Heparin-induced thrombocytopenia (HIT) is an immune-mediated adverse reaction occurring during the use of heparin-based drugs, characterized by a decline in platelet count and/or thrombosis. Patients undergoing hemodialysis (HD) may be at higher risk of developing HIT than the general population due to long-term, repeated exposure to heparin preparations, and are more prone to life-threatening thrombotic events. However, there is currently no specific consensus or guideline for the management of HIT in the HD population either domestically or internationally, leading to difficulties in diagnosis, insufficient testing capacity, and inconsistent treatment strategies in clinical practice. To address these issues, a multidisciplinary expert committee comprising nephrologists, cardiovascular physicians, and clinical pharmacists developed recommendations for the prevention and treatment of HIT specifically applicable to the HD population. Based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach and Delphi method expert voting, the committee systematically integrated domestic and international evidence-based medicine on HIT and clinical experience in HD. The recommendations cover the definition, risk factors, pathogenesis, clinical manifestations, diagnosis and differential diagnosis, screening strategies, anticoagulation therapy and monitoring, special treatments, and management of heparin re-exposure. This consensus aims to provide evidence-based guidance for standardized HIT management in HD patients, enhance clinical awareness and vigilance of the disease, reduce the rate of missed diagnosis and thrombotic mortality, and ultimately improve patient outcomes.

Objective To explore the effect of segmental citrate anticoagulation on unplanned discontinuation of continuous renal replacement therapy (CRRT), and to provide a reference for clinical CRRT quality management. Methods  Eighty CRRT patients in the intensive care unit of Affiliated Hospital of Hebei University from January to September 2025 were retrospectively selected and divided into a segmental anticoagulation group and a non-segmental anticoagulation group. Indicators including general data, treatment duration, unplanned discontinuation rate, venous chamber coagulation, transmembrane pressure, return pressure, laboratory test results, and average treatment cost were collected, and the differences in these indicators between the two groups were compared. Results  The incidence of unplanned discontinuation (χ²=9.928, P=0.002), the incidence of venous chamber coagulation (χ²=12.679, P=0.002), and the average treatment cost (t=-5.498, P＜0.001) in the segmental anticoagulation group were all lower than those in the non-segmental anticoagulation group, while the average treatment duration (t=7.576, P＜0.001) was longer. There were no significant overall differences in internal environment indicators between the two groups during treatment, except that the post-filtration ionized calcium in the segmental anticoagulation group was slightly higher than that in the non-segmental anticoagulation group at the 6th hour of treatment (t=2.793, P=0.007), but this difference was within the clinical safety range. At the end of treatment, no significant differences were observed between the two groups in peripheral ionized calcium (t=-0.769, P=0.444), post-filtration ionized calcium (t=-0.358, P=0.721), pH value (t=1.030, P=0.306), or bicarbonate ion (t=-0.883, P=0.380). Conclusion  Segmental citrate anticoagulation can effectively reduce the incidence of CRRT unplanned discontinuation, improve the efficiency of CRRT treatment, and reduce the economic burden on patients.

Objective  To develop a prediction model for sleep disorders in maintenance peritoneal dialysis (PD) patients based on machine learning (ML) algorithms.  Methods  A multicenter cross-sectional study was conducted, enrolling 578 PD patients admitted to 20 hospitals, including Xinjiang Uygur Autonomous Region People's Hospital and The Second People's Hospital of Kashi Prefecture, from January to December 2024. Based on the pittsburgh sleep quality index (PSQI), the patients were divided into a non-sleep disorder group (total score ＜ 7) and a sleep disorder group (score≥ 7), and randomly assigned to a training set and an internal validation set at a 6:4 ratio. Univariate logistic regression (ULR), the random forest-based Boruta algorithm, and the least absolute shrinkage and selection operator (LASSO) were used to identify key predictive indicators. The union of these variables was further screened through multivariate logistic regression (MLR). The ultimately retained feature variables were used to train six machine learning models to identify the optimal model, and its interpretability was evaluated using Shapley additive explanations (SHAP). Results  MLR confirmed that age (OR=1.029, 95% CI: 1.011～1.049, P=0.002), pruritus (OR=2.266, 95%CI: 1.325～3.970, P=0.003), anxiety (OR=4.075, 95% CI: 2.399～7.012, P＜0.001), Kt/V (OR=2.065, 95%CI: 1.210～3.577, P=0.008), and serum calcium (OR=7.476, 95% CI: 2.614～22.610, P＜0.001) were independent risk factors for sleep disorders in PD patients. Among the constructed models, the extreme gradient boosting (XGB) model performed best, achieving an area under the receiver operating characteristic (ROC) curve of 0.830 (95% CI: 0.780～0.870) in the training set and 0.660 (95%CI: 0.560～0.760) in the internal validation set, with an accuracy of 0.800. SHAP plots indicated that total protein, serum calcium, and age were the three most important predictive features.   Conclusions  This study successfully developed the first XGB-based prediction model for sleep disorders among PD patients in China, facilitating the early identification of high-risk populations and supporting precise interventions.  

