The central venous catheter for blood purification is often used in combination with various extracorporeal circulation devices, such as dialyzers and hemoperforates. This article analyzes common issues with the registration information of the product from the perspective of medical device registration and supervision.

Objective T o analyze the current research status of eye lesions in patients with end-stage renal disease, and to explore the hotspots and frontiers of research.  Method  CiteSpace literature analysis software was used to analyze, summarize, and generalize the relevant literature published in the Web of Science database in the past 20 years.  Result  A total of 307 relevant literature were included, and the number of publications on eye lesions in patients with end-stage renal disease is slowly increasing. The research hotspots include the study of eye symptoms, the pathological and physiological mechanisms of eye lesions in end-stage renal disease, and the management of dialysis patients. The research frontier mainly focuses on the impact of hemodialysis treatment on patients' eye lesions.  Conclusion  The overall research on eye lesions in patients with end-stage renal disease is in a slow upward development stage. Researchers in the fields of nephrology and ophthalmology can broaden their research ideas, actively explore from multiple perspectives, and provide high-quality evidence support for the development and clinical practice of eye lesions in patients with end-stage renal disease.

Objective  To analyze the risk factors of Muscle Wasting Syndrome (MWS) in Maintenance Hemodialysis (MHD) patients based on LASSO regression model.  Methods   Subei People's Hospital, Jiangsu Province of 280 MHD patients were selected and divided into normal muscle group and sarcopenia group according to the Asian sarcopenia comprehensive diagnostic criteria. The baseline data of the two groups were compared, and the risk factors of MWS in MHD patients were analyzed by LASSO regression. The Receiver Operating Characteristic (ROC) curve was used to verify the accuracy of the prediction model.  Results  There were 152 patients in the normal muscle group and 128 patients in the sarcopenia group. LASSO regression analysis showed that age (OR 1.164, 95% CI:1.043～1.299, P=0.007), weight after dialysis (OR 0.749, 95% CI:0.610～0.920, P=0.006), upper arm circumference (OR 1.802, 95% CI:1.299～2.500, P＜0.001), leg circumference (OR 2.787, 95% CI:1.463～5.311, P=0.002), muscle mass (OR 0.680, 95% CI:0.532～0.868, P＜0.001), and muscle mass (OR 0.680, 95% CI:0.532～0.868, P=0.002), creatinine (OR 0.456, 95% CI:0.232～0.897, P=0.023) and urea nitrogen (OR 0.162, 95% CI:0.070～0.373, P＜0.001) were risk factors for MWS in MHD patients. ROC Curve showed that the Area Under Curve (AUC) of LASSO regression was 0.713 (95% CI: 0.654～0.773), the sensitivity was 76.60%, the specificity was 64.60%, and the Youden index J=0.412. Conclusions  The LASAS-Logistic regression model can predict the high-risk factors of MWS in MHD 

Objective  To explore the nomogram model based on LASSO-logistic regression analysis to evaluate the risk of anticoagulation failure in continuous renal replacement therapy (CRRT).  Methods  The clinical data of 168 patients who underwent CRRT in our hospital from March 2021 to March 2024 were retrospectively collected by convenient sampling method. According to whether the patients had coagulation during cardiopulmonary bypass within 24 hours, they were divided into coagulation group and non-coagulation group. The risk factors were selected by single factor analysis, then all variables were screened by LASSO regression, and the common variables were combined. Logistic regression analysis was used to analyze the influencing factors, and then nomogram model was constructed, and the performance of nomogram model is verified by using receiver operating characteristic (ROC) curve, calibration curve and Bootstrap method. The decision curve was used to evaluate its clinical utility.  Results  50 patients with CRRT had cardiopulmonary bypass coagulation within 24 hours, and the incidence rate was 29.76%. Logistic regression results showed that high platelet count (PLT), high hematocrit (HCT), shortened activated partial prothrombin time (APTT), increased transmembrane pressure (TMP), slow blood flow and pump failure with blood were the risk factors for coagulation during 24h of CRRT cardiopulmonary bypass (OR=2.672, 3.040, 0.435, 2.568, 0.471, 2.662, 95% CI: 1.436～4.974, 1.507～6.133, 0.220～0.861, 1.288～5.119, 0.253～0.874, 1.284～5.519, P=0.002, 0.002, 0.017, 0.007, 0.017, 0.008，respectively). To construct a nomogram model of the risk of coagulation during 24h of CRRT cardiopulmonary bypass. The results of Bootstrap method and ROC curve show that the model has a good discrimination, and the consistency index (C-index) was 0.936 (95% CI: 0.844～0.963), and the area under the curve (AUC) was 0.978 (95% CI: 0.958～0.997). Hosmer-Lemeshoe goodness-of-fit test results show that the model has good fitting effect and accuracy (χ2=2.922, P=0.939), and the calibration curve was close to the ideal curve.  Conclusions  Coagulation during 24h of CRRT cardiopulmonary bypass is closely related to PLT, HCT, APTT, TMP, slow blood flow and pump stop, and the nomogram model has good predictive value and clinical benefits. 

