Correlation between glycemic control levels and blood pressure variability with prognosis in hemodialysis patients complicated with type 2 diabetes     YIN Tao1, LI Yue-hong1, WEN Wen1    1Department of Nephrology, Beijing Tsinghua Changgung Hospital affiliated to Tsinghua Universit, Beijing 102218, China
Corresponding author: LI Yue-hong, Email: lyha01051@btch.edu.cn
【Abstract】Objective  To investigate the relationship between blood pressure variability and blood pressure control in patients with type 2 diabetes mellitus (T2DM) undergoing maintenance hemodialysis (MHD). BPV), and to analyze the prognosis of patients with different glycosylated hemoglobin (HbA1c) groups.  Methods  The clinical data of T2DM patients with regular hemodialysis in the Department of Nephrology of Beijing Tsinghua Changgung Hospital from January 2024 were retrospectively analyzed. Patients were divided into three groups according to HbA1c levels: HbA1c < 7%, HbA1c7%～8%, and HbA1c > 8%. Blood pressure fluctuations were compared among the different HbA1c patients, and independent influencing factors of BPV were explored. A cohort follow-up study was conducted from January 2024 to January 2025 to compare and analyze the clinical prognosis of patients with stable HbA1c over the one-year follow-up period.  Results  A total of 70 T2DM patients on hemodialysis were enrolled, including 45 males and 25 females, with a mean age of (62.79±11.70) years and a median dialysis vintage of 52.94 (30.25, 68.75) months. Statistically significant differences were observed among the groups in dialysis blood glucose (H=19.259, P<0.001), glycemic variability (GV) (H=15.291, P<0.001), dialysis systolic blood pressure (H=11.253, P=0.004), systolic blood pressure variability (SBPV) (H=11.560, P=0.003), premix insulin use [(χ²=7.412, P=0.003). P=0.025], severe Coronary Artery stenosis (Coronary Artery Disease Reporting and Data System (CAD-RADS) ≥4) (χ²=7.665, P=0.022), cerebral infarction (National Institutes of Health Stroke Scale (NIHSS) score ≥2 points) (χ²=7.084, P=0.029) between the two groups were statistically significant. SBPV was positively correlated with GV (r=0.267, P=0.026). Logistic regression analysis showed that HbA1c (HbA1c7%～8%) (OR=0.147, 95% CI: 0.032～0.678, P=0.014), dialysis duration (OR=1.040, 95% CI: 1.011～1.070, P=0.006), standard deviation of NN intervals (SDNN) (OR=0.975, 95%CI: 0.954～0.996, P=0.022) were the independent influencing factors of SBPV. When comparing the groups defined by HbA1c (< 7%, 7%～8%, and >8%), patients with HbA1c 7%-8% had lower incidence of cardiovascular and cerebrovascular adverse events (χ²=7.500, P=0.024) and shorter average length of hospital stay (F=3.344, P=0.042).   Conclusion   There is a positive correlation between blood glucose variability and blood pressure variability in T2DM patients undergoing hemodialysis. Patients with larger GV during hemodialysis also have higher BPV. Patients with HbA1c levels 7%-8% have a better prognosis. HbA1c, dialysis age and SDNN are independent influencing factors for SBPV during dialysis.

Objective To investigate the therapeutic effect of magnesium isoglycyrrhizinate combined with hybrid blood purification in patients with severe acute pancreatitis (SAP), and its impacts on inflammatory indicators and prognosis.  Methods  A total of 102 SAP patients admitted to the First Affiliated Hospital of Henan University of Science and Technology were selected and randomly divided into two groups: the monotherapy group (n=51) and the combination  group (n=51). The monotherapy group received hybrid blood purification alone, while the combination group received magnesium isoglycyrrhizinate in addition to hybrid blood purification. The following outcomes were compared between the two groups: total effective rate, time to symptom relief, laboratory biochemical indicators, serum inflammatory markers, prognosis, and adverse reactions.  Results  The combination group showed a significantly higher overall effective rate (94.12%) compared with the monotherapy group (80.39%) (χ2=4.320, P=0.038). Additionally, the combination group had significantly shorter times to pain relief, nausea and vomiting relief, and hospitalization (t=9.112, t=13.679, t=6.537, all P＜0.001). The following indicators were significantly lower in the combination group than in the monotherapy group:  Acute Physiology And Chronic Health Evaluation II (APACHE II) score, C-reactive protein (CRP), amylase (AMS), interleukin-8 (IL-8), and high mobility group protein 1 (HMGB1) levels (t=5.386, t=15.051, t=12.850, t=12.312, t=13.771, all P＜0.001). There was no significant difference in the incidence of adverse reactions such as edema and rash between the two groups (χ2=0.917, P=0.338).  Conclusion  The combination of magnesium isoglycyrrhizinate and hybrid blood purification in SAP patients can effectively reduce inflammatory injury, shorten hospitalization time.