Objective  Rapid peritoneal solute transport rate (PSTR) is a key factor affecting the prognosis of patients on peritoneal dialysis (PD). This study aimed to investigate the clinical risk factors for early development of rapid PSTR in PD patients.  Methods  A cross‑sectional study was conducted, enrolling 89 patients with end‑stage renal disease who initiated PD treatment at Beijing Tongren Hospital, Capital Medical University, between June 2020 and November 2025. All patients underwent a standard peritoneal equilibration test at 3 months (±2 weeks) after PD initiation. Rapid PSTR was defined as a 4-hour dialysate-to-plasma creatinine ratio (D/Pcr)≥0.65, and normal PSTR as D/Pcr＜0.65. Clinical data were collected concurrently, and independent risk factors for rapid PSTR were identified using univariate and multivariate logistic regression analyses.  Results  Fifty‑eight patients (65.2%) were classified as the rapid PSTR group and 31 as the normal PSTR group. Univariate analysis showed that the rapid PSTR group had significantly higher prevalence of diabetes (χ²=10.907, P=0.001), higher levels of carbon dioxide combining power (t=−1.995, P =0.049) and alkaline phosphatase (t=−2.343, P=0.021), and lower levels of serum albumin (t=3.564, P=0.001) and hemoglobin (t=2.447, P=0.017) compared with the normal PSTR group. Correlation analysis revealed that D/Pcr was positively correlated with glycated hemoglobin (r=0.311, P=0.017) and B‑type natriuretic peptide (r=0.274, P=0.012), and negatively correlated with serum albumin (r=−0.481, P＜0.001) and hemoglobin (r=−0.227, P=0.037). Multivariate logistic regression identified a history of diabetes (OR=4.379, 95% CI: 1.531～12.522, P =0.006) and decreased serum albumin level (OR=0.835, 95% CI: 0.739～0.943, P=0.004) as independent risk factors for rapid PSTR. Conclusion  In the early stage of PD, a history of diabetes and hypoalbuminemia are independent risk factors for rapid PSTR. For PD patients with diabetes or malnutrition, early monitoring of peritoneal function is recommended to enable individualized prescription management. 

