Prolonged intermittent renal replacement therapy (PIRRT) is a hybrid kidney replacement modality positioned between intermittent hemodialysis (IHD) and continuous renal replacement therapy (CRRT). By extending the treatment duration of each session while lowering blood and dialysate/replacement fluid flow rates, PIRRT provides hemodynamic tolerability comparable to that of CRRT while preserving the intermittent nature of IHD. To standardize the clinical application of PIRRT in China, a multidisciplinary panel of experts in nephrology, critical care medicine, clinical pharmacy and pediatric nephrology developed this consensus based on a systematic literature review, evidence grading and multiple rounds of modified Delphi consultations. Recommendations cover terminology and definitions, indications and contraindications, equipment and parameter settings, vascular access, anticoagulation strategies, antimicrobial dose adjustment, and the prevention and management of complications. Specific guidance is provided on criteria for assessing hemodynamic stability, ultrafiltration rate control, the use of bedside PIRRT in maintenance hemodialysis (MHD) patients, nafamostat mesylate (NM) anticoagulation, and reference ranges for therapeutic drug monitoring of antimicrobials. This consensus aims to provide systematic, practical and evidence-based guidance for the standardized implementation of PIRRT in medical institutions at different levels, thereby improving treatment safety and effectiveness and ultimately improving outcomes in patients with severe kidney disease.

Objective To investigate the clinical efficacy and safety of sucroferric oxyhydroxide in the treatment of hyperphosphatemia in maintenance hemodialysis (MHD) patients with inadequately controlled serum phosphorus levels.  Methods  A retrospective analysis was performed on 90 MHD patients from four tertiary hospitals in Shanxi Province between May 2024 and December 2025. All patients had persistent hyperphosphatemia (serum phosphorus＞1.78 mmol/L) despite standard phosphate binder therapy and were switched to sucroferric oxyhydroxide for 12 weeks. A self-controlled, before-and-after design was employed to monitor serum phosphorus (P) levels at baseline and at 2, 4, 8 and 12 weeks after treatment initiation. Iron metabolism parameters were assessed at baseline and after 12 weeks of treatment, and adverse events occurring during treatment were recorded.  Results Among the 90 MHD patients treated with sucroferric oxyhydroxide, the mean age was (51.88±12.95) years, and the mean dialysis vintage was (56.01±48.39) months. The primary underlying diseases included chronic glomerulonephritis in 44 patients (48.89%) and diabetic nephropathy in 20 patients (22.22%). The median baseline serum phosphorus levels were 2.360 (2.118, 2.658) mmol/L. Serum phosphorus levels at all follow-up time points were significantly lower than the baseline level (Week 2: Z=6.081, adjusted P＜0.001; Week 4: Z=10.465, adjusted P＜0.001; Week 8: Z=13.081, adjusted P＜0.001; Week 12: Z=12.327, adjusted P＜0.001). The serum phosphorus target achievement rate reached 83.33% at Week 8 and 85.56% at Week 12. After 12 weeks of treatment, serum ferritin levels were significantly higher than at baseline (t=2.934, P=0.004). Although transferrin saturation (t=1.170, P=0.245) and serum iron (t=0.307, P=0.759) were slightly higher than baseline, the differences were not statistically significant. No serious adverse events occurred in any patient.  Conclusion  Sucroferric Oxyhydroxide effectively reduced serum phosphorus levels in MHD patients with inadequate phosphorus control, increased serum ferritin levels, and improved iron stores, with an overall favorable safety profile.