Objective  To analyze the relationship between the expression of serum Krüppel-like factor 4 (KLF4), thioredoxin-interacting protein (TXNIP) and vascular calcification (VC) in maintenance hemodialysis (MHD) patients.  Methods  Patients who received MHD at Baoding First Hospital from March 2019 to March 2024 were selected as the study subjects. They were divided into a calcification group and a non-calcification group based on the presence or absence of VC. Data on gender, age, Body Mass Index (BMI), dialysis vintage, smoking, alcohol consumption and primary disease were collected. Serum levels of albumin, blood phosphorus, blood calcium, blood creatinine, urea nitrogen and fasting blood glucose were measured using a DXI-800 automatic biochemical analyzer. Hemoglobin was detected by an automated hematology analyzer, intact parathyroid hormone (iPTH) was detected by electrochemiluminescence. The urea removal index (Kt/V) and glomerular filtration rate were calculated. The levels of KLF4 and TXNIP were determined by enzyme-linked immunosorbent assay (ELISA). The Pearson correlation method was used for correlation analysis. Multivariate Logistic regression and risk analysis were performed to evaluate the effects of KLF4 and TXNIP on VC. The predictive value was evaluated using the receiver operating characteristic (ROC) curve, and the clinical application value of the model was evaluated by decision curve analysis (DCA).  Results  The KLF4 and TXNIP levels in the calcification group were significantly higher than those in the non-calcification group (t=7.312, 8.419; both P＜0.001). Pearson analysis showed that KLF4 was positively correlated with age, dialysis vintage, fasting blood glucose, blood phosphorus, and iPTH (r=0.425, 0.328, 0.396, 0.550, 0.386), and negatively correlated with hemoglobin and albumin (r=-0.397, -0.315). TXNIP was positively correlated with age, dialysis vintage, fasting blood glucose, blood phosphorus, and iPTH (r=0.407, 0.501, 0.421, 0.385, 0.314), and negatively correlated with hemoglobin and albumin (r=-0.437, -0.418), all P＜0.001 Multivariate Logistic analysis showed that KLF4 [OR (95% CI) =2.591 (1.434～4.683), P=0.002] and TXNIP [OR (95% CI) =1.926 (1.505～2.466), P＜0.001] were both independent influencing factors for VC (P＜0.05). Risk analysis showed that the risk of VC in patients with high levels of serum KLF4 and TXNIP was 1.483 (1.149～1.915) times and 1.432 (1.125～1.822) times that of patients with low levels, respectively. The ROC curve showed that the AUC of the combined KLF4 and TXNIP for VC prediction was 0.930 (Z combined VS KLF4=2.232, P=0.026) (Z combined VS TXNIP=2.432, P=0.015). The DCA indicated that when the high-risk threshold probability ranges from 0.26 and 0.95, the combined model has high clinical application value in predicting the occurrence of VC. Conclusion  Patients with VC after MHD exhibit high expression of KLF4 and TXNIP. Both factors are related to the occurrence of VC in MHD patients. The combined of KLF4 and TXNIP has high prediction value of VC in MHD patients.