Objective  To investigate the changes in serum levels of sphingosine‑1‑phosphate receptor 1 (S1P1), soluble CD14 subtype (sCD14‑ST), and stress‑induced protein 2 (Sestrin2) in peritoneal dialysis (PD) patients with septic peritonitis (SP), and to evaluate their diagnostic value.  Methods  PD patients treated at Shenzhen Longgang Central Hospital from July 2022 to July 2025 were enrolled and divided into an SP group and a non‑SP group according to the presence of SP. Serum levels of S1P1, sCD14‑ST, and Sestrin2 were measured by ELISA. Logistic regression was used to analyze influencing factors. Receiver operating characteristic (ROC) curve analysis was performed to evaluate diagnostic value. Internal validation was conducted using the Bootstrap method. Model calibration was assessed with the Hosmer‑Lemeshow test, and clinical utility was evaluated using decision curve analysis (DCA).  Results  A total of 92 patients were included, with 33 in the SP group and 59 in the non‑SP group. Among the pathogenic organisms, Gram‑negative bacteria accounted for 22 strains (62.86%) and Gram‑positive bacteria for 13 strains (37.14%). Compared with the non‑SP group, the SP group had significantly higher serum levels of C‑reactive protein (CRP), sCD14‑ST, and Sestrin2, and lower levels of albumin (Alb) and S1P1 (t = 17.840, 7.053, 7.395, 5.189, and 7.053, respectively, all  P＜0.001). Serum levels of S1P1 (OR=0.493, 95% CI: 0.318～0.765, P=0.002), sCD14‑ST (OR=2.305, 95% CI: 1.202～4.419, P=0.012), and Sestrin2 (OR=2.918, 95% CI: 1.416～6.014, P=0.004) were factors influencing the occurrence of SP in PD patients. The areas under the ROC curve (AUC) for S1P1, sCD14‑ST, Sestrin2 alone, and their combination in diagnosing SP in PD patients were 0.887～(95% CI: 0.804～0.944), 0.796 (95% CI: 0.699～0.873), 0.801 (95% CI: 0.705～0.877), and 0.948 (95% CI: 0.881～0.984), respectively. The combined diagnostic performance was superior to each individual marker (Z/P = 2.079/0.038, 2.948/0.003, and 2.893/0.004, respectively).  Conclusion  In PD patients with SP, serum S1P1 level is decreased, while sCD14‑ST and Sestrin2 levels are increased. The combination of these three markers demonstrates higher diagnostic efficacy for SP in PD patients.

Objective  To investigate the predictive value of serum Wnt family member 3A (Wnt3A), serum uric acid/creatinine ratio (SUA/Scr), and adropin for the prognosis of uremic hemodialysis patients based on receiver operating characteristic (ROC) curve and decision curve analysis (DCA).  Methods Patients undergoing hemodialysis at the 305th Hospital of the People's Liberation Army of China from September 2022 to September 2024 were prospectively enrolled as the study group and divided into poor‑prognosis and good‑prognosis subgroups based on 1‑year follow‑up outcomes. Non‑hemodialysis patients with chronic kidney disease (CKD) during the same period were selected as the control group. Serum levels of Wnt3A and adropin were measured by enzyme‑linked immunosorbent assay, and SUA and Scr were determined using an automated biochemical analyzer, with SUA/Scr calculated accordingly. Multivariate logistic regression was used to analyze prognostic factors. ROC curve analysis was performed to evaluate the predictive value of Wnt3A, SUA/Scr, and adropin for prognosis, and DCA was applied to assess the clinical utility of the prediction model.  Results  A total of 204 patients were enrolled in each group. The study group had significantly higher Wnt3A and lower SUA/Scr and adropin levels than the control group (t/Z = 8.377, 14.621, and 12.759, respectively, all P＜0.001). Based on 1-year follow-up, the study group was divided into the good-prognosis (n=141) and poor-prognosis (n=63) subgroups. Patients in the poor-prognosis subgroup had significantly higher Wnt3A and SUA/Scr and lower adropin levels compared with the good-prognosis subgroup (t/Z = 8.138, 6.934, and 10.811, respectively, all P＜0.001). Multivariate logistic regression identified age, dialysis vintage, intact parathyroid hormone, Wnt3A, SUA/Scr, and adropin as factors influencing poor prognosis [OR=1.261 (95% CI: 1.049～1.516), 1.762 (95% CI: 1.177～2.638), 1.553 (95% CI: 1.171～2.059), 1.892 (95% CI: 1.319～2.714), 1.942 (95% CI: 1.310～2.880), and 0.449 (95% CI: 0.270～0.746), with P=0.014, 0.006, 0.002, 0.001, 0.001, and 0.002, respectively]. ROC analysis showed that the area under the curve (AUC) for the combined prediction of poor prognosis using Wnt3A, SUA/Scr, and adropin was 0.953 (95% CI: 0.928～0.979), which was significantly greater than that of each marker alone [Wnt3A: AUC=0.803, SUA/Scr: AUC=0.822, adropin: AUC=0.837; Z values vs. combined model were 4.121, 3.693, and 3.650, respectively, all P＜0.001]. DCA results indicated that the combined prediction model provided a higher net benefit than each individual marker across threshold probabilities ranging from 0.04 to 0.95.  Conclusion  In hemodialysis patients with poor prognosis, serum Wnt3A and SUA/Scr levels are elevated while adropin level is decreased. The combined detection of these three markers offers superior predictive value for prognosis.

