, Pnonlinea r=0.853).  Conclusion   RDW and hsCRP levels have a significant interaction on cardiovascular events, and the coexistence of high RDW and high hsCRP significantly increases the risk of cardiovascular events in MHD patients. 

Objective  To develop and compare three machine learning prediction models for predicting vascular calcification in patients with maintenance hemodialysis (MHD).  Methods  A total of 300 MHD patients were enrolled and randomly divided into a training set (n=210) and a validation set (n=90) in a 7:3 ratio. Based on the presence or absence of vascular calcification, the training set was further categorized into a calcification group (n=124) and a non-calcification group (n=86). Logistic Regression (LR), Random Forest (RF), and Support Vector Machine (SVM) models were developed to predict vascular calcification. The predictive performance of these models was evaluated using the validation set.  Results  In the training set, the area under curve (AUC) values for the LR, RF, and SVM models were 0.835, 0.886, and 0.872, respectively. In the validation set, the AUC values were 0.823, 0.879, and 0.866, respectively. DeLong's test showed significant differences in the AUC values among the three models (Z=2.663, 2.751; P=0.003, 0.001). All three models demonstrated good goodness-of-fit (χ²=4.018, 4.661, 3.892; P=0.642, 0.887, 0.739).  Conclusion  The LR, RF, and SVM machine learning models demonstrated good predictive performance for vascular calcification in MHD patients, with the Random Forest model showing superior performance.

Objective  This study aimed to use a two-sample Mendelian randomization approach to investigate the causal relationship between smoking behavior and chronic renal failure, along with related renal disease markers.  Methods  Using R Studio and packages such as TwoSampleMR for analysis, data from relevant large-scale genome-wide association studies were downloaded from public databases. Single nucleotide polymorphism sitess serving as instrumental variables were extracted for analysis. The results were mainly analyzed by Inverse variance weighted method for significance analysis and heterogeneity test, and the results were analyzed for horizontal multiplicity of results using MR-Egger intercept and MR-PRESSO methods. In addition, funnel plots and the leave-one-out method were used to confirm the potential bias and the robustness of the results.  Results  The instrumental variables included in the study were chronic renal failure (n=22), estimated glomerular filtration rate (n=17), urinary albumin (n=21), urinary microalbumin (n=22), haematuria (n=18), and cystatin C (n=9). The results of the inverse variance weighted method showed that smoking behavior was associated with chronic renal failure (OR=1.216, 95% CI: 1.051～1.408, P=0.009); lower estimated glomerular filtration rate (OR=0.990，95% CI: 0.984～0.996, P＜0.001); higher albumin urine (OR=1.051, 95% CI: 1.027～1.076, P＜0.001); higher microalbumin urine (OR=1.065, 95% CI: 1.021～1.110, P=0.003); haematuria (OR=1.002. 95% CI: 1.001～1.003, P=0.005); and higher cystatin C (OR=1.050, 95% CI:1.001～1.101, P=0.046) were causally related.  Conclusion  Smoking behavior leads to an increased risk of chronic renal failure and worsening of key renal function indicators, suggesting that smoking is a risk factors for renal disease. Smoking cessation can help prevent the development of kidney disease in smokers.

