Central venous catheter is an important type of vascular access, among which tunneled cuffed central venous catheter (TCC) is increasingly used and has been adopted by many institutions in China. However, due to inconsistencies in concepts and techniques across different institutions, some demonstrate deficiencies in the indications for TCC insertion, replacement, and removal, as well as in procedural standardization and operational risk management. Given that TCC insertion and replacement are inherently high-risk procedures, non-standard practices may lead to complications such as asphyxia, catheter dysfunction, and catheter-related infections, which can severely affect patients' dialysis outcomes and quality of life. Meanwhile, many institutions still require the performance of TCC insertion, replacement, and removal. In view of this, an expert consensus panel established a writing committee to systematically outline standardized oper ating procedures for the insertion, replacement, and removal of tunneled cuffed central venous catheters, integrating evidence-based consensus with clinical experience. It is hoped that under the guidance of this consensus, the techniques for TCC insertion, replacement, and removal in China can be further promoted, standardized, and refined, thereby benefiting a broader population of hemodialysis patients.

Renal anemia is one of the most common complications in patients undergoing maintenance hemodialysis (MHD), profoundly impacting on their quality of life and long-term prognosis. With the steadily growing number of MHD patients in China, standardized management of renal anemia is essential for improving their clinical outcomes. However, there is currently no specific clinical management guidance for renal anemia in MHD patients, both domestically and internationally. To address this unmet need, the Blood Purification Committee of the Chinese Research Hospital Association organized a panel of national experts to develop this consensus based on evidence-based medicine and clinical experience. This consensus covers definition, assessment, monitoring, treatment, and patient education of renal anemia in MHD patients, aiming to further standardize the management of renal anemia, improve anemia control, and enhance patients' quality of life and long-term prognosis in MHD patients.

Standard YY 0267-2025, “Extracorporeal systems for blood purification - Extracorporeal blood and fluid circuits for haemodialysers, haemodiafilters, haemofilters and haemoconcentrators” was released on February 26, 2025, and will be implemented from March 1, 2028. This article provides an overview of YY 0267-2025, introduces its application scope, and interprets the main changes of technical items. Furthermore, it  analyzes the differences and connections among YY 0267-2025，YY 0267-2016 and ISO 8637-2:2024, aiming to facilitate the application and implementation of the updated standard in production, supervision and clinical practice.

This consensus, developed by multidisciplinary experts led by the Blood Purification Center Branch of the Chinese Hospital Association, addresses the high prevalence of metabolic acidosis (MA) in Chinese patients with chronic kidney disease (CKD) and the urgent need to standardize its management. It systematically elucidates the core mechanisms by which MA acts as an independent risk factor for CKD progression, musculoskeletal wasting, and adverse outcomes, and innovatively introduces the concept of “subclinical MA”, which provides a theoretical basis for early intervention. The consensus establishes an individualized alkali therapy strategy derived from optimizing dietary net acid load, follows a precise stepwise monitoring pathway of serum bicarbonate, and adheres to the principle of “prefer mild acidosis to excessive alkalization” (i.e., favoring a mildly acidotic state over overcorrection). It further emphasizes multidimensional management for patients receiving blood purification, encompassing comprehensive volume control, nutritional assessment, and tailored adjustment of dialysate buffer prescriptions. Accordingly, the consensus puts forward a series of recommendations covering early screening, diagnostic evaluation, and integrated interventions, aiming to equip clinicians with a standardized and systematic management framework to delay disease progression and improve patients’ long-term outcomes.

Objective  To retrieve, extract, evaluate, and integrate evidence on dry weight management in maintenance hemodialysis (MHD) patients to provide an evidence-based basis for healthcare professionals to develop a dry weight management program for MHD patients.  Methods  To search for evidence related to the management of dry body quality in MHD patients in domestic and international websites, guideline repositories, and databases according to the “6S” evidence pyramid model, including guidelines, expert consensus, evidence summaries, clinical decision-making, systematic evaluations, meta-analyses, and original studies. The timeframe for the search was January 1, 2020 to January 1, 2025.  Results  A total of 16 articles were ultimately included in the literature, comprising 5 guidelines, 4 systematic evaluations, 1 evidence summary, 5 randomized controlled trials, and 1 cohort study. A total of 27 pieces of evidence were summarized in 6 dimensions: dry weight assessment and optimization, sodium restriction and behavioral interventions, scientific management of dry weight, frequency and duration of dialysis, personalized adjustment of dialysis solution, and dialysis temperature and duration.   Conclusion  This study provides the best evidence for the management of dry body quality in MHD patients and serves as a reference for evidence-based clinical practice by healthcare professionals.