Objective To analyze the predictive value of serum sterol regulatory element binding protein-1 (SREBP1), kidney injury molecule-1 (KIM-1), and zinc finger protein Zic family member 3 (ZIC3) levels for the occurrence of major adverse cardiac and cerebrovascular events (MACCE) in maintenance hemodialysis (MHD) patients.  Methods A total of 189 patients undergoing MHD in Handan First Hospital from May 2021 to May 2024 were prospectively enrolled as the MHD group, and a total of 189 healthy individuals from the health check-up department in the same period were recruited as the control group. Based on the presence or absence of MACCE, patients in the MHD group were further divided into MACCE group (n=51) and none MACCE (N-MACCE) group (n=138). Clinical data, serum levels of SREBP1, KIM-1 and ZIC3 were compared between MACCE and N-MACCE groups, and their correlations with MACCE were analyzed. Multivariate regression was conducted to explore the factors associated with MACCE. ROC curve and DCA curve were used to evaluate the predictive value and clinical practicability of serum levels of SREBP1, KIM-1 and ZIC3 for MACCE.  Results  The MHD group had higher serum levels of SREBP1 (t=13.937, P＜0.001) and KIM-1 (t=73.041, P＜0.001), and a lower level of ZIC3 (t=8.894, P＜0.001), as compared with those in the control group. The MACCE group had higher dialysis age (t=4.156, P＜0.001), triglyceride (t=2.802, P=0.006), blood calcium (t=3.644, P＜0.001), SREBP1 (t=5.812, P＜0.001), and KIM-1 levels (t=6.081, P＜0.001), and a lower ZIC3 level (t=5.764, P＜0.001), as compared with those in the N-MACCE group. Serum levels of SREBP1, KIM-1 and ZIC3 were significantly correlated with dialysis age (to SREBP1, r=0.435; to KIM-1, r=0.503; to ZIC3, r=-0.464; P＜0.001), triglyceride (to SREBP1, r=0.327; to KIM-1, r=0.352; to ZIC3, r=-0.381; P＜0.001) and blood calcium (to SREBP1, r=0.514; to KIM-1, r=0.487; to ZIC3, r=-0.497; P＜0.001). Dialysis age (OR=1.327, 95% CI: 1.080～1.630, P=0.007), blood calcium (OR=1.878, 95% CI: 1.189～2.965, P=0.007), SREBP1 (OR=2.539, 95% CI: 1.449～4.447, P=0.001), KIM-1 (OR=2.744, 95% CI: 1.454～5.178, P=0.002), and ZIC3 (OR=0.596, 95% CI: 0.432～0.822, P=0.002) were the associated factors for the occurrence of MACCE. The AUCs of serum SREBP1, KIM-1, ZIC3 and combination of the three serum levels for predicting MACCE were 0.783, 0.784, 0.774, and 0.900, respectively, indicating that combination of the three serum levels is better than SREBP1, KIM-1 or ZIC3 for predicting MACCE (Zcombination-SREBP1=2.601, P=0.009; Zcombination-KIM-1=2.533, P=0.011; Zcombination-ZIC3=2.857, P=0.004). When the high-risk threshold was set at 0.07～0.85, the prediction model of combined SREBP1, KIM-1 and ZIC3 levels had a better clinical practicability.  Conclusion Serum levels of SREBP1, KIM-1 and ZIC3 are abnormal in MHD patients with MACCE. Combination of the three serum levels has a higher value and clinical practicability for predicting MACCE.