Objective  This study aimed to investigate the sleep status of maintenance hemodialysis (MHD) patients and explore its influencing factors, to provide a scientific basis for developing targeted interventions to improve sleep quality, and to offer data support for real-world research. Methods  A total of 346 MHD patients treated at multiple hemodialysis centers in Luoyang city between June 2023 and March 2024 were enrolled. Patients were divided into a no-sleep-disorder group and a sleep-disorder group based on their total Pittsburgh Sleep Quality Index (PSQI) score. Standardized questionnaires were used to collect demographic and socio-economic information. Laboratory indicators from the 3 months prior to enrollment, including intact Parathyroid Hormone (iPTH) and C-reactive protein (CRP), were extracted from the electronic medical record system. Differences in indicators between the two groups were compared. Spearman correlation analysis was used to assess the correlation between indicators and sleep disorder occurrence. Multivariate logistic regression models were employed to identify independent risk factors for sleep disorders.  Results  The prevalence of sleep disorders among MHD patients was 75.2% (260/346). Univariate analysis identified significant associations between the two groups in age, type of medical insurance,dialysis vintage, commodities (diabetes,cardiovascular/cerebrovascular diseases), and iPTH and CRP levels (all P＜0.05). Further Spearman correlation analysis showed that patient age (r=0.233, P＜0.001), dialysis vintage (r=0.130, P=0.021), presence of diabetes (r=0.153, P=0.006), presence of cardiovascular/cerebrovascular diseases (r=0.235, P＜0.001), and CRP level (r=0.216, P＜0.001) were significantly positively correlated with sleep disorders (all P＜0.05). Multivariate logistic regression analysis indicated that MHD patient age (OR=1.021, 95% CI: 1.001～1.041, P=0.036), dialysis vintage (OR=1.006, 95% CI: 1.001～1.012, P=0.028), presence of diabetes (OR=1.971, 95% CI:1.127～3.447, P=0.017), and CRP level (OR=1.027, 95% CI: 1.003～1.051, P=0.024) were independent risk factors for sleep disorders (all P＜0.05).   Conclusion  This study found a high prevalence of sleep disorders (75.2%) among MHD patients. Advanced age, longer dialysis vintage, presence of diabetes, and elevated CRP levels were confirmed as independent risk factors. Therefore, special attention is needed in clinical practice for MHD patients who are older, have a longer dialysis vintage, and have underlying comorbidities. Actively managing underlying conditions and conducting regular monitoring may help reduce the incidence of sleep disorders in MHD patients, thereby effectively improving their prognosis and quality of life.

Objective Using untargeted metabolomics technology, this study analyzed the differential metabolites and metabolic pathways in the dialysate of long-term peritoneal dialysis (PD) patients with peritoneal dysfunction versus short-term PD patients with normal peritoneal function, and aimed to identify potential metabolic biomarkers and intervention targets for peritoneal fibrosis (PF).  Methods  A total of 26 PD patients were included and divided into two groups: the long-term group with peritoneal dysfunction (net ultrafiltration volume of 2.5% peritoneal dialysate at 4 hours＜100 ml, dialysis vintage >6 years, n=13) and the short-term group with normal peritoneal function (dialysis vintage ＜12 months, n=13). Demographic characteristics and clinical data of the patients were collected. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) was used to detect and analyze metabolites in the dialysate. The differential metabolites were screened. Metabolic pathway annotation and enrichment analysis were performed for the differential metabolites.  Results  Compared to the short-term group, the long-term group with peritoneal dysfunction had lower serum albumin (t=-2.320，P=0.029), and higher levels of serum creatinine (t=2.723，P=0.012) and blood urea nitrogen (t=2.231，P=0.026). The long-term group also showed lower 4-hour ultrafiltration volume (t=-8.308, P＜0.001) and higher 4-hour dialysate-to-plasma creatinine ratio (D/Pcr) (t=3.037, P=0.006). Compared to the short-term group, the long-term group had 2040 up-regulated metabolites and 992 down-regulated metabolites. Furthermore, 2-ketobutyric acid, indoxyl sulfate and other metabolites increased in the long-term group. Metabolites such as serine, L-carnitine, and butyrolactone II were more abundant in the short-term group. Pathway annotation of differential metabolites revealed enrichment in amino acid metabolism, mainly phenylalanine metabolism, and carbohydrate metabolism, including propionate metabolism, citric acid cycle, etc. Further analysis of the metabolic pathways identified phenylalanine metabolism, glycerate and dicarboxylic acid metabolism, and the citric acid cycle as key pathways for subsequent research.  Conclusion The analysis of differential metabolites and metabolic pathways in the effluent of PD patients with different peritoneal functions based on non-targeted metabolomics provides key information and a new perspective for identifying biomarkers and intervention targets for PF.

