Secondary hyperparathyroidism (SHPT) represents a prevalent and severe complication in patients with chronic kidney disease (CKD), particularly those progressing to end-stage renal disease. The parathyroid hormone type 1 receptor (PTH1R), serving as a pivotal regulator of calcium-phosphate homeostasis, has emerged as a compelling therapeutic target for innovative interventions. Compared to traditional peptide-based drugs, antibody-based drugs targeting PTH1R offer advantages such as high affinity, high specificity, and the potential for engineered modifications. Antagonistic PTH1R antibodies can effectively block the PTH/PTHrP signaling pathway and have demonstrated potential in SHPT animal models to reduce serum intact Parathyroid Hormone (iPTH) and phosphorus levels, as well as alleviate parathyroid hyperplasia. Based on recent domestic and international literature, this paper systematically analyzes the biological functions of PTH1R, its mechanism of action in SHPT, and the technical advantages of antibody screening—particularly nanobodies—such as phage display technology. It aims to review the functional characteristics of therapeutic antibodies targeting PTH1R and their potential application value in SHPT treatment. Future research should focus on antibody humanization, long-acting design, and long-term safety evaluation in CKD models to facilitate their clinical translation.

Objective To investigate the role of serum transforming growth factor beta 1 (TGF?β1) in the maturation of autogenous arteriovenous fistula (AVF) in maintenance hemodialysis (MHD) patients, and to provide a potential biomarker for predicting AVF functional outcome. Methods Clinical data of 30 MHD patients treated in our hospital from December 2023 to September 2025 were prospectively collected. All patients received internal jugular vein semi?permanent catheters as initial vascular access, followed by forearm radial artery?cephalic vein end?to?side anastomosis for AVF construction. Serum TGF?β1 levels were measured by enzyme?linked immunosorbent assay (ELISA) before operation and 3 months after operation. At 3 months after operation, brachial artery blood flow and cephalic vein diameter were measured by ultrasonography. Patients were divided into good AVF function group (n=21) and poor AVF function group (n=9). Serum TGF?β1 levels and increase rates were compared between the two groups, and the correlation between TGF?β1 and AVF function was analyzed. Partial patients with poor function underwent AVF reconstruction, and the above indicators were detected 3 months after reconstruction. Results All 30 cases completed surgery and follow?up without severe complications. There was no statistically significant difference in preoperative TGF?β1 levels between the two groups (Mann?Whitney U test, U=92.000, P=0.929). At 3 months postoperatively, the serum TGF-β1 level was (356.846±200.492) pg/mL in the good function group and (207.099±174.002) pg/mL in the poor function group, with no statistically significant difference (t=1.945, P=0.062). The TGF?β1 growth rate in the good function group [1.314（-2.416，5.044）] was significantly higher than that in the poor function group [0.280（-1.050，1.610）] (Mann?Whitney U test, U=44.000, P=0.022). Spearman rank correlation showed that the magnitude of TGF?β1 increase was positively correlated with brachial artery blood flow (r?=0.531, P=0.003) and positively correlated with cephalic vein diameter (r?=0.376, P=0.041). TGF?β1 level, growth rate, blood flow and cephalic vein diameter were all significantly improved in 5 cases after reconstruction (paired Wilcoxon signed?rank test was used for each indicator, Z=-2.023, P=0.043). Conclusion The increase amplitude of serum TGF?β1 after AVF operation is closely related to fistula maturation and function in MHD patients. The increase amplitude is significantly lower in patients with poor AVF function, and significantly increased after successful reconstruction. The increase amplitude of TGF?β1 can be used as a biomarker for predicting AVF dysfunction, providing reference for early clinical intervention. Key words: Maintenance hemodialysis; Autogenous arteriovenous fistula; Transforming growth factor β1; Biomarker; Vascular access

Dialysis indwelling catheters are commonly used consumables in blood purification centers. high-molecular-weight material catheters provide better comfort when left in blood vessels, earning recognition from medical professionals and patients, leading to increasing clinical usage. In the face of the lack of national and industry standards for this medical device, identifying key effectiveness and safety criteria and conducting reasonable technical evaluations will ensure the safe use of dialysis catheters in blood purification centers. This article summarizes recent technical review principles, introduces key technical evaluation and testing points for dialysis indwelling catheters, as well as requirements for critical performance research, providing references for regulatory agencies, manufacturers, technical reviewers, and blood purification centers.