Objective  To evaluate the efficacy and safety of enarodustat in patients with stage 3-5 non-dialysis dependent chronic kidney disease (NDD-CKD) with concurrent renal anemia.  Methods  This retrospective study analyzed clinical data from NDD-CKD stage 3～5 patients with renal anemia treated at the Department of Nephrology, The Affiliated Taizhou People's Hospital of Nanjing Medical University between June 1, 2024 and February 1 2025. Serial laboratory parameters were compared before and after treatment, and adverse events were systematically documented.  Results  The study included 89 patients (69±10 years old, 39 males) with NDD-CKD stage 3～5 combined with renal anemia. After 4～16 weeks of observation (median follow-up was 8 weeks), hemoglobin (Hb) significantly increased from (87.70±13.65) g/L to (100.83±16.28) g/L (t= -5.403, P＜0.001). Date from 21 patients who underwent reassessment of hematopoietic parameters showed that ferritin decreased from 197.12 (73.89, 272.93) μg/L to 116.74 (51.78, 242.35) μg/L (Z=         -2.374, P=0.018), while soluble transferrin receptor levels increased from 1.29 (0.89, 2.12) μg/L to 1.78 (1.01, 2.38)μg/L (Z=-2.052, P=0.040). Notably, in patients with malignancies (n=9), Hb increased from (80.89±14.19)g/L to （96.67±18.24）g/L (t=-3.784, P=0.005). Among patients with parathyroid hormone (PTH) ＞300 pg/mL, Hb increased from (82.50±18.20)g/L to (95.50±12.50)g/L (t=-3.227, P=0.006). During treatment and follow-up, 10 patients required intensification of antihypertensive medication, 8 developed hyperkalemia, and 1 experienced arteriovenous fistula thrombotic embolism; no treatment discontinuations due to adverse reactions occurred. No additional clinically significant adverse events were observed.  Conclusion  Enarodustat safely and effectively increases Hb levels in NDD-CKD patients with renal anemia, with consistent efficacy in subgroups with malignancies or secondary hyperparathyroidism. These findings support its potential as a therapeutic option for anemia management in complex clinical settings.

Objective To compare the anticoagulation efficacy, safety, and economic benefits of Nafamostat Mesylate (NM) injection versus Regional Citrate Anticoagulation (RCA) in hemodialysis for uremic patients at high risk of bleeding.  Methods  A retrospective analysis was conducted on uremic patients at high risk of bleeding who underwent hemodialysis in the Department of Nephrology, First Affiliated Hospital of Army Medical University, between January 2016 and December 2023. Patients were divided into the NM group and the RCA group. The effectiveness and safety were compared between the two groups, and the incremental cost-effectiveness ratio (ICER) was calculated.  Results  A total of 91 patients were included, with 59 in the NM group and 32 in the RCA group. No statistically significant difference was found in anticoagulation efficacy between the NM and RCA groups (96.61% vs. 87.50%,  χ²=2.796, P=0.095). The NM group showed lower rates of premature termination due to clotting events (0% vs. 9.38%, χ²=5.720, P=0.017), Grade 3 clotting events (1.69% vs. 12.50%, χ²=4.665, P=0.031), and hypocalcemia (0% vs. 12.50%, χ²=7.714, P=0.005) compared to the RCA group. Compared to RCA, the ICER for NM was -1843.91 Chinese Yuan.  Conclusion  As an anticoagulant for hemodialysis in patients at high risk of bleeding, NM demonstrates favorable efficacy and safety, along with good cost-effectiveness. 

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.

Approximately 80% of patients with end-stage renal disease (ESRD) undergo hemodialysis (HD) treatment. However, due to factors such as long-term catheter use and hypoalbuminemia, HD patients often face a heightened risk of infection, including blood-borne infectious diseases caused by hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), and Treponema pallidum (causing syphilis). According to the latest Criteria for Nosocomial Infection Surveillance (WS/T312—2023) and the Standard Operating Procedures for Blood Purification (2021 Edition), outpatient HD patients are required to undergo monitoring for these four types of infectious diseases. Nevertheless, surveillance techniques are greatly influenced by detection methodologies and infection control measures. In recent years, with advances in laboratory technology, there is an urgent need to refine and update the relevant detection procedures and infection control measures. Therefore, to better protect HD patients and improve relevant technical requirements, the Guangdong Provincial Hospital Association Clinical Laboratory Management Professional Committee, in collaboration with multiple societies, organized an expert group based on the latest clinical practices and technological advancements in clinical laboratories, nosocomial infection management, and nephrology departments. The consensus document, authored by this expert group, aims to recommend the application of highly sensitive detection technologies, nosocomial infection prevention measures, and standardized diagnostic and therapeutic practices among healthcare professionals, thereby effectively controlling the transmission of blood-borne pathogens in HD 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.