Objective  To explore the concurrent symptom network characteristics of post-dialysis fatigue (PDF) in hemodialysis (HD) patients, identify the core symptoms and their interaction mechanisms, and thereby provide a basis for formulating precise symptom management strategies.  Methods A cross-sectional study design was adopted. Convenience sampling was used to select maintenance hemodialysis patients from the Fifth Affiliated Hospital of Sun Yat-sen University between June and September 2021 as the study subjects. The Post-Dialysis Fatigue Scale was used to assess symptoms. Factor analysis was used to extract symptom clusters, and a symptom network was constructed based on the Gaussian graphical model (EBICglasso) to analyze core symptoms and network stability.  Results  A total of 147 patients were included. Factor analysis extracted 4 symptom clusters (depressive tendency, somatic pain, general debilitation, cardiopulmonary-metabolic symptoms), with a cumulative variance contribution rate of 70.90%. Symptom network analysis revealed a network containing 13 nodes and 36 edges, with a sparsity index of 0.538. The core symptom was lack of appetite (strength=1.793). Bootstrap testing confirmed the stability of the network structure [edge centrality stability coefficient (CS-C) > 0.75, centrality CS-C > 0.5].  Conclusion  PDF in HD patients exhibits characteristics of a multidimensional symptom interaction network, with lack of appetite as the core driver. Clinical interventions should focus on nutritional management and adopt a multidimensional symptom co-intervention strategy to improve patients' quality of life.

Objective  To investigate the association of serum calciprotein particles (CPPs), soluble Klotho protein, and growth differentiation factor 11 (GDF11) with coronary artery calcification (CAC) and major adverse cardiovascular events (MACE) in patients undergoing maintenance hemodialysis (MHD).  Methods  A total of 179 MHD patients treated at Handan Central Hospital between January 2022 and June 2023 were enrolled. Serum levels of CPPs, Klotho, and GDF11 were measured by ELISA. Pearson correlation analysis, Kaplan-Meier survival curves, COX regression, and ROC curves were used for analysis.  Results  Compared with the non-calcification group (n=64), patients in the calcification group (n=115) had increased serum CPPs levels (t=3.949, P=0.001) and decreased levels of Klotho and GDF11 (t=6.327, 6.378, P<0.001). The 1-year MACE incidence in the low CPPs expression group (n=86) was lower than that in the high CPPs expression group (n=93) (χ2=27.225, P<0.001). The 1-year MACE incidence in the low Klotho and GDF11 expression groups (n=91, 97) was higher than that in the high Klotho and GDF11 expression groups (n=88, 82) (χ2=35.554, 37.789, P=0.005, 0.005). Patients in the MACE group (n=76) had higher age, dialysis vintage, CACs, and CPPs than those in the non-MACE group (n=103) (t/χ2=3.426, 4.351, 27.351, 8.117, P<0.001), and lower Klotho and GDF11 levels (t=7.247, 7.031, P<0.001). CPP levels showed a positive correlation with CACs (r=0.472, P<0.001), while Klotho and GDF11 levels both exhibited a negative correlation with CACs (r=-0.384 and -0.417, respectively, both P<0.001). Advanced age (HR=2.317, 95%CI=1.140～4.710), higher CACs (HR=2.031, 95%CI=1.307～3.157), and elevated CPPs (HR=1.549, 95%CI=1.191～2.014) were risk factors for MACE in MHD patients. Elevated Klotho (HR=0.614, 95%CI=0.409～0.921), GDF11 (HR=0.762, 95%CI=0.623～0.932) levels were protective factors (P<0.001). The AUC of the combined prediction of CPPs, Klotho, and GDF11 for MACE in MHD patients was 0.919, which was superior to their individual predictions (Z=3.911, 2.819, 3.831, P=0.000, 0.005, 0.000).  Conclusion  Elevated serum CPPs and reduced Klotho and GDF11 levels in MHD patients are closely associated with coronary artery calcification and MACE in MHD patients. Combined detection of these three markers may serve as an important indicator for predicting MACE.