Objective  To explore the risk factors and prognosis of intracerebral hemorrhage (ICH)  in dialysis dependent end stage renal disease (ESRD) patients.  Methods  We retrospectively analyzed ESRD patients receiving regular maintenance dialysis at Beijing Shunyi District Hospital (January 2021-January 2024). Participants were stratified into ICH and non-ICH groups. Demographic characteristics, medical history, laboratory parameters, imaging findings, and treatment data were compared to identify ICH risk factors.  Results  Among 206 enrolled patients, 42 (20.4%) developed ICH. Compared to non-ICH controls (n=164), the ICH group showed significantly higher proportions of males χ²=4.323, P=0.016), stroke history (χ²=7.621, P=0.000), hemodialysis (vs. peritoneal dialysis; χ²=0.294, P=0.043), elevated mean pre-dialysis systolic blood pressure (SBP) within 3 months (Z=3.532, P=0.030), antiplatelet drug use (χ²=4.021, P=0.026), white matter hyperintensity (χ²=6.202, P=0.002), and cerebral microhemorrhage (χ²=9.282, P＜0.000), along with elevated B-type natriuretic peptide (t=4.326, P=0.024), fibrinogen (t=3.002, P=0.038), serum calcium (t=4.234, P=0.023), and  phosphorus (t=5.203, P=0.006) levels, but decreased platelet count (t=3.469, P=0.032) and serum sodium (t=9.821, P＜0.000) levels. Multivariate Logistic regression analysis identified independent ICH risk factors: stroke history (OR=1.610, 95% CI:1.021～4.320, P=0.041), elevated mean pre-dialysis SBP within 3 months (OR=2.526, 95% CI:1.470～5.323, P=0.004), hemodialysis (OR=3.190, 95% CI: 1.620～6.270, P=0.007), white matter hyperintensity (OR=3.521,95% CI:1.313～6.482, P=0.030), and cerebral microhemorrhage (OR=2.797,95% CI:1.168～6.701, P=0.011). At 3-month follow-up,  31.0% (13/42) of ICH patients had favorable outcomes (modified Rankin scale, mRS ≤2)；while 69.0% (29/42) had poor outcomes (mRS>2), including 4 deaths (9.5%).   Conclusion  ESRD patients face elevated ICH risk with relatively poor prognosis in this population. 

Objective  Vascular calcification is closely related to cardiovascular disease in patients with peritoneal dialysis (PD). Fibroblast growth factor 21 (FGF21) as an endocrine hormone has a protective effect on cardiovascular function. This study explored the correlation between serum FGF21 and vascular calcification in different parts of vessels in PD patients.  Methods  PD patients who were evaluated for adequacy of PD in the Department of Nephrology, The First Affiliated Hospital of Soochow University from August 2021 to October 2022 were included in this study. Healthy people who underwent physical examination during the same period were recruited as the controls. Fasting blood serum was collected from all subjects, and serum FGF21 and FGF23 levels were determined by enzyme-linked immunoassay. Chest and abdomen CT were conducted in PD patients and processed by the GE workstation. Volume of coronary artery calcification (CAC) and abdominal aortic calcification (AAC) was quantitatively assessed. PD patients were grouped according to the presence of CAC or AAC. Multivariate logistic regression was used to analyze the relationship between serum FGF21 level and the presence of CAC or AAC.  Results  A total of 136 PD patients and 20 healthy controls were included in this study. Serum FGF21 in PD patients was significantly higher than that in normal subjects [383.0 (110.3～767.9) vs. 13.3 (5.5～129.1) pg/mL, Z=5.087, P＜0.001]. With the increase of age (r=0.247, P=0.004) and dialysis vintage (r=0.306, P＜0.001), serum FGF21 in PD patients was gradually increased. FGF21 was positively correlated with CAC volume (r=0.254, P=0.005) and AAC volume (r=0.354, P＜0.001). Furthermore, there were different risk factors for CAC and AAC. The increase of FGF21 was independently associated with the increased risk of AAC (OR=1.783, 95% CI: 1.251～2.541, P=0.001) rather than CAC in PD patients.  Conclusions  Serum FGF21 in PD patients is significantly higher than that in healthy people. The increase of FGF21 is associated with an increased risk of AAC. Therefore, FGF21 may serve as a biomarker and potential therapeutic target for vascular calcification.