Objective  To explore the association of nutrition and inflammation with bone metabolism and cardiovascular calcification in elderly patients undergoing hemodialysis (HD).  Methods Elderly patients (age>60 years) undergoing HD who were treated at the 983th Hospital of PLA Joint Logistic Support Force between January 2020 and December 2024 were retrospectively enrolled as the study group, while elderly individuals undergoing routine health examinations during the same period were enrolled as the control group. Serum nutritional indexes [albumin (ALB), prealbumin (PA), and transferrin (TRF)], inflammatory indexes [C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6)], bone metabolism indexes [bone gla-protein (BGP), parathyroid hormone (PTH), and N-terminal propeptide of type I procollagen (PINP)], as well as hemoglobin (Hb), serum creatinine (Scr), blood urea nitrogen (BUN), blood calcium, blood phosphorus and alkaline phosphatase (ALP) were compared between the two groups. The correlation between serum nutritional indexes, inflammatory indexes and bone metabolism was analyzed by Pearson correlation analysis. According to the presence or absence of cardiovascular calcification, patients were divided into non-calcification group and calcification group, and serum indexes in the two groups were compared. The risk factors of cardiovascular calcification were analyzed by Logistic regression analysis, and patients’ diagnostic efficiency for cardiovascular calcification was evaluated by ROC curves.  Results  There were 195 patients in the study group and 195 individuals in the control group, respectively. The levels of ALB, PA, TRF, BGP and Hb in the study group were lower than those in the control group (t=30.709, 21.301, 14.406, 34.047, 28.805, all P＜0.001). The levels of CRP, TNF-α, IL-6, PTH, PINP, Scr and BUN in study group were higher than those in the control group (t=32.416, 28.101, 24.524, 36.802, 29.094, 52.846, 38.140, all P＜0.001). Among in the study group, the levels of ALB, PA, TRF, BGP, blood calcium and Hb in the calcification group were lower than those in the non-calcification group (t=8.667, 9.082, 3.061, 4.389, 5.642, 3.003, P＜0.001, ＜0.001, 0.003, ＜0.001, ＜0.001, 0.003), whereas the levels of CRP, TNF-α, IL-6, PTH, PINP, blood phosphorus, ALP, Scr and BUN, age and dialysis vintage were higher than those in non-calcification group (t=4.529, 3.892, 3.477, 4.732, 2.782, 3.813, 2.094, 4.268, 3.882, 4.871, 2.052; P＜0.001, ＜0.001, 0.001, ＜0.001, 0.006, ＜0.001, 0.038, ＜0.001, ＜0.001, ＜0.001, 0.042, respectively). Pearson correlation analysis showed that ALB (r=0.412, -0.523, -0.385, all P＜0.001), PA (r=0.368, -0.486, -0.356, all P＜0.001) and TRF (r=0.395, -0.508, -0.472, all P＜0.001) were positively correlated with BGP, and negatively correlated with PTH and PINP. CRP (r=-0.358, 0.456, 0.336, all P＜0.001), TNF-α (r=-0.325, 0.423, 0.312, all P＜0.001) and IL-6 (r=-0.342, 0.445, 0.328, all P＜0.001) were negatively correlated with BGP and positively correlated with PTH and PINP. Logistic regression analysis showed that lower ALB levels (OR=0.882, 95%CI: 0.813～0.958, P=0.003), lower PA levels (OR=0.816, 95%CI: 0.676～0.985, P=0.023), higher CRP levels (OR=1.070, 95%CI: 1.015～1.129, P=0.012), lower serum calcium levels (OR=0.271, 95%CI: 0.080～0.921, P=0.037) and longer dialysis vintage (OR=2.892, 95%CI: 1.048～7.983, P=0.041) were independent risk factors for cardiovascular calcification in elderly HD patients. ROC curves analysis showed that ALB (AUC=0.810, P＜0.001), PA (AUC=0.824, P＜0.001), TRF (AUC=0.608, P=0.006), CRP (AUC=0.685, P＜0.001), TNF-α (AUC=0.627, P=0.002) and IL-6 (AUC=0.611, P=0.004) had significant diagnostic value for cardiovascular calcification. The AUC of the combined model was 0.913, which was greater than the AUCs of the individual index (all P＜0.050).  Conclusion  Nutrition and inflammatory status were closely associated with bone metabolism in elderly patients undergoing HD. Nutritional and inflammatory indexes showed diagnostic value for cardiovascular calcification, and their combination provided better diagnostic performance than individual indexes.