Objective  To explore the predictive value of three-dimensional speckle tracking imaging (3D-STI) combined with red blood cell distribution width (RDW) for major adverse cardiovascular events (MACE) in hemodialysis (HD) patients.  Methods  This is a retrospective cohort study, which includes 350 HD patients admitted to the 942nd Hospital of the Joint Logistics Support Force of Chinese PLA from January 2023 to June 2024. Patients were followed for 6 months and divided into MACE group (n=117) and non-MACE group (n=233) based on the presence or absence of MACE. Clinical data, conventional echocardiographic parameters, and 3D-STI parameters, which include global area strain (GAS), global circumferential strain (GCS), global longitudinal strain (GLS), global radial strain (GRS) and three-dimensional left ventricular ejection fraction (3D-LVEF), were collected, and RDW was measured using a fully automated hematology analyzer. Risk factors for MACE were analyzed, and receiver operating characteristic (ROC) curve was used to evaluate the predictive value of 3D-STI combined with RDW for MACE in HD patients.  Results  During the 6-month follow-up, the incidence of MACE was 33.43% (117/350). Compared with the non-MACE group, the MACE group had higher age, higher levels of left atrial diameter (LAD), GAS, GCS, GLS, RDW, low-density lipoprotein cholesterol (LDL-C) and intact parathyroid hormone (iPTH), and longer dialysis vintage, but lower GRS and 3D-LVEF (t/Z=3.752, 2.906, 5.322, 5.499, 3.756, 9.609, 5.271, 5.967, 4.835, 5.922 and 5.288 respectively; all P＜0.001). Multivariate logistic regression identified dialysis vintage (OR=1.042, 95% CI: 1.023～1.062, P＜0.001), LDL-C (OR=1.281, 95% CI: 1.154～1.422, P＜0.001), iPTH (OR=1.002, 95% CI: 1.001～1.004, P＜0.001), GAS (OR=1.129, 95% CI: 1.051～1.214, P=0.001), GCS (OR=1.217, 95% CI: 1.107～1.339, P＜0.001), GLS (OR=1.137, 95% CI: 1.034～1.250, P=0.008), and RDW (OR=2.522, 95% CI: 1.832～3.473, P＜0.001) as the independent risk factors for MACE, while GRS (OR=0.965, 95% CI: 0.938～0.992, P=0.012) and 3D-LVEF (OR=0.922, 95% CI:0.878～0.968, P=0.001) as the independent protective factors for MACE. The area under ROC curve (AUC) for predicting MACE using 3D-STI parameters (including GAS, GCS, GLS, GRS and 3D-LVEF) combined with RDW was 0.887, higher than that using 3D-STI parameters (0.821) or RDW (0.770) alone (Z=3.876 and 5.319, P＜0.001).  Conclusion  3D-STI parameters (GAS, GCS, GLS, GRS and 3D-LVEF) and RDW are independently associated with MACE in HD patients. 3D-STI parameters combined with RDW has higher predictive value for MACE in HD patients.

Objective To investigate the relationship between mitochondrial DNA (mtDNA) in peripheral blood mononuclear cells (PBMC) and the activation of the Toll-like receptor 9 (TLR9)/myeloid differentiation factor 88 (MyD88)/nuclear factor-κB (NF-κB) signaling pathway, as well as its association with  sarcopenia (SP) in patients undergoing maintenance hemodialysis (MHD).  Methods Patients undergoing MHD treated at Zhejiang Xianju People's Hospital from June 2023 to December 2024 were enrolled and divided into the SP group and the non-sarcopenia (NSP) group. The differences in biochemical blood indicators, interleukin 6 (IL-6), tumor necrosis factor-α (TNF-α), TLR9, MyD88, NF-κB, mtDNA, skeletal muscle index (SMI), and handgrip strength were compared between the two groups. Risk factors for SP were analyzed.  Results A total of 87 patients were enrolled, including 25 in the SP group and 62 in the NSP group. The levels of IL-6 (t=4.129,P＜0.001), TNF-α(t=4.483,P＜0.001), TLR9 (t=5.207,P＜0.001), MyD88 (t=7.918,P＜0.001), NF-κB (t=2.837,P=0.006) and mtDNA (t=2.081,P=0.040) expression levels were all significantly higher in the SP group than in the NSP group. mtDNA was positively correlated with TLR9, MyD88,NF-κB, and TNF-α (r=0.338,P=0.001;r=0.415,P＜0.001; r=0.451, P＜0.001; r=0.569, P＜0.001; r=0.435, P＜0.001, respectively). SMI and handgrip strength were negatively correlated with TLR9, MyD88, NF-κB, IL-6, TNF-α, mtDNA (r=  -0.490, P＜0.001; r=-0.677, P＜0.001; r=-0.421, P＜0.001; r=-0.500,P＜0.001; r=-0.388,P＜0.001; r= -0.432, P＜0.001 and r=-0.400, P＜0.001;r=-0.475, P＜0.001; r=-0.323, P=0.002; r=-0.358, P=0.001; r=-0.274, P=0.010; r=-0.332, P=0.002, respectively). Elevated levels of MyD88 (β=0.735, P＜0.001), TLR9 (β=0.311, P＜0.001) and mtDNA (β=0.185, P=0.008) were identified as risk factors for the development of SP in MHD patients. Conclusion  mtDNA may contribute to the development of SP in MHD patients by activating the TLR9/MyD88/NF-κB signaling pathway.