Objective  To investigate the clinical efficacy and safety of telitacicept in the treatment of IgA nephropathy.  Methods  The clinical data of patients with IgA nephropathy treated with telitacicept from March 2022 to March 2024 were retrospectively collected. Their laboratory indicators and adverse reactions were recorded to evaluate the efficacy and safety of telitacicept.  Result  A total of 106 patients were analyzed, with a median medication time of 3.2 (2.2～5.7) months and median follow-up time of 5.4 (3.2～11.5) months. The 24-hour proteinuria decreased by 38.6% (-58.9%～1.8%) (Z=-2.929, P=0.003) from baseline at the sixth month after medication. The levels of IgA, IgG and IgM decreased from baseline; IgA decreased by 30.9% (t=8.857, P＜0.001), IgG 18.1% (t=5.305, P＜0.001) and IgM 43.6% (t=6.732, P＜0.001). Before medication, proteinuria ＜3.5 g/d (OR=6.483, 95% CI:1.259～33.389, P=0.025) and eGFR＞60ml/(min·1.73m2) (OR=4.552, 95% CI:1.043～19.860, P=0.044) were associated with proteinuria dropping to 1.0g/d after medication. Adverse reactions were infections and injection site reactions.  Conclusion  Telitacicept can significantly reduce proteinuria in patients with IgA nephropathy, and early application may be more effective.

Objective  To investigate the relationship between peripheral blood cyclophilin A (CyPA) level and vascular calcification and prognosis in patients with end-stage kidney disease (ESKD).  Methods  A total of 240 patients with ESKD admitted to the hospital from April 2020 to May 2024 were selected as the research objects, including 156 patients in the vascular calcification group and 84 patients in the non-calcification group. Blood CyPA level, serum calcium (Ca2+), serum phosphorus (P3-), Ca2+ x P3- product, C-reactive protein (CRP), serum creatinine (Scr) and blood lipid were compared between vascular calcification group and non-calcification group and between survival group and death group to correlate these indexes with vascular calcification and death.  Results  P3-(t=4.140, P＜0.001), Ca2+×P3- product (t=34.168, P＜0.001), CRP (t=40.459, P＜0.001), CyPA (t=14.743, P＜0.001), PTH (t=15.737, P＜0.001) and albumin (t=33.470, P＜0.001) were statistically different between vascular calcification group and non-calcification group. P3-(t=15.916, P＜0.001), Ca2+×P3- product (t=25.969, P＜0.001), CRP (t=26.705, P＜0.001), CyPA (t=9.757, P＜0.001), PTH (t=206.716, P＜0.001) and albumin (t=57.496, P＜0.001) were statistically different between survival group and death group. Multivariate analysis showed that P3- (OR=0.313), Ca2+×P3- (OR=0.320), CRP (OR=0.299), CyPA (OR=0.362), PTH (OR=0.343) and albumin (OR=3.271) were the risk factors for vascular calcification, while P3- (OR=0.339), Ca2+×P3- product (OR=0.351), CRP (OR=0.345), CyPA (OR=0.303), PTH (OR=0.336) and albumin (OR=2.965) were the risk factors for death.  Conclusion  Peripheral blood CyPA level is significantly correlated with vascular calcification and survival in ESKD patients. Therefore, blood CyPA level can serve as an important indicator for the assessment of clinical diagnosis and prognosis.

Chronic kidney disease (CKD) is often complicated with different degrees of mineral metabolism disorders, including bone metabolism abnormalities and secondary osteoporosis. Osteoporosis is characterized by loss of bone mass and lower bone strength, leading to the increase of fracture risk. The fracture risk is higher in CKD patients than in non-CKD patients. Imaging technique is currently a noninvasive method to assess the fracture risk, and provides a guidance for clinical management of skeletal abnormalities and early drug intervention to reduce the fracture risk and improve the quality of life in CKD patients. This article summarizes different imaging techniques and artificial intelligence applied in the fracture risk in CKD patients.