Objective To investigate the changes in serum tenascin-C (TN-C), soluble CD40 ligand (sCD40L), and secreted phosphoprotein 24 (SPP24) in patients undergoing maintenance hemodialysis (MHD) and their relationship with cardiac valve calcification (CVC).  Methods  A total of 160 MHD patients treated at Hebei PetroChina Central Hospital from January 2022 to May 2025 were selected as the study subjects. General data were collected, and cardiac ultrasound examinations were performed. According to the occurrence of CVC, the patients were divided into a CVC group and a non-CVC group. The general data and serum levels of TN-C, sCD40L, and SPP24 were compared between the two groups. The influencing factors for CVC in MHD patients were analyzed, and receiver operating characteristic (ROC) curves were constructed to evaluate the efficacy of serum TN-C, sCD40L, and SPP24 levels in predicting CVC in MHD patients.  Results  Among the MHD patients included in this study, 83 (51.88%) developed CVC. Compared with the non-CVC group, patients in the CVC group had higher age, dialysis vintage, serum phosphorus, C-reactive protein, TN-C, and sCD40L levels (t=3.188, 2.290, 2.064, 2.049, 5.298, 6.309; P=0.002, 0.023, 0.041, 0.042, ＜0.001, ＜0.001), and lower serum albumin and SPP24 levels (t=2.234, 5.271; P=0.027, ＜0.001). Multivariate logistic regression analysis showed that increased age and elevated serum TN-C and sCD40L levels were risk factors for CVC in MHD patients (OR=1.054, 4.455, 5.512; 95% CI: 1.010～1.101, 1.484～13.377, 1.997～15.215; P=0.016, 0.008, 0.001), while elevated SPP24 levels were a protective factor for CVC in MHD patients (OR=0.322; 95% CI: 0.145～0.713; P=0.005). The AUCs of serum TN-C, sCD40L, and SPP24 alone and in combination for predicting CVC in MHD patients were 0.746, 0.680, 0.752, and 0.858, respectively. The AUC of the combined prediction was higher than that of TN-C, sCD40L, and SPP24 alone (Z=3.333, 4.277, 3.347; all P＜0.001).  Conclusion  In MHD patients with CVC, serum TN-C and sCD40L levels are elevated, while SPP24 levels are decreased. The combined detection of these indicators has high clinical efficacy in predicting CVC in MHD patients.

Objective  To investigate the efficacy of iron isomaltoside in peritoneal dialysis (PD) patients with anemia caused by absolute iron deficiency and the effects of different doses on residual kidney function.  Methods  A retrospective analysis was conducted on patients who had undergone regular PD for more than 3 months, with ferritin ＜100 μg/L and transferrin saturation ＜20%. According to the dose of a single intravenous injection of iron isomaltoside, the patients were divided into group A (500 mg) and group B (1000 mg). The retreatment time, hemoglobin, iron metabolism indicators, and changes in residual kidney function were compared between the two groups.   Results  A total of 34 patients were included, with 17 patients in each group. After intravenous iron therapy, ferritin (t=-6.675, P＜0.001), transferrin saturation (t=-5.244, P＜0.001), and hemoglobin (t=-3.986, P＜0.001) increased. The retreatment time in group A and group B was (3.41±1.33) months and (5.31±2.56) months, respectively, with group A being shorter than group B (t=-2.771, P=0.009); the last ferritin level in group A was lower than that in group B (t=-2.225, P=0.033). In group B, residual kidney Kt/V decreased from 0.35 to 0.23 after iron isomaltoside treatment (Z=-2.556, P=0.011), while there was no statistically significant difference in group A before and after treatment (Z=-1.183, P=0.237).  Conclusion Iron isomaltoside can effectively improve iron metabolism status and increase hemoglobin levels in PD patients with absolute iron deficiency. Intravenous iron at 500 mg and 1000 mg has comparable efficacy in improving anemia, but 1000 mg intravenous iron may be associated with a rapid increase in ferritin and a decline in residual kidney function, and should be used with caution.