Objective  To establish a mouse  model of internal carotid arteriovenous fistula (AVF) and screen for differentially expressed proteins during AVF intimal hyperplasia and stenosis, and analyze the aberrant signaling pathways associated with this process.  Methods  A common carotid artery-external jugular vein AVF model was established in C57BL/6 mice using microsurgical techniques. The mice were divided into a sham operation group (n=10) and an AVF operation group (n=10). Vascular pathological changes in the AVF were evaluated. Tandem mass tag (TMT) quantitative proteomics analysis was used to identify differentially expressed genes and proteins between the two groups, and bioinformatics methods were applied to perform enrichment analysis of the differentially expressed proteins. For the cell experiment, human umbilical vein endothelial cells (HUVECs) were divided into a control group and a shear stress group, to detect reactive oxygen species (ROS) and mitochondrial morphology.  Results  In the animal experiment, compared with the sham operation group, the AVF operation group exhibited significant venous intimal hyperplasia, characterized by a mixture of collagen fiber proliferation and muscular layer components. Proteomic analysis identified a total of 595 differentially expressed proteins. Enrichment analysis revealed that these genes were primarily involved in biological processes such as mitochondrial homeostasis and energy metabolism, and were enriched in glycolipid metabolism pathways and the peroxisome proliferators-activated receptors (PPAR) signaling pathway.  In the cell experiment, ROS production in HUVECs in the shear stress group was higher than in the control group (t=8.840, P＜0.001). Mitochondrial area and mitochondrial length were lower in the shear stress group compared to the control group (t=5.926, 4.579, both P＜0.001), while mitochondrial superoxide levels were higher  (t=28.170, P＜0.001).  Conclusion  Mitochondrial oxidative stress injury plays a role in the process of intimal hyperplasia and stenosis in AVF.

High volume hemodiafiltration (HVHDF) has been proven to reduce the risk of death in dialysis patients, but the existing evidence mainly comes from the European population. Recent clinical data from Fresenius Kidney Care (FKC) Singapore demonstrated consistent achievement of convection volume targets across diverse ethnic groups. Patients with Chinese ethnicity, representing the majority, achieved outcomes comparable to global benchmarks. Moreover, HVHDF may offer reduced hospitalization burden compared to conventional HD, and better symptom control as adjudged by patient reported outcomes. Singapore’s experience affirms that HVHDF can be safely and effectively integrated into routine care, in a multi-ethnic group, offering a scalable model for improving dialysis outcomes in Asia. This review explores the institutional, operational, and clinical enablers that supported the implementation of HVHDF in Singapore to distil practical lessons applicable for broader HDF implementation across Asia.