 Bioelectrical impedance analysis (BIA) is a technique to evaluate body composition and nutritional status by measuring the small electrical current through human body. This technique has the advantages of relatively simple, speedy, and non-invasive. BIA measures the original values of extracellular water volume (ECW), intracellular water volume (ICW), phase angle (PhA), resistance (R), reactance (Xc) and impedance vector length, which can be used to evaluate volume status, nutritional status, protein energy wasting (PEW) status, muscle tissue analysis and adipose tissue analysis with clinical importance in dialysis patients. This article reviews BIA used in hemodialysis and peritoneal dialysis patients.

Autogenous arteriovenous fistula (AVF) is the preferred vascular access method with higher dialysis efficiency for maintenance hemodialysis patients. However, many patients with end-stage renal disease (ESRD) are complicated with cardiovascular events, which is the leading cause of mortality in this population. The establishment of an AVF induces significant hemodynamic changes in cardiovascular system and structural and functional remodeling of the heart, which may adversely affect the quality of life and survival of the patients. Therefore, elucidating the impact of AVF on cardiac function can provide theoretical bases for prevention and management of AVF-associated cardiac complications. This review summarizes the effect of AVF establishment on cardiac function in ESRD patients.

The outcome of continuous progression of chronic kidney disease (CKD) is the end-stage renal disease (ESRD). Hemodialysis (HD) is one of the main treatment options for ESRD patients. Arteriovenous fistula (AVF) is the preferred type of vascular access for maintenance HD patients. However, AVF dysfunction occurs frequently within 12 months after surgery. This article mainly focuses on the causes and mechanisms of AVF dysfunction, the treatment progress in improving AVF patency, the pharmacology of indobufen and atorvastatin and their effects on cerebral, cardiac and peripheral blood vessels and AVF patency; the preventive measures of vascular access dysfunction after AVF surgery, in particular the drug treatment after AVF surgery, are comprehensively studied, in order to prolong the lifespan of AVF in HD patients and to provide theoretic basis for maintaining vascular access. 

Objective  To compare the diagnostic value of transthoracic echocardiography (TTE) and chest X-ray (CXR) in identifying tip position of tunnel cuffed central venous catheter (TCC).  Method  Patients who underwent hemodialysis and used TCC for blood access at The Affiliated Hospital of Chengde Medical College from February 1, 2021 to December 31, 2022 were recruited as the research subjects. Demographic data was collected before and after the catheterization. TTE, CXR, and computerized tomography (CT) were used to determine the tip position of TCC, and CT result was used as the reference. The sensitivity, specificity, misdiagnosis rate, missed diagnosis rate, and positive/negative likelihood ratio for catheter tip localization by TTE and CXR were calculated. Chi square test was used to analyze the consistency between TTE, CXR and CT. ROC curve was used to evaluate the validity of different diagnostic methods.  Results  A total of 164 hemodialysis patients were included in the study. The diagnostic sensitivity, specificity and positive predictive values were 0.972, 0.923 and 12.132 respectively for TTE method, higher than the values of 0.900, 0.424 and 1.553 respectively for CXR method. The misdiagnosis and missed diagnosis rates were 0.082 and 0.034 respectively for TTE method, lower than the values of 0.584 and 0.100 respectively for CXR method. The diagnostic consistency between TTE and CT was higher than that between CXR and CT (TTE/CT:Kappa=0.896, χ2=0.068 and P=0.727; CXR/CT: Kappa=0.357, χ2=13.457, P＜0.001). The diagnostic accuracy of TTE was higher than that of CXR (TTE: AUC=0.984, 95% CI: 0.959～1.000, P＜0.001; CXR: AUC=0.794, 95% CI: 0.714～0.873, P＜0.001).  Conclusion  TTE is better than CXR for localization of the TTC tip.