【Abstract】Objective: To establish an HPLC method for simultaneous determination of acetate and citrate in hemodialysis solution and its concentrate, so as to improve detection efficiency, reduce cost and simplify operation. Methods: An octadecylsilyl-bonded monodisperse porous silica microsphere column was used with 50 mmol/L phosphate buffer (pH=2.0) as mobile phase. The flow rate was 1.0 mL/min, the detection wavelength was 210 nm, and the column temperature was 30℃. The contents of acetate and citrate in samples were determined. Results: Acetate showed good linearity in the range of 1-20 mmol/L (r=0.999957), with recoveries of 99.07%-103.41% and RSD of 2.37% (n=3). Citrate showed good linearity in the range of 0.1-15 mmol/L (r=0.999966), with recoveries of 101.71%-104.49% and RSD of 1.42% (n=3). Conclusion: The method is simple and accurate, which can be used for simultaneous determination of acetate and citrate in hemodialysis solution and its concentrate, and is suitable for quality control in production and use, effectively improving detection efficiency.

Objective: To explore the relationship between blood pressure variability during dialysis and post-dialysis fatigue in maintenance hemodialysis (MHD). Method: Patients who undergoing maintenance hemodialysis treatment at the Blood Purification Center of Renji Hospital affiliated to Shanghai Jiao Tong University School of Medicine from November 2024 to February 2025 were enrolled in this study. Blood pressure values were collected for a total of 6 times of patients undergoing dialysis treatment, and the coefficient of variation was calculated. The Visual Analog Fatigue Scale was used to evaluate post-dialysis fatigue symptoms. Analyzed the correlation between the coefficient of variation of blood pressure during dialysis and post-dialysis fatigue.Patients were divided into four groups based on the quartiles of blood pressure variability coefficient, and comparisons are made between the groups. Result: A total of 285 patients were included, with a post-dialysis fatigue score of 4.00 (3.00, 6.00). Correlation analysis showed that the coefficient of variation of systolic blood pressure, diastolic blood pressure, and pulse pressure difference were positively correlated with post-dialysis fatigue(r=0.243, P<0.001; r=0.108, P=0.034; r=0.119, P=0.023). Intergroup comparisons showed that post-dialysis fatigue increased progressively across groups with different systolic blood pressure variation coefficients [Low variability group (n=71), medium-low variability group (n=72), medium-high variability group (n=71), high variability group (n=71)] (χ2=17.184, P=0.001). For diastolic blood pressure variation coefficients, post-dialysis fatigue initially decreased and then increased across groups [Low variability group (n=71), medium-low variability group (n=72), medium-high variability group (n=71), high variability group (n=71)] (χ2=11.988, P=0.007). No statistically significant association was observed between pulse pressure variation coefficients and post-dialysis fatigue across groups[Low variability group (n=71), medium-low variability group (n=72), medium-high variability group (n=71), high variability group (n=71)] (χ2=3.048, P=0.284). Further analysis revealed that post-dialysis fatigue in elderly (n=177) and non-elderly (n=108) MHD patients was affected by the coefficient of variation of systolic blood pressure (χ2=17.208, P=0.001) and diastolic blood pressure (χ2=11.275, P=0.010), respectively. Conclusion: Blood pressure variability during dialysis was associated with post-dialysis fatigue. The management of post-dialysis fatigue should therefore differ between elderly and non-elderly MHD patients: elderly patients should prioritize controlling the coefficient of variation of systolic blood pressure, whereas non-elderly patients should focus on the coefficient of variation of diastolic blood pressure.