Here we analyze the mechanism of blood sodium fluorescein interfering with the blood leakage detector in hemodialyzer and propose the solution methods through the description of a patient who had an intravenous sodium fluorescein administration for fundus angiography before hemodialysis. Serval blood leakage alarms happened during hemodialysis of this patient, and the alarms disappeared after adjusting dialysate flow rate and delaying treatment time

Objective  This paper aims to reveal the domestic and international research trends in hemodialysis technology from the perspective of patents, to compare the technological differences between domestic and foreign technologies, and to provide references for technological breakthroughs and patent layout of domestic enterprises.  Methods   Based on global patent data, the analysis is conducted from the dimensions of application trends, and applicant distribution. The development and evolution of core technologies such as dialysis membranes, dialysis fluids, and monitoring alarms are also studied.  Results  The annual average growth rates of domestic patent applications during the slow growth, oscillating growth, and rapid growth phases were 19.74%, 30.48%, and 33.56%, respectively. In contrast, foreign applications began to decline gradually starting in 2017 (The annual average growth rate from 2017 to 2021 was -2.01%). Three domestic applicants ranked among the top 20 global patent applicants. Domestically, 38% of patent applications originated from enterprises, while 33% came from hospitals. The key development directions for dialyzer membranes focus on membrane materials, forming processes, and functionalization. Patent technologies for dialysate concentrate on personalized regulation and the addition of therapeutic drugs tailored to different individuals. Dialysate delivery and heating technologies focus on intelligence and safety.  Conclusions  Domestic entities have evolved from technology followers into a significant force driving the global development of hemodialysis technology. The domestic landscape possesses the advantage of collaborative innovation between clinical institutions and enterprises.

Objective  To explore the influencing factors for restenosis of autologous arteriovenous fistula (AVF) after percutaneous transluminal angioplasty (PTA) in hemodialysis (HD) patients, so as to provide references for early identification and targeted intervention.  Methods  Computer retrieval of the literatures about influencing factors for AVF restenosis after PTA in HD patients was conducted by search of the databases of CBM, CNKI, Wanfang Database, Pubmed, Web of Science, Embase and The Cochrane Library. The retrieval time was from March 2015 to March 2025, and the meta-analysis was carried out by using software Stata 18.0.  Results  A total of 18 articles were included, with a total of 3,789 patients. Meta-analysis results showed that age (HR=1.058, 95% CI: 1.036～1.081, P＜0.001), AVF service life (HR=0.869, 95% CI: 0.665～1.074, P＜0.001), diabetes mellitus (HR=1.019, 95% CI: 1.009～1.028, P＜0.001), serum parathyroid hormone level (HR=1.042, 95% CI: 0.942～1.141, P＜0.001), serum albumin level (HR=0.744, 95% CI: 0.592～0.897, P＜0.001), abdominal aortic arch calcification score (HR=1.46, 95% CI: 0.925～1.995, P＜0.001), higher fistula position (HR=1.836, 95% CI: 1.128～2.544, P＜0.001), vascular calcification (HR=2.390, 95% CI: 1.164～3.615, P＜0.001), lesion length (HR=1.03, 95% CI: 1.001～1.060, P＜0.001), vascular access blood flow velocity (HR=0.983, 95% CI: 0.960～1.005, P＜0.001) and PTA treatment history (HR=1.632, 95% CI: 0.407～2.858, P=0.009) were the risk factors for AVF restenosis after PTA in HD patients.  Conclusion  Many influencing factors are related to AVF restenosis after PTA in HD patients. Medical staff should identify the risk factors in this kind of population at an early stage and carry out personalized intervention.