Dialysis fluid is the final product of a multi-step precision manufacturing process, with its quality directly impacting treatment efficacy and patient safety. Strict standards for dialysis water and ultrapure dialysis fluids have been established as essential prerequisites for online convective therapies, such as high-volume hemodiafiltration (HDF). These standards enhance the biocompatibility of the dialysis system, reduce systemic inflammation in dialysis patients, improve the response to erythropoiesis-stimulating agents, and ultimately have the potential to improve patient survival. This review provides a comprehensive update on the quality management requirements for water and dialysis fluids, with a specific focus on their role in optimizing high-volume hemodiafiltration.

Hemodiafiltration (HDF) is a dialysis technique that combines the principles of diffusion and convection. Cardiovascular disease is the leading cause of death among dialysis patients, accounting for approximately 32% to 55.9% of all-cause mortality. Studies have shown that HDF can significantly reduce the risk of cardiovascular death. The potential mechanisms include enhancing hemodynamic stability, effectively removing uremic toxins, correcting electrolyte disturbances, and alleviating inflammation and oxidative stress. In addition, HDF may also effectively ameliorate anemia and improve malnutrition, thereby further reducing the risk of cardiovascular events. This article reviews the research evidence and potential mechanisms of HDF in cardiovascular protection.

The bodyweight management (including nutritional and obesity status) and dry weight assessment (fluid balance) of patients undergoing peritoneal dialysis (PD) are key factors affecting their clinical prognosis. In recent years, progress has been made in weight management for PD patients with the development of nutritional intervention strategies, volume assessment methods, and personalized dialysis prescription. However, many challenges remain unresolved. Based on recent literature and summarizes, this article summarized the current status and progress of weight and volume management in PD patients, covering aspects such as diet management, physical exercise, medication treatment, dialysis prescription adjustment, and future prospects.

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.

The industry standard YY/T 1274-2025 "Peritoneal Dialysis Equipment" was released in 2025 and is scheduled for implementation in 2027. This standard will replace YY/T 1493-2016, "Gravity-Controlled Peritoneal Dialysis Equipment" and YY/T 1274-2016, "Pressure-Controlled Peritoneal Dialysis Equipment". By comparing the main technical differences between the new edition and the previous editions, this paper interprets the key clauses of the new standard, aiming to provide references for the industry to understand and implement the standard, so as to improve the safety of peritoneal dialysis equipment and promote the high-quality development of the industry.

Objective  To compare the clinical efficacy and safety of intravenous iron isomaltoside and iron sucrose in maintenance hemodialysis (MHD) patients with iron deficiency anemia (IDA).  Methods  A total of 82 MHD patients with IDA treated at the People’s Hospital of Xinjiang Uygur Autonomous Region between March 2022 and January 2025 were retrospectively analyzed. Patients were divided into an iron isomaltoside group (n=54) and an iron sucrose group (n=28). Changes in hemoglobin (Hb), serum ferritin (SF), transferrin saturation (TSAT), and adverse events were compared between the groups during a 6-month follow-up period. Results  The mean age of the patients was 54 years (range 19～83), with 56.1% males. At 1 month after treatment, the increase in Hb was significantly greater in the iron isomaltoside group than in the iron sucrose group (18 g/L vs. 11 g/L; P=0.030, Z=-2.164). The hematological response rate (40.7% vs. 17.9%; P=0.011, χ2=6.413) and target Hb achievement rate (22.2% vs. 0%; P =0.004, χ2=8.472) were also higher in the iron isomaltoside group, and this advantage persisted at 2 months. No significant differences were observed in SF or TSAT between the groups (P＞0.05). One patient in the iron isomaltoside group experienced transient fever, while no adverse events occurred in the iron sucrose group. Conclusion  Compared with iron sucrose, iron isomaltoside provides a faster correction of anemia and a superior short-term hematologic response in MHD patients, with a comparable safety profile. Its single high-dose infusion regimen may also enhance patient compliance and convenience.

Nowadays maintenance hemodialysis (MHD) uses the vascular access of autologous arteriovenous fistula (AVF), graft arteriovenous fistula (AVG) or central venous catheter (CVC), in which AVF is the preferred vascular access route recommended by various guidelines and is also the main method for MHD patients in China. Well-functioning vascular access is essential to hemodialysis, while adverse events in AVF including late maturation, stenosis, occlusion and thrombosis often disturb the hemodialysis. Thrombosis in AVF directly leads to lower hemodialysis efficiency or even completely interrupts the hemodialysis. Here we summarize the mechanism and influencing factors of thrombosis in AVF in order to prevent this event from happening.