Objective  To investigate the relationship between net ultrafiltration rate (UFNET) and prognosis of the patients with acute kidney injury (AKI) receiving continuous renal replacement therapy (CRRT) based on the propensity score matching method (PSM).  Methods  Clinical data of 162 AKI patients treated with CRRT in The First People's Hospital of Lanzhou from February 2020 to February 2024 were retrospectively analyzed. The survival rate within 28 days of hospitalization was analyzed. UFNET value was recorded during CRRT. Receiver operating characteristic (ROC) curve was used to determine the cut-off UFNET value to predict death within 28 days of hospitalization in AKI patients receiving CRRT. PSM was used to balance the confounding factors between high UFNET group and low UFNET group, and the mortality rate within 28 days of hospitalization after PSM was compared by 1:1 matching. Univariate Cox regression was used to analyze the relationship between UFNET and 28-day death in AKI patients receiving CRRT.   Results  Among the 162 AKI patients treated with CRRT, 68 (41.98%) died within 28 days in hospital. The cut-off UFNET value to predict the death rate within 28 days of hospitalization in AKI patients was 1.51 ml/(kg·h).  Patients were divided into high UFNET group (78 cases) and low UFNET group (84 cases) according to the cut-off UFNET value. Before PSM, the proportion of patients with the Acute Kidney Injury stage Ⅲ (57.69% vs. 38.10%), the Oxford Acute Severity of Illness Score (OASIS) at admission (49.35±6.09 points vs. 45.02±5.71 points), the Sequential Organ Failure Assessment Score (SOFA) at admission (13.65±2.04 points vs. 10.08±2.14 points), the proportion of patients receiving mechanical ventilation (57.69% vs. 41.67%), the highest level of blood urea nitrogen (BUN) [(16.35±3.02)mmol/L vs. (13.09±2.61)mmol/L] and the highest level of serum creatinine (Scr) [(109.33±6.21）μmol/L vs. (101.12±5.09)μmol/L] were significantly higher in high UFNET group than in low UFNET group (t/χ²=6.228, 4.671, 10.850, 8.414, 7.366 and 9.253 respectively; P=0.013, 0.000, 0.000, 0.004, 0.000 and 0.000 respectively), while the lowest pH value (7.20±0.16 vs. 7.33±0.19), the lowest base excess [(-10.32±2.41)mmol/L vs. (-6.32±1.59)mmol/L] and the lowest estimated glomerular filtration rate (eGFR) [(60.34±6.09 ml/(min·1.73m²) vs. 66.75±7.82 ml/(min·1.73m²)] were significantly lower in high UFNET group than in low UFNET group (t=4.692, 12.553 and 5.790 respectively; P=0.000, 0.000 and 0.000 respectively). PSM matched 92 AKI patients, and the distribution of variables reached equilibrium between the two groups after PSM (P>0.05); the 28 day in-hospital mortality was higher in high UFNET group than in low UFNET group (52.17% vs. 26.09%; log-rank: χ²=6.324, P=0.000). Univariate COX regression analysis showed that the risk of 28 day in-hospital death in high UFNET group was 2.123 times higher than that in low UFNET group (HR=2.123, 95% CI: 1.152～3.914, P=0.000).   Conclusion   High UFNET is associated with death within 28 days of hospitalization in AKI patients receiving CRRT.

Intrahospital transfer is often required among patients on  blood purification due to differences in disease characteristics, disease progression and treatment needs. How to carry out effective handover during intrahospital transfer to ensure the continuity of care has become critical issues to be solved. This paper reviews the handover management, handover models, handover tools and handover implementation of hemodialysis patients, with the aim of reducing the risk of adverse events during intrahospital transfer and providing reference basis for the safe transfer.