Objective To explore the risk factors for intradialytic hypotension (IDH) from the perspective of lipid metabolism, so as to provide a new basis for the prevention and treatment of hypotension during dialysis. Methods Patients undergoing maintenance hemodialysis at the Blood Purification Center of Maoming People's Hospital from September 2023 to September 2025 were retrospectively enrolled, and clinical data, laboratory test results, and cardiac ultrasound results were collected. IDH was defined as a decrease in systolic blood pressure ≥20 mmHg or a decrease in mean arterial pressure ≥10 mmHg during dialysis, accompanied by symptoms of hypotension requiring nurse intervention (such as drowsiness, lethargy, dizziness, and muscle cramps), occurring ≥1 time per month. Non-IDH group: frequency of intradialytic hypotension ＜1/10 within 3 months; IDH group: at least one hypotensive event per month within 3 months, with frequency of intradialytic hypotension ≥1/10. Pearson or Spearman analysis was used to analyze factors related to apolipoprotein A1 (apoA1) and high-density lipoprotein-cholesterol (HDL-C), and binary logistic regression was used to analyze the risk factors for IDH.  Results  A total of 216 patients were included in this study, with 120 in the non-IDH group and 96 (44.4%) in the IDH group. The levels of HDL-C (t=5.203, P＜0.001) and apoA1 (t=5.571, P＜0.001) in the IDH group were lower than those in the non-IDH group. ApoA1 was negatively correlated with triglycerides (r=-0.262, P＜0.001), C-reactive protein (r=-0.227, P=0.002), white blood cell count (r=-0.274, P=0.016), and neutrophil count (r=-0.270, P=0.018), and positively correlated with total cholesterol (r=0.294, P＜0.001) and apolipoprotein E (r=0.177, P=0.009); HDL-C was negatively correlated with triglycerides (r=-0.538, P＜0.001), C-reactive protein (r=-0.150, P=0.044), white blood cell count (r=-0.193, P=0.005), and neutrophil count (r=-0.192, P=0.005), and positively correlated with total cholesterol (r=0.159, P=0.020). ROC curve analysis was used to assess the accuracy of apoA1 and HDL-C in predicting IDH. The area under the curve for apoA1 was 0.717 (95% CI: 0.648～0.787, P＜0.001), and the area under the curve for HDL-C was 0.686 (95% CI: 0.615～0.756, P＜0.001). The optimal cut-off value for apoA1 was 1.005, and the cut-off value for HDL-C was 1.185. The binary logistic regression model after multivariate adjustment (adjustment factors included age, sex, body mass index, history of hypertension, history of diabetes, dialysis vintage, ultrafiltration rate, pre-dialysis antihypertensive drugs, albumin, serum prealbumin, hemoglobin, serum creatinine, cardiac ejection fraction, pre-dialysis systolic blood pressure, and diastolic blood pressure) showed that low levels of apoA1 (OR=0.012, 95% CI: 0.001～0.125, P=0.001) and HDL-C (OR=0.050, 95% CI: 0.008～0.319, P=0.002) remained risk factors for IDH.  Conclusion This study found that low levels of apoA1 and HDL-C are independent risk factors for IDH, and apoA1 and HDL-C  have potential protective effects against IDH.