Dialysate leakage is a major non-infectious complication of peritoneal dialysis (PD). Late-stage leakage typically occurs more than 30 days after catheter insertion, and may present as subcutaneous edema, genital edema, hernia, or other manifestations. Treatments for dialysate leakage include surgical repair, temporary conversion to hemodialysis, and reduction of dialysate volume. Previous literature advocates early surgical repair to minimize complications when conservative treatment fails. Nevertheless, recurrence still occurs following surgical repair, resulting in the conversion to hemodialysis in many cases. The recurrence rate after surgery is high. In addition, some patients cannot accept surgery or switch to hemodialysis due to underlying diseases or personal will, which makes clinical management difficult. This article describes three patients with late-stage PD fluid leakage (all from the Peritoneal Dialysis Center of Zhongnan Hospital, Wuhan University), who presented with scrotal edema, subcutaneous leakage, and inguinal hernia, respectively. These patients continued to receive peritoneal dialysis via low-volume nocturnal automated peritoneal dialysis (LV-NAPD, a modality of automated peritoneal dialysis [APD]). No leakage recurred after 2–3 months, and the patients gradually resumed continuous ambulatory peritoneal dialysis (CAPD) treatment, thus avoiding conversion to hemodialysis. The center followed up the three patients for more than 5 years, and no recurrence of leakage was observed during this period. Therefore, low-volume nocturnal automated peritoneal dialysis can be considered an effective alternative therapeutic option for patients with dialysate leakage.

The Double Plasma Molecular Adsorption System (DPMAS) is a commonly used blood purification technique for treating severe liver diseases, with nurses playing a dominant role in its implementation. Therefore, the standardization and professionalism of nursing procedures are crucial for ensuring treatment safety. Currently, clinical nursing practice is characterized by inconsistent operational standards, inadequate implementation of procedural details, and improper use of equipment and consumables, which may affect treatment efficacy. To standardize nursing procedures and improve nursing quality, the Blood Purification Nursing Professional Committee of the Chinese Nursing Association organized experts from relevant fields to develop the Expert Consensus on Nursing Procedures for the Double Plasma Molecular Adsorption System (2026 Edition) based on domestic and international literature and clinical experience, with a focus on the standardization, practicality, and feasibility of nursing procedures. This Consensus aims to promote the standardized and consistent implementation of DPMAS procedures, thereby enhancing the safety and stability of the treatment process and providing more reliable and controllable blood purification support for patients with severe liver diseases.

Objective  To investigate the association between bone mineral density (BMD) and sarcopenia-related indicators and evaluate the predictive value of BMD for prognosis in patients undergoing maintenance hemodialysis (MHD). Methods This prospective cohort study enrolled MHD patients who received treatment at the Hemodialysis Center of the First Hospital of Hebei Medical University from June 1 to June 30, 2024. Baseline lumbar spine BMD was measured using quantitative computed tomography. Muscle function (handgrip strength, chair stand time, gait speed) and the skeletal muscle mass index (SMI) were assessed simultaneously. Clinical data and laboratory parameters were collected, and the patients were followed prospectively for 20 months. Multiple linear regression analysis was used to identify independent factors associated with BMD, and a Cox proportional hazards model was employed to assess the association with BMD and adverse clinical outcomes.  Results  A total of 125 MHD patients were included, with a mean BMD of (118.318±40.344) mg/cm³. Multiple linear regression revealed that increased age (β=-1.196, 95% CI:-1.797～
-0.595, P＜0.001) and prolonged chair stand time (β=-2.179, 95% CI:-3.968～-0.390, P=0.017) were independent risk factors for reduced BMD, while SMI was an independent protective factor (β=10.146, 95% CI: 3.550～16.742, P=0.003). During follow-up, BMD was an independent protective factor against cardio-cerebrovascular events in MHD patients (HR=0.990, 95% CI: 0.980～1.000, P=0.042).  Conclusion In MHD patients, increased age and impaired lower limb muscle function are independent risk factors for reduced BMD, while a higher SMI is a protective factor. Lower BMD is associated with an increased risk of cardio-cerebrovascular events in MHD patients. 