Objective  To observe the efficacy of preoperative contrast-enhanced ultrasound combined with intraoperative ultrasound-guided percutaneous transluminal angioplasty (PTA) in treating autologous arteriovenous fistula (AVF) stenosis.  Methods  A retrospective analysis was conducted on the data of 98 patients with AVF stenosis admitted to Baoding Second Hospital from August 2022 to January 2024. They were separated into an ultrasound group (n=47, performing PTA under ultrasound guidance) and an contrast-enhanced ultrasound group (n=51, performing preoperative contrast-enhanced ultrasound combined with intraoperative ultrasound guided PTA). After 1:1 propensity score matching (PSM), 30 cases in the ultrasound group and 30 cases in the contrast-enhanced ultrasound group were included in the study. Surgical outcomes, ultrasound parameters, postoperative complications, and restenosis rate were compared between the two groups.  Results  Compared with the ultrasound group, the contrast-enhanced ultrasound group had a shorter surgical duration (t=2.315, P=0.020) and a higher one-time success rate (χ2=5.192, P=0.023). After surgery, the degree of internal fistula stenosis was lower than before surgery in both groups (t=98.505 and 87.315, P<0.001), the degree of internal fistula stenosis in the contrast-enhanced ultrasound group was lower than that in the ultrasound group (t=3.715, P<0.001). After surgery, the inner diameter of stenosis site and brachial artery blood flow were higher than those before surgery in both groups (t=29.061, 31.852; 57.226 and 52.369 respectively; P<0.001), and the two indices in the contrast-enhanced ultrasound group were higher than those in the ultrasound group (t=2.481, P=0.016; t=3.698, P<0.001). After the operation for 6 months, the brachial artery blood flow in the contrast-enhanced ultrasound group was greater than that in the ultrasound group (t=5.623, P<0.001). There were no significant differences in the incidence of postoperative complications and restenosis between the two groups (χ2=0.417, P=0.519; χ2=0.647, P=0.421).  Conclusion  The use of preoperative contrast-enhanced ultrasound combined with intraoperative ultrasound-guided PTA can better improve the surgical efficacy of AVF stenosis, the degree of stenosis,  and the blood flow in AVF.

Objective  To observe the effects of different anastomotic angles (30° vs. 45°) between radial artery and cephalic vein on early postoperative brachial artery blood flow in autogenous arteriovenous fistulas (AVFs).  Methods  A prospective, randomized and controlled trial was conducted for patients with end-stage renal disease (ESRD) undergoing first AVF creation at the Department of Nephrology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine from October 2022 to December 2024. The participants were randomized into two groups using a random number table: group 1 (30° anastomotic angle) and group 2 (45° anastomotic angle). After the surgery for 4 and 8 weeks, color Doppler ultrasound was used to measure internal diameter of the proximal inflow radial artery, peak systolic velocity (PSV) of the proximal inflow radial artery, blood flow, internal diameter and peak velocity of the brachial artery, and the anastomotic diameter. These parameters were compared between the two groups.  Results  After the surgery for 4 and 8 weeks, no statistically significant differences were observed between the two groups in: proximal inflow radial artery diameter (4 weeks: 3.49±0.83 mm vs. 3.27±0.70 mm, t=0.554, P=0.294; 8 weeks: 3.89±0.30 mm vs. 3.93±0.90 mm, t=-0.086, P=0.466), radial artery PSV [4 weeks: 99.00 (89.00, 104.25) cm/s vs. 99.00 (89.15, 101.75) cm/s, Z=-0.845, P=0.412; 8 weeks: 110.31±18.12 cm/s vs. 113.56±20.01 cm/s, t=-0.340, P=0.369), brachial artery blood flow (4 weeks: 681.75±251.35 mL/min vs. 593.63±198.85 mL/min, t=-0.778, P=0.450; 8 weeks: 752±161.74 mL/min vs. 827.38±350.04 mL/min, t=-0.553, P=0.296), brachial artery diameter [4 weeks: 4.80 (4.55, 5.05) mm vs. 5.40 (4.58, 6.00) mm, Z=-0.956, P= 0.339; 8 weeks: 4.85±0.47 mm vs. 5.33±0.70 mm, t=-1.579, P=0.066], brachial artery peak velocity (4 weeks: 125.03±26.51 cm/s vs. 112.54±15.23 cm/s, t=1.155, P=0.272; 8 weeks: 127.99±23.78 cm/s vs. 123.21±21.18 cm/s, t=0.424, P=0.339), anastomotic diameter [4 weeks: 4.00 (3.93, 4.00) mm vs. 4.00 (3.33, 4.00) mm, Z=-0.785, P=0.432; 8 weeks: 4.00 (4.00, 4.18) mm vs. 4.00 (3.73, 4.00) mm, Z=-1.574, P=0.115].   Conclusion  In radial artery-cephalic vein AVF creation, 30° and 45° anastomotic angles had no significant difference in early postoperative brachial artery blood flow. To increase the postoperative brachial artery flow, the factors of vascular condition, surgical technique, suture method, and postoperative management must be comprehensively considered.