Objective To investigate the correlation between periodontitis severity and sarcopenia in patients undergoing maintenance hemodialysis (MHD) and to analyze the influencing factors. Methods Patients receiving MHD at the Blood Purification Centers of Nantong Haimen People's Hospital and the Affiliated Hospital of Nantong University from January to December 2024 were enrolled. Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia 2019 (AWGS 2019) criteria, and patients were divided into a sarcopenia group and a non‑sarcopenia group. General data, laboratory parameters, and oral health status were compared between the two groups. Logistic regression analysis was used to identify factors influencing sarcopenia, with sarcopenia as the dependent variable. Results A total of 468 patients were included, comprising 126 in the sarcopenia group and 342 in the non‑sarcopenia group, yielding a sarcopenia prevalence of 26.9% among MHD patients. Compared with the non‑sarcopenia group, the sarcopenia group had significantly higher probing depth (PD), attachment loss (AL), and bleeding index (BI) (t=6.103, 5.561, 6.718, respectively; all P<0.001), as well as higher Oral Health Impact Profile‑14 (OHIP‑14) scores (Z=9.848, P<0.001). The distribution of periodontitis severity differed significantly between the two groups (χ²=29.841, P<0.001). Further analysis showed that the prevalence of sarcopenia in patients with no/mild, moderate, and severe periodontitis was 16.9%, 25.9%, and 51.6%, respectively (χ²=40.110, P<0.001). Multivariate logistic regression identified age (OR=1.086, 95% CI: 1.035～1.147, P=0.001), dialysis vintage (OR=1.029, 95% CI: 1.015～1.062, P=0.015), periodontitis severity (OR=3.032, 95% CI: 1.531～6.411, P=0.002), and interleukin‑6 (IL‑6) (OR=1.619, 95% CI: 1.188～2.084, P=0.012) as independent influencing factors for sarcopenia. Marginal standardization analysis revealed that the adjusted probabilities of sarcopenia for patients with no/mild, moderate, and severe periodontitis were 0.091, 0.223, and 0.321, respectively. A trend test indicated that the risk of sarcopenia increased with increasing periodontitis severity (P for trend=0.022). Conclusion The prevalence of sarcopenia is relatively high in MHD patients. Periodontitis severity is an independent influencing factor, and the risk of sarcopenia shows a significant upward trend with increasing severity of periodontitis.

Magnesium serves both as a risk marker and as a potential therapeutic target in chronic kidney disease (CKD). Recent systematic reviews have shown that lower serum magnesium is associated with adverse outcomes in CKD patients, but observational associations cannot directly prove that magnesium supplementation improves prognosis. Basic research suggests that magnesium may reduce the tendency toward calcification by interfering with calcium-phosphate crystal formation, delaying the maturation of calcifying protein particles, and modulating the phenotype of vascular smooth muscle cells. However, the results of clinical intervention studies are inconsistent: although oral magnesium supplementation and increasing dialysate magnesium concentration can raise serum magnesium and improve some indicators of calcification tendency, their effects on the progression of coronary artery calcification remain inconclusive, and current evidence is insufficient to demonstrate that magnesium intervention can improve patient-related outcomes; some oral magnesium supplementation trials have also observed an increase in gastrointestinal adverse effects. These discrepancies may be related to patients' baseline serum magnesium levels and calcification burden, CKD stage, magnesium formulation and dose, effective tissue exposure, follow-up duration, endpoint selection, and safety window. Current evidence supports monitoring serum magnesium in the clinical context, identifying reversible causes of hypomagnesemia, and preventing uncontrollable magnesium accumulation, but it does not yet support indiscriminate magnesium supplementation in CKD patients. Future studies should adopt risk-stratified designs and simultaneously evaluate mechanistic indicators, imaging-based vascular calcification, and patient-related outcomes.

Objective  To evaluate the application effects of different priming schemes in the treatment of double plasma molecular absorption system (DPMAS).  Methods  A total of 99 patients with liver failure who underwent DPMAS treatment at Beijing You'an Hospital affiliated to Capital Medical University from September 2024 to September 2025 were recruited for this study. The patients were randomly divided into a basic group, a bubble canister group, and a bubble canister + static group, with 33 patients in each group. Heparin dosage, coagulation grade in post-treatment plasma separator and tubing, incidence of adverse reactions, insoluble particle detection in priming solution, and doctor-nurse satisfaction rate were compared among the three groups undergoing DPMAS treatment.  Results  There were no statistically significant differences in heparin dosage, coagulation grade in post-treatment plasma separator and tubing among the three groups (F=0.703, P=0.497; χ2=0.457, P=0.988). There were no statistically significant differences in adverse reaction rates, including perioral numbness (χ2= 0.471, P=0.790), hypotension (χ2=0.612, P=0.731) and catheter site bleeding (P=1.000). The mean value of insoluble particles detected in the priming solution met the requirements. The satisfaction rates of medical staff were 100%, 6.06% and 0%, respectively, with statistically significant differences among the 3 groups (P＜0.001).  Conclusion  The basic group scheme does not increase the risk of adverse reactions in patients and can achieve effective priming. In addition to the low operational complexity, short priming time, reduced drug use, and decreased nursing workload in basic group, it is highly satisfactory among medical staff. This method is worthy of clinical promotion.