Objective  To evaluate the efficacy and safety of oral adsorbent agents in patients with chronic kidney disease (CKD) or chronic renal insufficiency.   Methods   A systematic search of randomized controlled trials (RCTs) was conducted in The Cochrane Library, PubMed, Web of Science, Embase, CNKI, Wanfang, VIP, and SinoMed databases. Quality of the included studies was assessed using the Cochrane Risk of Bias tool (RoB2). Meta-analysis was performed using Stata 15.0 and Stata 16.0 software.  Results  A total of 27 RCTs involving 2,569 patients were included. Compared to the control group, the treatment group showed significantly better outcomes in terms of overall efficacy (RR=1.643, 95% CI:1.405～1.920, P＜0.001), serum creatinine (SMD=-0.545, 95% CI: -0.643～-0.448, P＜0.001), and blood urea nitrogen (SMD=-0.756, 95% CI: -0.972～-0.541, P＜0.001), without an increased incidence of adverse reactions (RR=0.741, 95% CI: 0.512～1.073, P=0.113). Pre-specified subgroup analysis (short-term vs. long-term intervention) revealed that in the short-term (＜2 months) indicators such as serum creatinine, blood urea nitrogen, 24-hour urinary protein quantification, and creatinine clearance improved significantly. In contrast in long-term intervention (≥2 months), oral adsorbents mainly served to maintain efficacy without further therapeutic improvement.   Conclusion  Compared with conventional treatment alone, oral adsorbent agents may help delay renal function deterioration in patients with chronic kidney disease or chronic renal insufficiency, without increasing the incidence of drug-related adverse events.

Objective To review the research status, evaluation tools, and influencing factors of post-dialysis fatigue in maintenance hemodialysis (MHD) patients, aiming to provide references for clinical workers to improve their prognosis and quality of life.  Methods  We searched the databases of PubMed, Web of science, Cochrane library, Science Direct, Embase, CINAHL, CNKI, Wanfang, VIP and SinoMed for post-dialysis fatigue in MHD patients from inception to September 2024.  Results  A total of 22 articles were included. The commonly used evaluation tool was the open-ended assessment questionnaire for post-dialysis fatigue. The incidence and severity of post-dialysis fatigue were different among the research series. The main influencing factors included sociodemographic factors, dialysis related factors, disease-related factors, physical factors, and psychological factors.  Conclusions  The incidence of post-dialysis fatigue is high in MHD patients. Various tools were available for the assessment of post-dialysis fatigue, but multidimensional and specific assessment tools are yet absent. A diverse of influencing factors are present for the post-dialysis fatigue in MHD patients.

 Objective To investigate the effect of DSA-guided PTA on serum sVCAM-1, apelin-13 and rehabilitation in hemodialysis patients with AVF stenosis.  Methods  A total of 120 patients who received hemodialysis and had AVF stenosis during July 2020 to February 2024 at the First People's Hospital of Qujing City, Yunnan Province were retrospectively analyzed. According to the treatment methods, the 120 patients were divided into a control group (undergoing AVF resection and reconstruction surgery) and an experimental group (implementing PTA therapy), with 60 patients in each group. AVF function, serum sVCAM-1 and apelin-13 levels, surgical success, comfort level, and complications were compared between the two groups.  Results  Before treatment, the internal fistula diameter, dialysis blood flow and internal fistula blood flow were similar in the two groups (t=0.237, 0.477 and 0.157 respectively; P=0.813, 0.634 and 0.875 respectively); after treatment, the internal fistula diameter, dialysis blood flow and internal fistula blood flow were improved in both groups (control group: t=2.864, 3.691 and 5.803 respectively; P＜0.001. experimental group: t=6.043, 6.594 and 9.043 respectively; P＜0.001). The improvement of internal fistula diameter, dialysis blood flow and internal fistula blood flow were better in experimental group than in control group (t=2.681, 3.522 and 3.481 respectively; P＜0.001). Before treatment, serum levels of sVCAM-1 and apelin-13 were similar in the two groups (t=0.354, and 0.656; P=0.724 and 0.513); after treatment, serum sVCAM-1 decreased and serum apelin-13 increased in the two groups (control group: t=3.753 and 2.284, P＜0.05. experimental group: t=7.507 and 5.319, P＜0.05). The decrease of serum sVCAM-1 and increase of serum apelin-13 were more in experimental group than in control group (t=3.841 and 2.389; P＜0.05). There were no differences in success rate of surgical technique (χ²=0.209, P=0.648) and clinical success rate (χ²=1.008, P=0.315) between experimental group and control group. The incidence of complications was lower in experimental group than in control group (1.67% vs. 16.67%; χ²=8.107, P=0.004).  Conclusion  PTA under ultrasound shows better therapeutic effect and safety in the treatment of AVF stenosis in hemodialysis patients. By reducing serum sVCAM-1, increasing serum apelin-13 and improvement of vascular function and endothelial cell function, patients’ comfort and rehabilitation are enhanced.