Objective  This study aims to evaluate the effectiveness of double guide wire technique through the binding of fibrin sheath to improve long-term patency rate of tunneled-cuffed catheter (TCC).  Methods  A retrospective study was conducted on the patients undergoing TCC replacement due to fibrin sheath at Beijing Zhongguancun Hospital from January first to September 30, 2024. Double guide wire technique through the binding of fibrin sheath was used to re-implant TCC. Clinical data, surgical information, and follow-up study within 180 days were collected to evaluate TCC patency.  Results  A total of 30 patients were included in this study. The success rate of TCC replacement using double guide wire to break the fibrin sheath constraint was 100%. No surgery-related complications such as massive hemorrhage, pericardial tamponade and catheter-related infections happened in perioperative period. After catheter replacement for 90 and 180 days, the primary patency rates were 93.3% and 80.0% respectively, and the primary assistant patency rates were 100% and 90.0% respectively.  Conclusion  The double guide wire technique through the binding of fibrin sheath is a safe and effective method for in situ replacement of TCC.

Objective  To explore the symptom experiences in patients undergoing peritoneal dialysis (PD) at home in order to provide the bases for improvement of symptomatic management.    Methods  Phenomenological study was conducted, involving semi-structured interviews with 11 PD patients. The Colaizzi's 7-step method was used for data analysis and theme extraction.  Results  The symptom experiences of home-based PD patients are summarized into 3 themes and 7 sub-themes: multi-faceted symptom perception (physiological, psychological, social); symptom evaluation (inadequate understanding of symptom causes, identification and assessment; insufficient self-management in medication, diet, fluid volume and exercise); symptom coping (problem-oriented coping, avoidant coping).  Conclusion  The dialysis care team should pay attention to the symptom experiences of PD patients, implement targeted and precise nursing care, and improve patients' symptom burden and quality of life.

Objective To investigate the symptoms occurred in patients receiving hemodiafiltration (HDF), and to analyze the relationship between the symptoms and HDF dose.  Methods  This was a cross-sectional study. Patients receiving regular maintenance hemodialysis thrice a week as well as post-diluted HDF at least once a week between November 2024 and January 2025 were recruited. Patients’ general data, HDF information and laboratory examinations were collected. Symptom burden was assessed using the Dialysis Symptom Index (DSI). The relationship between symptom burden and HDF dose was analyzed.  Result  A total of 179 patients were included in this study. The total DSI was 12.00 (9.00, 17.00) points. The first 5 most common symptoms were dry skin (89.94%), itching (81.56%), dry mouth (81.01%), feeling irritable (76.53%) and fatigue (68.72%). The first 5 most severe symptoms were irritable feeling [2.00 (1.00, 2.00) points], difficult falling asleep [1.00 (0.00, 2.00) points], dry skin [1.00 (1.00, 2.00) points], itching [1.00 (1.00, 2.00) points], and dry mouth [1.00 (1.00, 2.00) points]. The weekly convective volume of HDF was 41.44 (35.01, 53.76) L. With the increase of HDF frequency, weekly convective volume and β2-microglobulin reduction rate increased (H=122.516 and 24.138, P<0.001), accompanied by the decrease of pre-treatment β2-microglobulin levels (H=20.903, P<0.001). Patients receiving HDF therapy twice weekly(Z=-2.388，P=0.017) or thrice weekly (Z=-2.182, P=0.029) demonstrated lower total DSI scores compared to those receiving therapy once weekly. Locally weighted regression analysis showed that when convection volume is over 51.94 L/week, patients' DSI showed a downward trend.  Conclusion  Patients receiving HDF often experience a considerable symptom burden. The symptom burden can be improved with the increase of HDF dose, which is probably attributed to the clearance of medium molecular toxins. Higher HDF dose may improve patient’s symptom experience and long-term outcomes.