Objective  Swollen hand  syndrome is a common vascular access complication in maintenance hemodialysis (MHD) patients. This study aimed to explore the risk factors for hand swelling at arteriovenous fistula (AVF) side in MHD patients, so as to provide theoretical evidences for early identification and clinical intervention of hand swelling syndrome.  Methods  This was a cross-sectional study. A total of 422 MHD patients treated at the Blood Purification Center of Guangdong Provincial People’s Hospital from July to August 2025 were enrolled and divided into two groups based on the presence or absence of hand swelling. General information, underlying diseases, vascular access history and arm circumference measurements at multiple sites were collected. Univariate and multivariate logistic regression analyses were performed to identify the risk factors for hand swelling.  Results  Among the 422 MHD patients with functional AVFs, the incidence of hand swelling was 15.6% (66/422). Significant intergroup differences were observed in gender (F=14.120, P＜0.001), history of internal jugular vein catheterization on AVF side (F=10.156, P=0.001), history of previous AVF creation (F=5.376, P=0.020), and circumference differences at lateral wrist (F=11.972, P＜0.001), mid-forearm (F=16.553, P＜0.001) and mid-upper arm (F=40.083, P＜0.001) between hand swelling group and non-hand swelling group. Multivariate logistic regression demonstrated that mid-upper arm circumference difference between the two arms (OR=3.526, 95% CI：2.494～4.985, P＜0.001), high-pitched murmur at stenosis site (OR=4.675, 95% CI：2.018～10.827, P＜0.001), reduced AVF thrill (OR=5.080,  95% CI：1.372～18.807, P=0.015), age (OR=0.967, 95% CI：0.955～0.980, P＜0.001), and gender (OR=0.375, 95% CI：0.197～0.716, P=0.003) were the risk factors for the presence of hand swelling at AVF side.  Conclusions  Monitoring of mid-upper arm circumference and auscultation to detect stenosis in AVF should be regularly carried out to reveal the risk factors for hand swelling during the use of AVF for blood access, especially for female and younger MHD patients. Standardized surveillance of arm circumference differences combined with ultrasonography facilitate early intervention and adverse outcome prevention of hand swelling syndrome.

Objective  To explore the predictive value of ultrasound and clinical features for restenosis of autogenous arteriovenous fistula (AVF) within one year after percutaneous transluminal angioplasty (PTA).  Methods  A total of 105 hemodialysis patients who underwent ultrasound-guided PTA for autogenous AVF stenosis in our hospital from January 2022 to December 2024 were enrolled in this study. They were followed up for 12 months after the operation. Ultrasound features and clinical data before and after the operation were collected. Kaplan-Meier analysis and Cox univariate and multivariate regression analyses were used to identify the influencing factors for restenosis.  Results  Within one year after PTA, restenosis occurred in 46 patients (43.81%). The primary patency rates at 3, 6, 9, and 12 months after PTA were 88.57%, 70.48%, 59.05% and 56.19%, respectively. Cox univariate analysis showed that patient age (χ2=5.153, P=0.023), and pre-operative number of fistula stenosis (χ2=31.521, P＜0.001), stenosis diameter (χ2=28.943, P＜0.001), stenosis length (χ2=37.798, P＜0.001), stenosis location classification (χ2=28.719, P＜0.001), thickness of the venous intima (χ2=14.701, P＜0.001), calcification of the arterial media (χ2=25.231, P＜0.001) and diameter expansion ratio (χ2=8.681, P=0.003) were the influencing factors for restenosis after PTA. Cox multivariate analysis showed that multiple stenoses (OR=4.294, 95% CI: 1.330～13.867, P=0.015), stenosis diameter≤1.0mm (OR=4.076, 95% CI: 1.569～10.585, P=0.004) and longer stenosis (stenosis length ≥20mm) (OR=3.671, 95% CI: 1.789～7.534, P＜0.001) were the independent risk factors for restenosis.  Conclusions  The ultrasonic features of autogenous AVF stenosis can be used to predict the risk of recurrence of stenosis within one year after PTA. Preoperative ultrasound examinations can identify the risk factors at an early stage and provide important reference for diagnosis, treatment and prognosis assessment of restenosis after PTA.