Objective  To observe cognitive function and changes in neuroimaging markers in patients with chronic kidney disease (CKD) before and after initiation of hemodialysis (HD), and to analyze the relationship between them. Methods  A prospective cohort study was conducted in 40 patients with stage 5 CKD. Laboratory tests, cognitive function assessment using the Montreal Cognitive Assessment (MoCA) scale, and brain magnetic resonance imaging (MRI) were performed before HD initiation and after 1 year of HD. Arterial spin labeling (ASL) and quantitative susceptibility mapping (QSM) were used to assess the cerebral blood flow (CBF) and susceptibility values in brain regions including the bilateral hippocampus, thalamus, caudate nucleus, and putamen. Changes in clinical indicators, cognitive function, as well as CBF, susceptibility values, and CBF- susceptibility coupling in the above-mentioned regions of interest before and after HD initiation were analyzed, and the relationship between cognitive function and CBF-susceptibility coupling was also explored. Results  32 patients completed the cohort follow-up of the study. After one year of HD treatment, cognitive function was significantly improved compared with t baseline (Z=-3.266, P＜0.001). Compared with the baseline, the CBF in the bilateral hippocampus and right thalamus decreased, while the CBF in the right caudate nucleus increased (t=2.192, P=0.036; Z=2.616, P=0.009; t=2.488, P=0.018; Z=-2.460, P=0.020); the susceptibility values in the bilateral hippocampus increased, and those in the bilateral caudate nucleus and bilateral putamen decreased (Z=-3.983, P＜0.001; Z=-3.833, P＜0.001; t=4.352, P＜0.001; t=2.165, P=0.038; t=3.810, P=0.001; Z=3.665, P＜0.001). More importantly, the CBF-susceptibility coupling in the bilateral hippocampus was significantly increased (Z=-3.646, P＜0.001; Z=-4.600, P＜0.001), and the improvement in cognitive function was correlated with an increase of CBF-susceptibility coupling in the right hippocampus (r=0.431, P=0.014).  Conclusion   After one year of HD, the changes in CBF, susceptibility values, and CBF-susceptibility coupling in some brain regions of CKD patients are partially reversed, which was associated with the improvement in cognitive function.

Objective  To investigate the serum expression levels of Notch homolog 1 (Notch1), vitamin K2 (VK2), and fibroblast growth factor receptor 1 (FGFR1) in patients undergoing maintenance hemodialysis (MHD), and to analyze their relationship with the development of vascular calcification.  Methods This cross-sectional study enrolled MHD patients treated at Hebei PetroChina Central Hospital from January 2022 to June 2023. Patients were divided into a calcification group and a non-calcification group based on abdominal lateral X-ray plain films. Serum levels of Notch1 and FGFR1 were measured using enzyme-linked immunosorbent assay (ELISA), and serum VK2 levels were determined by high-performance liquid chromatography–tandem mass spectrometry (HPLC-MS/MS). Clinical data of both groups were collected. Multivariate logistic regression analysis was used to identify independent risk factors for vascular calcification, and receiver operating characteristic (ROC) curves were employed to evaluate the predictive value of Notch1, FGFR1, and VK2.  Results  A total of 120 patients were included in this study, comprising 78 patients in the calcification group and 42 in the non-calcification group. Serum levels of Notch1 [(95.67±1.16) ng/L vs. (91.21±1.20) ng/L, t=81.189, P<0.001] and FGFR1 [(12.62±0.28) μg/L vs. (11.09±0.38) μg/L, t=2.600, P=0.011] were significantly higher in the calcification group than in the non-calcification group, while serum VK2 levels were significantly lower [(1.31±0.03)ng/L vs. (1.48±0.04) ng/L, t=40.391, P<0.001]. Multivariate logistic regression analysis identified prolonged dialysis vintage (OR=1.132, 95% CI: 1.022～1.253, P=0.017), elevated serum phosphorus (OR=3.228, 95% CI: 1.290～8.079, P=0.012), elevated intact parathyroid hormone (iPTH) (OR=1.030, 95% CI: 1.012～1.056, P=0.003), elevated Notch1 (OR=1.147, 95% CI: 1.002～1.313, P=0.047), low VK2 (OR=0.503, 95% CI: 0.339～0.746, P=0.001), and elevated high-sensitivity C-reactive protein (hs-CRP) (OR=5.447, 95% CI: 1.768～16.778, P=0.003) as independent risk factors for vascular calcification in MHD patients. ROC analysis demonstrated that the area under the curve (AUC) values for Notch1, VK2, and FGFR1 alone were 0.639, 0.700, and 0.656, respectively, whereas the combined detection of the three markers yielded an improved AUC of 0.785. The sensitivities of Notch1, VK2, and FGFR1 alone were 33.33%, 80.95%, and 78.57%, with specificities of 100.00%, 59.52%, and 47.62%, respectively; the combined detection achieved a sensitivity of 76.19% and a specificity of 73.81%. Conclusion  Serum Notch1 and FGFR1 expressions are up-regulated, while VK2 expression is down-regulated in MHD patients. Notch1 and VK2 are independent influencing factors for VC. The combined detection of these markers demonstrates high predictive value for VC, potentially providing a basis for early clinical screening and intervention.