Objective  To observe the effect, complication and patient’s tolerance to remove tunnel-cuffed catheter without incision, in order to find out a catheter withdrawal method more suitable for hemodialysis patients.  Method  A total of 19 patients undergoing routine hemodialysis from March 2021 to July 2024 at the Blood Purification Center, Department of Nephrology, Beijing Ditan Hospital affiliated to Capital Medical University were recruited as the experimental group. They were treated with non-invasive method to remove the tunnel-cuffed catheter (direct and blunt separation at the tunnel opening). A total of 20 patients were recruited as the control group; their tunnel-cuffed catheters were removed by traditional cuff separation after incision. Patients’ baseline data were collected.  Result  There were 19 patients in the experimental group, with an average surgical time of 7.95±1.00 minutes, intraoperative blood loss of 1.74±0.17ml, lidocaine hydrochloride dosage of 2.79±0.21ml, and pain tolerance score of 1.96±0.32 points. There were 20 patients in the control group, with an average surgical time of 27.00±2.29 minutes, intraoperative blood loss of 5.05±0.32ml, lidocaine hydrochloride dosage of 5.15±0.44ml, and tolerance pain score of 5.40±0.34. All of the indicators were statistically better in experimental group than in control group (average surgical time: χ2=7.014, P＜0.001; intraoperative bleeding: χ2=9.160, P＜0.001; lidocaine hydrochloride dosage: χ2=4.867, P＜0.001; tolerance pain score: χ2=7.341, P＜0.001). There were no statistical differences in age, gender, dialysis age, catheter indwelling time, reason for catheter removal, occurrence of bleeding and/or hematoma, and postoperative infection between the two groups (age: χ2=0.147, P=0.884; gender: t=0.445, P=0.946; dialysis age: χ2=0.766, P=4.48; catheter indwelling time: χ2=0.729, P=0.470; reason for catheter removal: t=0.174, P=0.676; occurrence of bleeding and/or hematoma: t=1.004, P=3.16).  Conclusion  The non-incision method to remove tunnel-cuffed catheters can shorten the operation time, reduce the amount of bleeding, and decrease the incidence of hematoma, especially can significantly reduce pain and increase patient’s tolerance. This method is safe and effective.

Objective  This study explored the relationship between maturation failure of autologous arteriovenous fistula (AVF) and frailty in elderly maintenance hemodialysis (MHD) patients to provide a basis for planning vascular access and intervention in frailty patients.  Methods  A total of 275 elderly patients undergoing AVF surgery in a hospital in Shanxi province from January 2020 to December 2023 were investigated. Propensity score matching (PSM) was used to control confounding factors, post-matching univariate analysis was performed, and then modified Poisson regression analysis was applied for effect estimation.  Results  The survey showed that the incidence of maturation failure was 27.3% and frailty was 35.6% in elderly MHD patients. Univariate analysis after PSM showed that the incidence of maturation failure in frail patients was significantly different compared to the non-frail patients (χ2=9.341, P=0.002). After controlling for other confounding factors by modified Poisson regression analysis, it was further concluded that frailty (RR=1.921, 95% CI:1.302～2.835, P=0.001) was an independent risk factor for AVF maturation failure.  Conclusion  The incidence of preoperative frailty was higher in elderly MHD patients. The risk of AVF maturation failure in frail patients was 1.9 times higher than that in non-frail patients. To provide a basis for long-term vascular access decision-making and intervention, comprehensive evaluation of the elderly before AVF surgery should be emphasized.

Objective  To explore the application of novel single-needle puncture technique for safe puncture in the maintenance hemodialysis (MHD) patients with complex autologous arteriovenous fistulas (AVF).   Methods   A total of 42 MHD patients undergoing regular hemodialysis in the Department of Nephrology, Beijing Haidian Hospital (Peking University Third Hospital Haidian District Section) between May 2023 and May 2024 were enrolled in this study. They were divided by random table method into observation group (using single-needle technique for hemodialysis) and control group (using traditional puncture method for hemodialysis). Puncture related data were compared between the two groups.   Results   There were no statistical differences in baseline data, including age, gender, primary disease, the status of complex AVF (initial fistula, acute thrombosis secondary to stenosis, and difficulties in puncture) and central venous indwelling catheter, between the two groups at the time of enrollment (P >0.05). The total number of punctures was 43 in observation group, lower than that of 81 times in control group, with the average number of punctures statistically lower in observation group than in control group (t =8.446, P >0.001). The incidence of puncture injury was statistically lower in observation group than in control group (c2=9.860, P=0.007). The rate of indwelling catheter usage was statistically lower in observation group than in control group (c2=16.800, P <0.001). The average value of online real-time Kt/V monitoring was statistically lower in observation group than in control group (t =-3.594, P=0.001).   Conclusion  The novel single-needle puncture technique can effectively reduce the number of punctures, the complications caused by multiple needle punctures, and the rate of central venous catheter usage, and ensure safe puncture to the complex AVF during its difficult puncture period. Therefore, this method is worthy of clinical promotion.

The rapid development of continuous renal replacement therapy (CRRT) technology has resulted in an increasingly complex treatment modality and the constant emergence of new equipment, posing new obstacles for practical training. Like homogenized nomenclature, CRRT urgently requires standardized teaching atlases to help students learn the working principles and operational points of various CRRT systems. Using the circuit diagram as inspiration paired with existing literatures, the author's team created a set of CRRT teaching atlases in three stages: creating components, sketching sketches, and optimizing details, to allow CRRT knowledge diffusion and academic interchange.