Objective To summarize the clinical features and management experience of infective endocarditis (IE) in maintenance hemodialysis (MHD) patients, and to provide features for early recognition and treatment of IE.  Methods  We retrospectively analyzed 8 patients with MHD-related infective endocarditis (MHD-IE) admitted to Department of Nephrology, the First Hospital of Hebei Medical University between June 2020 and October 2024. Demographic data, clinical characteristics, treatments, and outcomes were reviewed.  Results  All patients were males, with a median age of 49.5 years (IQR 41.0～59.5) and a median dialysis vintage of 48 months (IQR 15～96). Fever (75.0%) was the most common presenting symptom, followed by dyspnea (25.0%). Blood cultures were positive in 6 patients (75.0%). All of the 4 patients with tunneled cuffed catheter-related IE underwent prompt removal of the catheters after diagnosis. Two patients received valve replacement surgery. In-hospital mortality was 62.5% (5/8). All of the 3 patients with isolated right-sided IE survived.   Conclusion  MHD-IE is associated with high mortality and nonspecific clinical presentation. Staphylococcus aureus is the major pathogen. Right-sided infective endocarditis (LSIE) has a better prognosis than left-sided infective endocarditis(LSIE). IE patients with inadequate response to medical therapy or severe complications should be promptly evaluated for the possibility of surgical intervention.

Objective  To explore the predictive value of serum levels of upstream stimulatory factor 2 (USF2), thioredoxin interacting protein (TXNIP), and Rho-associated coiled-coil containing protein kinase 2 (ROCK2) for the prognosis of patients with chronic renal failure (CRF) on hemodialysis.  Methods  A total of 85 CRF patients treated with hemodialysis for the first time in Cangzhou Hospital of Integrated TCM-WH Hebei from January 2021 to December 2022 were recruited as the research subjects. Enzyme linked immunosorbent assay (ELISA) was used to determine serum levels of USF2, TXNIP, and ROCK2. Logistic regression was used to explore the factors affecting prognosis of the CRF patients. Receiver operating characteristic (ROC) curve was used to assess the predictive value of serum levels of USF2, TXNIP, and ROCK2 for prognosis of the CRF patients. Moreover, Hosmer-Lemeshow (H-L) test was used for internal verification of the predictive models.  Results  Among the 85 CRF patient after hemodialysis treatment, 29 (34.12%) had a poorer prognosis, and 56 (65.88%) had a better prognosis. Compared with the better prognosis group, the poorer prognosis group had higher levels of serum USF2, TXNIP, and ROCK2 (t=6.603, 7.230 and 8.731 respectively; P＜0.001). Serum USF2 (HR=2.914, 95% CI: 1.365～6.222, P=0.006), TXNIP (HR=3.209, 95% CI: 1.717～5.997, P＜0.001), and ROCK2 (HR=2.135, 95% CI: 1.268～3.596, P=0.004) were the risk factors affecting prognosis of the CRF patients. The combination of serum USF2, TXNIP, and ROCK2 had higher area under the curve (AUC) than USF2, TXNIP or ROCK2 for predicting prognosis of the CRF patients (Zcombination-USF2=3.088, P=0.002; Zcombination-TXNIP=2.402, P=0.016; Zcombination-ROCK2=2.872, P=0.004).  Conclusion  Serum levels of USF2, TXNIP, and ROCK2 have a better predictive value for the prognosis of CRF patients on hemodialysis.