Objective  To evaluate the safety and efficacy of a tunnel cuffed central venous catheter (TCC) re-implantation technique.  Methods  We recruited the hemodialysis patients who had subcutaneous TCC and needed to be replaced in the period from January 2023 to December 2024. General information of the patients, hemodialysis status, previous catheter use and other information were collected. Patients were tried to use the original subcutaneous tunnel to re-implant the catheter in situ. If this manipulation failed, TCC was re-implanted after re-puncture. Surgical techniques, operation time, complications, postoperative catheter use and other information were recorded.  Results  A total of 53 patients were included. TCC was successfully placed using the original subcutaneous tunnel in 45 patients, and was successfully placed after re-puncture in 8 patients. TCC was successfully replaced and used in all patients. The success rate of TCC replacement through the original tunnel was 84.91 %, and the operation time was less than that of re-puncture (t=5.142, P=0.002). There were no complications such as massive hemorrhage and infection after operation. The blood flow in dialysis catheter after operation was 233.77±17.23 ml/min.  Conclusions  Under the guidance of X-ray, the in situ re-placement of TCC with polyester sleeve is safe and effective, which shortens the operation time and reduces the difficulties of operation, and provides a new approach to re-establish the long-term dialysis vascular access.

Objective To determine the optimal heparinization protocol for hemoperfusion combined with hemodialysis (HP+HD) using a novel perfusion device (HP110) and to establish quality control tools for HP+HD therapy, including HP+HD installation and priming checklist and nursing quality indicators relating to the incidence of extracorporeal circulation coagulation, so as to provide a reference for clinical nursing quality control.  Methods This study enrolled maintenance hemodialysis (MHD) patients undergoing regular HP+HD therapy using heparin-based anticoagulants (unfractionated heparin or low molecular weight heparin) at Peking University People’s Hospital from June to November 2024. The study was divided into two phases: the initial phase (dynamic heparinization for installation and priming) and the improvement phase (closed-loop heparinization 5-step method for installation and priming). A project management team was established to develop the heparinization protocol, the HP+HD installation and priming checklist, and the nursing quality indicators relating to extracorporeal circulation coagulation.  Results   A total of 52 MHD patients were included (33 males and 19 females), aged 34～77 years (mean 56.8±10.2 years). Among 677 HP+HD treatments, 242 were conducted in the initial phase and 435 were in the improvement phase. During the initial phase and the improvement phase, the rates of extracorporeal circulation coagulation of grade II or more were 9.5% (23 treatments) and 0% (P＜0.001) respectively, and the rates of extracorporeal circulation coagulation of grade Ⅲ were 2.07% (5 treatments) and 0% (P＜0.001) respectively. The rate of recurrent coagulation in the same patient was 26.09% (6/23 treatments) in the initial phase. Monthly quality control score for nursing procedures showed no significant differences between the two phases (t=0.708; P=0.482). In the 435 treatments in the improvement phase, prothrombin time (10.2±0.8s), activated partial thromboplastin time (30.6±3.0s) and fibrinogen (314.0±57.2 mg/dl) were in the normal ranges, a total of 1000 mL normal saline and 12 500 IU of heparin (costed 15.16 RMB yuan) could be saved in a single HP+HD treatment, and the manipulation time was 5 minutes less than that reported in the literature.  Conclusion  The use of the closed-loop 5-step method for heparinization during HP+HD installation and priming significantly reduced the incidence of extracorporeal circulation coagulation and optimized the use of heparin and saline compared to the dynamic heparinization method. The nursing quality indicators, including the rates of grade Ⅱ and Ⅲ extracorporeal circulation coagulation and recurrent coagulation in the same patient, and the HP+HD installation and priming checklist are sensitive and effective tools for evaluating nursing quality of HP+HD installation and priming.