Objective  To investigate the current status of human resource and blood purification equipment in hemodialysis centers in Xizang Autonomous Region, and provide references for policy-making.  Methods A cross-sectional survey was conducted using questionnaires and on-site interviews to collect data of basic profiles, staffing, blood purification equipment, and technologies of all hemodialysis centers in Xizang Autonomous Region.  Results  As of July 31, 2025, there were 13 medical institutions providing hemodialysis services in Xizang, with 7 (53.85%) located in Lhasa. No county-level hospitals provided hemodialysis. The total number of maintenance hemodialysis patients was 1,062. These centers employed 116 registered nurses, resulting in a nurse-to-patient ratio of 1:9.2. There were 17 full-time physicians dedicated to hemodialysis, with a physician-to-patient ratio of 1:62.5. Six hemodialysis engineers were available across Xizang Autonomous Region. The 13 hemodialysis centers provided 282 dialysis machine stations. Most centers could offer conventional blood purification services including hemodialysis, hemodiafiltration and hemoperfusion. Continuous renal replacement therapy, plasma exchange, artificial liver support, and endotoxin adsorption could be conducted in 76.92%, 53.85%, 38.46% and 23.08% respectively of the centers.  Conclusions  Hemodialysis resources are relatively insufficient and unevenly distributed in Xizang Autonomous Region, especially with the shortages of professional nurses, physicians, engineers, and senior personnels. More policy support, optimized resource allocation, and enhanced recruitment and training of professionals are the key steps to promote sustainable development of hemodialysis services in Xizang.

Objective To culturally adapt the needling patient reported experience measure (NPREM) and to evaluate its reliability and validity in maintenance hemodialysis patients.  Methods  Following the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) guidelines, the NPREM was translated, back-translated, and culturally adapted. A total of 420 maintenance hemodialysis patients was consecutively recruited between December 2025 and January 2026 from the Hemodialysis Center of the Second Affiliated Hospital of The Third Military Medical University, Chongqing. These samples were randomly divided into two parts using simple randomization (approximately 1:1 ratio) for exploratory factor analysis (EFA, n=200) and confirmatory factor analysis (CFA, n=220). Sixty patients were randomly selected using a random number table for retest.  Results  The Chinese version of NPREM comprised 26 scored items. EFA extracted 5 factors with a cumulative variance contribution rate of 70.42%. CFA showed that the normed chi-square (χ²/df) was 1.480, root mean square error of approximation (RMSEA) was 0.047, and comparative fit index (CFI) was 0.950. The item-level content validity index (I-CVI) was 0.85～1.00, and scale-level content validity index/average (S-CVI/Ave) was 0.996. The total scale Cronbach's α was 0.931, and the test-retest intraclass correlation coefficient (ICC) was 0.824 (95% CI: 0.146～0.941).  Conclusion  The Chinese version of NPREM has good reliability and validity and can be used as a tool to assess needling experience in maintenance hemodialysis patients in China.

Acute boric acid poisoning is a rare clinical emergency. We report the successful treatment of acute boric acid poisoning in a patient with anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis. The patient accidentally ingested a lethal dose of boric acid during hospitalization, presenting with clinical symptoms including nausea, vomiting and dizziness. After hemodialysis treatment, the patient’s symptoms completely resolved without severe complications, and the vasculitis achieved a favorable response. Currently, there is no specific antidote for boric acid poisoning, and hemodialysis serves as an effective treatment modality. Clinical cases of hemodialysis for acute boric acid poisoning are relatively scarce. This case provides valuable reference for the management of acute boric acid poisoning in emergency settings.