Objective  To investigate the diagnostic value of peripheral blood coagulation parameters and procalcitonin (PCT) levels in sepsis‑associated acute kidney injury (AKI). Methods  Medical records of 131 septic patients admitted to Jieshou People’s Hospital from September 2021 to February 2025 were retrospectively selected. Patients were divided into an observation group (sepsis with AKI, n=55) and a control group (sepsis without AKI, n = 76). Coagulation parameters and PCT levels were compared between the two groups, and their diagnostic value for sepsis‑associated AKI was analyzed. Results  The observation group had significantly higher levels of activated partial thromboplastin time (APTT), fibrinogen (FIB), thrombin time (TT), D‑dimer, PCT, serum creatinine (Scr), blood urea nitrogen (BUN), and cystatin C (Cys C) than the control group (t=4.909, 6.139, 7.488, 6.629, 8.685, 2.797, 4.987, 4.333; all P＜0.001). Logistic regression analysis showed that elevated levels of APTT (OR=1.483, 95% CI: 1.293～1.700, P＜0.001), FIB (OR=11.761, 95% CI: 4.902～28.217, P＜0.001), TT (OR=5.755, 95% CI: 2.952～11.219, P＜0.001), D‑dimer (OR=13.573, 95% CI: 5.192～35.482, P＜0.001), PCT (OR=3.196, 95% CI: 1.946～5.249, P=0.036), Scr (OR=1.073, 95% CI: 1.045～1.101, P＜0.001), BUN (OR=1.030, 95% CI: 0.925～1.148, P＜0.001), and Cys C (OR=4.301, 95% CI: 2.546～7.268, P＜0.001) were independent risk factors for AKI in septic patients. The area under the curve (AUC) of the combined diagnosis using APTT, FIB, TT, D‑dimer, and PCT for sepsis‑associated AKI was 0.903(ZAPTT vs. combined=3.215, P=0.001; ZFIB vs. combined =3.458, P=0.001; ZTT vs combined=2.437, P=0.015; ZD-dimer vs. combined=3.681, P＜0.001; ZPCT vs. combined=2.519, P=0.012).  Conclusion  Elevated coagulation parameters, PCT, and renal function indices are independent risk factors for sepsis-associated AKI. The combination of coagulation parameters and PCT demonstrates good diagnostic performance.

Objective  To investigate the regulatory effects of intestinal-derived uremic toxin trimethylamine oxide (TMAO) on the JNK/Bcl-2 signaling pathway and the mechanisms of vascular endothelial cell injury in uremic rats.  Methods  Five-week-old SD rats were selected and established as uremia models. The rats were divided into model group, TMAO group (3% TMAO), SP600125 group (15 mg/kg), TMAO+SP group, and sham operation control group (n=12). Body weight, 24-hour urinary protein, serum creatinine (Scr), and blood urea nitrogen (BUN) levels were measured. Histopathological changes were observed using PAS and HE staining. The expressions of endothelial nitric oxide synthase (eNOS) and vascular cell adhesion molecule-1 (VCAM-1) were detected by RT-qPCR and immunohistochemistry. Tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and interleukin-6 (IL-6) were measured by ELISA. Superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and malondialdehyde (MDA) were measured. Cell apoptosis was assessed by TUNEL method. The expressions of Bax, Caspase-3, p-JNK, and p-Bcl-2 were determined by western blot.  Results  Compared with the sham operation control group, the model group exhibited elevated Scr, blood BUN, and urinary protein (F=8.640, 13.025 and 10.998 respectively; P＜0.001), decreased eNOS expression and increased VCAM-1 expression (F=21.951, 20.080; P＜0.001), elevated TNF-α, IL-1β, and IL-6 (F=10.678, 32.043 and 21.181 respectively; P＜0.001), reduced SOD and GSH-Px activity with increased MDA level (F=14.172, 11.445 and 13.984 respectively; P＜0.001), and increased TUNEL positivity rate along with elevated Bax, caspase-3, p-JNK, and p-Bcl-2 (F=36.357, 12.926, 10.092, 20.842 and 19.200 respectively; P＜0.001). TMAO further exacerbated these pathological changes. SP600125 reversed the pathological changes in model group as described above, including reduced Scr, BUN, and urinary protein (F=8.640, 13.025 and 10.998 respectively; P＜0.001), upregulated eNOS expression and downregulated VCAM-1 expression (F=21.951, 20.080; P＜0.001), decreased TNF-α, IL-1β, and IL-6 (F=10.678, 32.043 and 21.181 respectively; P＜0.001), increased the activities of SOD and GSH-Px and reduced MDA level (F=14.172, 11.445 and 13.984 respectively; P＜0.001), decreased TUNEL positivity rate and the expressions of Bax, Caspase-3, p-JNK, and p-Bcl-2 (F=36.357, 12.926, 10.092, 20.842 and 19.200 respectively; P＜0.001).  Conclusion TMAO aggravates vascular endothelial cell injury in uremic rats by activating the JNK/Bcl-2 signaling pathway, thereby promoting inflammatory responses, oxidative stress, and apoptosis.