Objective To investigate the clinical value of hemoperfusion with the neutral macroporous adsorption resin cartridge HA380 in patients with sepsis, and to analyze its effects on inflammatory levels, organ function, and short‑term prognosis. Methods  Eighty patients with sepsis admitted to FAW General Hospital of Jilin Province from January 2024 to December 2025 were enrolled and randomly divided equally into a control group and an observation group. The control group received standard comprehensive treatment for sepsis, while the observation group received additional HA380 hemoperfusion. Inflammatory markers, organ function indicators, Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and 28‑day mortality were compared between the two groups before and after treatment to evaluate the therapeutic efficacy. Results After the treatment course, the observation group showed significantly lower levels of C‑reactive protein, procalcitonin, interleukin‑6, tumor necrosis factor‑α, creatinine, and total bilirubin than the control group (Z/t=2.933, ‑2.012, ‑2.926, ‑2.276, 3.222, 2.998; P=0.004, 0.044, 0.003, 0.023, 0.002, 0.004, respectively), and a significantly higher oxygenation index (Z/t=‑4.478, P<0.001). The observation group also had lower SOFA and APACHE II scores than the control group (Z/t=4.418, 4.431, both P<0.001). Survival curve analysis showed that the mortality rate in the control group was higher than that in the observation group (χ²=3.971, P=0.046). Conclusion  HA380 hemoperfusion can effectively remove inflammatory mediators in septic patients, improve organ function, reduce the risk of organ failure and short‑term mortality, and optimize clinical prognosis.

Objective To retrospectively analyze the occurrence and clinical outcomes of peritoneal dialysis‑associated peritonitis (PDAP) at the largest peritoneal dialysis (PD) center in Xizang, and to provide evidence for improving the prevention and management of PDAP in this region. Methods Clinical data of patients with PDAP treated at the People's Hospital of Xizang Autonomous Region from October 2013 to July 2021 were collected. Patients were divided into a continued‑PD group and a PD‑withdrawal group based on final clinical outcomes. Clinical characteristics were analyzed, and factors influencing PDAP outcomes were explored. Results During the study period, 78 patients experienced 142 episodes of PDAP. The mean age at the time of peritonitis was (46.5±14.7) years, with a median dialysis vintage of 15 (6, 30) months. Non‑standard operation was identified in 49 episodes (34.5%), representing one of the leading causes of PDAP. Pathogenic culture of PD effluent was performed in 119 episodes (83.8%), among which 38 episodes (31.9%) were positive for Staphylococcus epidermidis, and 58 episodes (48.7%) yielded negative culture results. Regarding final outcomes among the 78 patients, 55 continued PD and 23 withdrew from PD. Compared with the continued‑PD group, the PD‑withdrawal group had a significantly higher proportion of patients who experienced three or more PDAP episodes (χ²=7.831, P=0.020), lower serum albumin levels (t=‑2.361, P=0.021), and higher effluent white blood cell counts on day 5 (Z=‑2.379, P=0.015). Multivariate logistic regression showed that three or more PDAP episodes was an independent risk factor for PD withdrawal (OR=5.155, 95% CI: 1.351～19.677, P=0.016), while higher serum albumin was a protective factor (OR=0.875, 95% CI: 0.777～0.987, P=0.029).  Conclusion Staphylococcal epidermidis infections due to improper procedures are prominent causes of PDAP in Xizang. Recurrent PDAP and hypoalbuminemia are independent risk factors for PD withdrawal. Strengthening training and re-education for PD patients in Xizang, along with improving nutritional status, may help reduce PDAP incidence and subsequent technique failure.