Objective To investigate the level of daily physical activity and its influencing factors in maintenance hemodialysis (MHD) patients, in order to provide a reference for interventional research and clinical practice of physical activity in MHD patients. Methods  Convenience sampling was used to select patients with MHD from February to June 2024 in the three blood purification centers in Shanghai as the study subjects. General information questionnaire, FRAIL (fatigue, resistance, ambulation, illnesses and loss of weight) scale and social support scale were used for the investigation. ActiGraph GT3X accelerometer was used to objectively assess the physical activity status of the patients. Paired t-test was used to analyze the difference in physical activity between dialysis and non-dialysis days. Logistic regression analysis was used to explore the factors affecting physical activity in MHD patients.  Results  Of the 184 MHD patients who participated in this study, only 52 (28.3%) achieved physical activity of the guideline-recommended level. The levels of light (χ²=33.686, P＜0.001), moderate (χ²=19.230, P＜0.001) and vigorous physical activity (χ²=4.390, P=0.037), and the number of steps (χ²=34.567, P＜0.001) were higher on dialysis days than on non-dialysis days. Physical activity levels were lower in older (β=-1.650, 95% CI: 0.087～0.424, P＜0.001) and more debilitated (β=-1.165, 95% CI:0.048～0.763, P=0.019) patients. Higher level of social support  was associated with a higher level of physical activity (β=2.385, 95% CI: 0.997～118.345, P=0.050).  Conclusion  The rate of daily physical activity level compliant with the guideline requirements was lower in MHD patients, and even more lower on dialysis days. In the intervention and practice of physical activity in MHD patients, older and debilitated patients should be more concerned about, and social support has a positive effect on physical activity. The aim of the management is to optimize their somatic function and improve their quality of life.

Objective  To explore the dynamic trajectories of post-dialysis fatigue and its influencing factors in maintenance hemodialysis (MHD) patients. Methods Using convenience sampling, 373 patients from a hemodialysis center were enrolled from January to June 2024. General information, the Brief Fatigue Inventory (BFI), and the Pittsburgh Sleep Quality Index (PSQI) were collected immediately after dialysis (T1), with BFI repeated at 1h (T2), 3h (T3), bedtime (T4), and the next day (T5). Latent class growth modeling (LCGM) identified fatigue trajectories, and multinomial logistic regression analyzed influencing factors. Results A 3-class LCGM model best fit the data: mild-rapid recovery (33.5%, C1), moderate-medium recovery (42.9%, C2), and severe-slow recovery (23.6%, C3). Logistic regression (reference: C1) showed C2 was significantly associated with sleep disorders (OR=0.141, P＜0.001), hypotension (OR=0.472, P=0.024), dialysis vintage (OR=1.278, P＜0.001), and hemoglobin (OR=0.939, P＜0.001); C3 was linked to female sex (OR=2.246, P=0.032), sleep disorders (OR=0.064, P＜0.001), hypotension (OR=0.275, P=0.002), dialysis vintage (OR=1.289, P=0.002), and hemoglobin (OR=0.939, P＜0.001). Conclusion Post-dialysis fatigue shows a declining trend but with population heterogeneity, suggesting personalized interventions targeting trajectory-specific factors.