Reliability maintenance is widely used in fields such as aerospace, high-speed rails, ships, and civil infrastructures. It indirectly reflects the performance of equipment by studying the statistical patterns of equipment and component failures under specified conditions, time, and functionality. The maintenance management of dialysis equipment is currently in the stage of shifting from post maintenance to preventive maintenance. This article introduces the basic content of reliability maintenance and applies the idea of reliability maintenance management to the maintenance of dialysis equipment, in order to improve the reliability of dialysis equipment and reduce maintenance costs. By applying reliability parameters such as mean time between failures, a basis is provided for evaluating the maintenance quality of dialysis equipment. In addition, reliability parameters can also be used to predict equipment maintenance and replacement needs, providing a basis for dialysis equipment management. 

Objective  To develop and evaluate an acceptance scale for arteriovenous fistula (AVF) ultrasound technology in hemodialysis nurses.  Methods   Based on the technology acceptance model, the primary pool of items for the scale was initially developed through conceptual analysis, literature review, and semi-structural interviews. The primary version of the evaluation scale for acceptance of AVF ultrasound technology in hemodialysis nurses was then formed through the Delphi method of expert consultation. The reliability and validity of the scale were evaluated through a survey of hemodialysis nurses.  Results  A total of 440 questionnaires were distributed in this study, and 430 valid questionnaires were retrieved, with a valid recovery rate of  97.73%. The scale encompasses 5 dimensions (38 items), namely perceived usefulness, perceived ease of use, external factors, user attitudes, and behavioral intentions. The Cronbach's α coefficient of the total scale is 0.934, and the test-retest reliability is 0.875. The scale-level content validity index (Scale-Content Validity Index, S-CVI) is 0.978, and the item-level content validity index (Item-Content Validity Index, I-CVI) ranges 0.800 to 1.000.  Conclusion  The acceptance assessment scale for AVF ultrasound technology in hemodialysis nurses has a better reliability and validity, and can be used as a tool to measure the willingness and difficulties  to widely use AVF ultrasound technology in hemodialysis nurses.

Objective  To evaluate and summarize the relevant evidence of pre-catheterization evaluation in peritoneal dialysis (PD) patients, and to produce a preoperative assessment sheet useful for planning clinical treatment.  Methods  Literature related to the preoperative assessment of PD catheterization was systematically searched in domestic and foreign guide websites, databases, and related professional association websites and others. The retrieval time was from the establishment of the database to May 2024. AGREE II and JBI evaluation tools were used to evaluate the quality of included literatures, and the evidences were then extracted and integrated. The preoperative assessment sheet for first placement of PD  catheter was made by a meeting of an expert group.  Results  A total of 10 articles were included, including 4 expert consensus, 4 guidelines and 2 clinical decisions. Twenty-three evidences were summarized, and seven aspects including general condition, medical history, physiological function, abdominal skin, personal habits, social/family support and patient willingness were used for making the assessment sheet.  Conclusions  This assessment sheet can help clinical staff obtain relevant evidence and make treatment plan and health education for the PD patients undergoing first catheterization. 

Objective  To explore the symptom clusters and their sentinel symptoms in patients undergoing maintenance hemodialysis, providing a reference for the early detection and identification of symptoms, the simplification of symptom cluster management, and the precise management of symptom clusters. Method  The convenience sampling method was adopted to select maintenance hemodialysis patients from the Blood Purification Center of the People's Hospital of Ningxia Hui Autonomous Region. Symptom clusters were extracted by using principal component analysis combined with the orthogonal rotation method of maximum variance. The Apriori algorithm was employed to determine the sentinel symptoms. Result  During dialysis, five symptom clusters were extracted from the patients: the uremic symptom cluster, the emotional symptom cluster, the electrolyte disorder symptom cluster, the gastrointestinal discomfort symptom cluster, and the sleep disorder symptom cluster. Their Cronbach's α coefficients were 0.853, 0.923, 0.850, 0.797, and 0.898, respectively. The results of Apriori correlation analysis and determination showed that skin dryness, anxiety, difficulty in keeping the legs still, constipation, and difficulty in falling asleep were the sentinel symptoms of the above-mentioned symptom clusters in sequence. Conclusion During the dialysis period, maintenance hemodialysis patients experience a variety of symptoms, and each symptom cluster contains sentinel symptoms. In light of this, it is recommended that medical staff in the future consider sentinel symptoms as the starting point for the assessment and management of symptom clusters. Subsequently, corresponding intervention measures can be implemented to enhance the efficiency of symptom management, improve the compliance of MHD patients, thereby reducing patients' disease burden and enhancing their quality of life.