Objective  To develop a risk prediction model for mortality in maintenance hemodialysis (MHD) patients based on Logistic regression analysis and a nomogram. Methods Clinical data of 319 MHD patients admitted to Hezhou People's Hospital from January 2019 to January 2021 were retrospectively collected as the training cohort, and data of 80 MHD patients admitted from February 2021 to March 2022 were collected as the validation cohort. Two‑year follow‑up outcomes were reviewed, and patients were divided into a death group and a survival group based on mortality status. Lasso regression was used to screen covariates, and Logistic analysis was performed to identify factors influencing mortality. A nomogram prediction model for mortality in MHD patients was constructed using R software. Internal validation was conducted using the Bootstrap method. Receiver operating characteristic (ROC) curves and calibration curves were used to assess the model's discrimination and calibration, and decision curve analysis (DCA) was applied to evaluate the clinical utility of the nomogram. Results In the training cohort, there were 81 deaths and 238 survivors; in the validation cohort, 16 deaths and 64 survivors. In the training cohort, significant differences were observed between the death group and the survival group in age (t=5.497, P<0.001), diabetic kidney disease (χ²=28.016, P<0.001), vascular access type (χ²=34.491, P<0.001), high‑sensitivity C‑reactive protein (hs‑CRP) (t=42.746, P<0.001), hemoglobin (Hb) (t=15.038, P<0.001), albumin (ALB) (t=11.973, P<0.001), intact parathyroid hormone (iPTH) (t=2.937, P=0.004), and B‑type natriuretic peptide (BNP) (t=2.937, P=0.011). Six predictors were screened by Lasso regression and subsequently included in Logistic analysis, which identified age (OR=1.269, 95% CI: 1.146～1.405, P<0.001), diabetic kidney disease (OR=3.347, 95% CI: 1.149～9.749, P=0.001), vascular access type (OR=3.205, 95% CI: 1.212～8.476, P=0.016), hs‑CRP (OR=2.842, 95% CI: 1.922～4.204, P<0.001), Hb (OR=0.940, 95% CI: 0.910～0.971, P<0.001), and ALB (OR=0.814, 95% CI: 0.742～0.894, P<0.001) as independent factors influencing mortality in MHD patients. The ROC curve showed an AUC of 0.830 for the training model, with a C‑index of 0.830 by Bootstrap and a Hosmer–Lemeshow χ² of 7.621 (P=0.704). The DCA curve indicated a favorable net benefit within the probability range of 0.13–0.92. Internal cross‑validation in the validation cohort yielded an AUC of 0.844, a C‑index of 0.844, and a Hosmer–Lemeshow χ² of 7.412 (P=0.681), with the DCA curve showing a positive net benefit within the probability range of 0.12–0.89.  Conclusion Age, diabetic kidney disease, vascular access type, hs‑CRP, Hb, and ALB are factors influencing mortality in MHD patients. The nomogram prediction model based on Logistic regression demonstrates good discrimination and high net benefit, which may assist clinicians in optimizing treatment strategies.