Objective: Analyzing the effects of intradialytic neuromuscular electrical stimulation(NMES) on maintenance hemodialysis (MHD) patients. Methods: Relevant studies were searched from PubMed, Web of Science, Embase, Cochrane Library, CNKI, Wanfang, VIP, and SinoMed. A meta-analysis was performed using RevMan 5.4 and Stata 15.1 software. Results: A total of 14 studies involving 806 patients were included. Meta-analysis showed that intradialytic NMES improved the quadriceps muscle strength in MHD patients (MD=4.53, 95%CI: 2.91~6.15, P<0.001), subgroup analyses revealed superior efficacy for stimulation frequencies≥50 Hz (MD=7.56, 95% CI: 5.45–9.66, P<0.001), and intervention durations≥30minutes (MD=4.72, 95% CI: 2.57–6.88, P<0.001). Intervention cycles ≥12 weeks (MD=4.47, 95% CI: 2.63–6.30, P<0.001) and <12 weeks (MD=4.82, 95% CI: 0.49–9.15, P=0.029) both improved muscle strength, but the difference between subgroups was not statistically significant (χ2=0.02,df=1,P=0.882). Intradialytic NMES improved the ?6-minute walk distance test, timed up and go test, and sit-to-stand test in MHD patients（MD=33.71，95%CI：10.25~57.17，P=0.005；MD=-0.75，95%CI：-1.35~-0.16，P=0.013；MD=2.16，95%CI：1.51~2.80，P＜0.001） and other indicators of physical functioning. There was no statistically significant difference in grip strength (MD=2.11, 95%CI: -0.39~4.61, P=0.099) between the two groups of MHD patients. Conclusion: Intradialytic NMES can improve the lower limb muscle strength and physical function of MHD patients, and medical staff can develop personalized intervention plans based on the patient's condition to achieve better clinical outcomes.

Objective  To investigate the risk factors for the occurrence of central venous stenosis (CVS) in patients undergoing maintenance hemodialysis (MHD) and to evaluate their predictive capabilities.  Methods   A retrospective study was conducted on the clinical data of 146 MHD patients treated at the First Affiliated Hospital of Gannan Medical University between January 2022 and September 2023. Seventy-five patients diagnosed with CVS were assigned to the observation group (comprising 54 cases of primary stenosis and 21 cases of restenosis), and 71 patients without CVS symptoms served as the control group. General clinical data and laboratory parameters were collected. Intergroup differences and univariate and multivariate logistic regression were used to identify the independent risk factors. The predictive performance was estimated using the area under the receiver operating characteristic curve (AUC) and other relevant indices.  Results  Intergroup analysis showed that the observation group had lower lymphocyte count (Z=-3.350, P＜0.001) and higher neutrophil-to-lymphocyte ratio (NLR) (Z=2.878, P=0.004) and platelet volume related indices (PVIs) (Z=3.500, P＜0.001), as compared those with the control group. Compared with the primary stenosis group, the restenosis group had bigger mean platelet volume (MPV) (t=-2.152, P=0.037), which was an independent risk factor for restenosis following CVS intervention (OR=1.821, 95% CI: 01.020～3.247, P=0.043). Multifactorial logistic regression indicated that lymphocyte count (OR=0.102, 95% CI: 0.016～0.653, P=0.016) and PVIs (OR=1.343, 95% CI: 1.015～1.778, P=0.039) were the independent risk factors for CVS in MHD patients. The predictive performance of PVIs (AUC=0.849) was superior to that of the lymphocyte count (AUC=0.798). The predictive value for CVS by combined both factors yielded an AUC of 0.854, with a sensitivity of 80.8% and a specificity of 78.4%.  Conclusion  PVIs and lymphocyte count are independent risk factors for the development of CVS in MHD patients. Combination of these two parameters obtains a higher predictive value and can serve as effective biomarkers for early screening and risk assessment of CVS.

Objective To compare the efficacy of five disinfection methods, including peracetic acid, sodium hypochlorite, enzymatic detergent, alkaline wash, and steam, for biofilm removal in hemodialysis water supply pipelines using a multidimensional evaluation system involving "bacterial count - endotoxin quantification - electron microscopic morphology".  Methods  A mature biofilm model of Pseudomonas aeruginosa (ATCC 27853) was established on 316L stainless steel carriers. The samples were divided into six treatment groups: a control group, 0.2% peracetic acid, 0.2% sodium hypochlorite, enzymatic detergent, alkaline wash and hot steam, with each group repeated independently three times. After treatment, bacterial residues were detected using both Luria-Bertani (LB) agar and Reasoner's 2A (R2A) low-nutrient agar to calculate the Log Reduction Value (LRV); endotoxin LRV was determined by kinetic turbidimetric assay; and physical removal was verified by scanning electron microscopy (SEM).  Results  ①Bacterial removal: The bacterial count in the control group on LB media was (1.37±1.10)×107 CFU/ml. There was a statistically significant difference in the overall LB-LRV values between the groups (F=64.330, P＜0.001). No bacteria were detected in the hot steam group in either of the two culture media (LB-LRV >7.14); there were no statistically significant differences in the bactericidal efficacy of the peracetic acid group and the sodium hypochlorite group compared with the hot steam group (t=1.017, 2.580; P=0.842, 0.148).  ②Endotoxin removal efficacy: The endotoxin concentration in the control group was (1.14±1.05)×104 EU/ml. Overall differences in endotoxin LRV among treatment groups were statistically significant (F=10.480, P=0.001). The hot steam group demonstrated superior removal efficacy (LRV=2.23) compared with the peracetic acid group (t=4.571, P=0.007), the enzymatic detergent group (t=4.636, P=0.006) and the alkaline detergent group (t=5.171, P=0.003).  ③Electron microscopic morphology: Fragments of biofilm were observed in the peracetic acid group, the sodium hypochlorite group and the hot steam group; in the peracetic acid group, bacteria appeared shrivelled but matrix residues remained; in the enzymatic detergent group and the alkaline detergent group, a large number of intact bacteria or cell aggregates were still observed.  Conclusions  Among the five biofilm removal methods, the steam group was significantly superior to other groups in sterilization, endotoxin removal, and physical detachment. Sodium hypochlorite achieved effective bacterial eradication while exhibiting favorable trends in endotoxin clearance and substrate detachment, yielding the second-best results. Although some disinfection methods met the bacterial quality control standards for dialysis water, none of the five single disinfection methods met the dialysis water standards for biofilm endotoxin removal.

Objectives  This study classified food consumed by patients during hemodialysis using K-means clustering analysis, observed the effect of different food type on blood glucose fluctuations during dialysis, and identified the food type beneficial to stabilize blood glucose.  Methods  The unit energy density index of every food was calculated based on its weight (in grams) and nutritional components (calories, carbohydrates, protein, and fat). K-means clustering was applied to categorize different food types.  Results  A total of 34 patients were enrolled in this study, with each type of food consumed by the patients regarded as one sample, yielding 144 samples in total. Four food groups were identified via clustering analysis: group 1 (high-sugar and high-fat), group 2 (high-carbohydrate), group 3 (low-density), and group 4 (high-protein). Different food group exerted significant effect on intradialytic blood glucose fluctuation: overall comparison showed H=61.593 and P=0.001; pairwise comparisons revealed significant differences in blood glucose change after food intake for one hour between the high-protein group and the high-sugar high-fat group (H=0.000, P＜0.01) as well as between the high-sugar high-fat group and the high-carbohydrate group (H=0.000, P＜0.01). The high-sugar high-fat group exhibited the most prominent glucose-raising effect [1.20 (0.70, 1.52) mmol/L]; blood glucose level generally decreased in the high-carbohydrate group [-1.20 (-2.08, -0.40) mmol/L] and the high-protein group [-1.31 (-2.08, 0.35) mmol/L]; the low-density group was associated with a slightly upward trend of blood glucose [0.30 (-1.50, 0.95) mmol/L].  Conclusions  High-protein food is recommended to the patients in the first hour of hemodialysis, followed by high-carbohydrate food. A small amount of high-sugar and high-fat food may be consumed in the final hour of dialysis. Large portions of low-energy-density food are not recommended on hemodialysis.