Dialysis is a crucial treatment for maintaining the lives of patients with End-Stage Kidney Disease (ESKD), and dry weight (DW) management is one of the key components of dialysis therapy. An inappropriate DW setting may lead to volume overload or volume depletion, which significantly increases the risk of complications in dialysis patients, particularly cardiovascular events and mortality. In addition, dialysis patients face a range of complex health challenges, including muscle atrophy, osteoporosis, obesity, and malnutrition. These factors collectively affect their "body composition," which refers to the proportion and functional status of lean tissue (such as muscles and bones) relative to adipose tissue. This review aims to explore recent advances in the management of "body composition" in dialysis patients, covering assessment methods, management strategies, and the role of adjunctive therapies in improving patient outcomes.

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 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.

Objective  To compare the clearance of small, medium, and larger medium-sized molecular toxins in patients undergoing pre-dilution/post-dilution hemodiafiltration (Pre-/Post-HDF) versus medium cut-off hemodialysis (MCO-HD). Methods 22 hemodialysis patients were treated with Pre-HDF, Post-HDF and MCO-HD respectively. The urea reduction rate (URR), as well as the serum reduction rates (RR) of β2-microglobulin (β2-MG) and α1-microglobulin (α1-MG), were compared among the three modalities. Additionally, the total clearance of β2-MG, α1-MG, and albumin (ALB) in the collected dialysate was evaluated. Results The URR in the MCO-HD group was significantly higher than that in the Pre-HDF group (q=13.151, P＜0.001) and Post-HDF group (q=19.063, P＜0.001). The reduction rate of β2-MG was higher in the Post-HDF group than that in the MCO-HD group (q=4.753, P=0.005) and the Pre-HDF group (q=11.022, P＜0.001). Conversely, the reduction rate of α1-MG was significantly higher in the MCO-HD group than that in the Pre-HDF group (q=11.647, P＜0.001) and the Post-HDF group (q=7.642, P＜0.001). Regarding total removal in dialysate, the Pre HDF group showed significantly lower β2-MG clearance than the Post-HDF group (q=5.691, P=0.002) and the MCO-HD group (q =7.058, P＜0.001), whereas no significant difference was observed between the Post-HDF group and MCO-HD group (q=3.252, P=0.083). For α1-MG, total removal was significantly higher in the MCO-HD group than that in the Pre-HDF group (q=22.218, P＜0.001) and Post-HDF group (q=12.286, P＜0.001). Similarly, ALB loss in dialysate was significantly greater in the MCO HD group than in the Pre HDF (q=10.831, P＜0.001) and Post-HDF groups (q = 5.345, P=0.004).  Conclusion  Compared with Pre/Post HDF, MCO HD demonstrates superior clearance of larger medium sized molecules but is associated with more pronounced albumin loss.

bjective  To investigate the relationship between the percentage of interdialysis weight gain (PIWG) and cardiovascular function in maintenance hemodialysis (MHD) patients.  Methods  A retrospective analysis was conducted on patients receiving MHD at the Hemodialysis Center of Aviation General Hospital between September and November 2024. Based on PIWG, patients were divided into a low PIWG group (PIWG＜5%,  n=64) and a high PIWG group (PIWG≥5%, n=36). Intergroup comparisons and multivariate correlation analyses were conducted for statistical evaluation of demographic data, biochemical parameters, blood pressure, and echocardiographic parameters between the two groups.   Results   A total of 100 patients were enrolled, including 64 in the low PIWG group and 36 in the high PIWG group. The high PIWG group exhibited higher pre-dialysis systolic blood pressure (t =-3.380, P =0.001), pre-dialysis pulse pressure (t =-2.276, P = 0.025), N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels (Z =-3.160, P =0.002), left atrial anteroposterior diameter (t =-3.573, P=0.001), left atrial volume index (t =-3.380, P =0.001), interventricular septal thickness (Z=-2.410, P=0.016), and E/e’ ratio (t =-3.003, P =0.003) , but lower left ventricular ejection fraction (Z=2.246, P=0.025) compared to the low PIWG group. Correlation analysis revealed that PIWG was positively associated with NT-proBNP (r=0.395, P=0.001), pre-dialysis systolic blood pressure (r=0.423, P= 0.001), pre-dialysis pulse pressure (r=0.277, P=0.005), left atrial volume index (r=0.211, P=0.035), interventricular septal thickness (r=0.201, P=0.045), and E/e’ ratio (r=0.224, P=0.025).  Conclusion  PIWG is closely associated with cardiovascular function in MHD patients, influencing systolic blood pressure, pulse pressure, and cardiac structural/functional parameters.

Increasing the dialysis blood flow rate enhances the blood volume through dialyzer and thereby improves solute clearance, which is a critical factor in ensuring adequate hemodialysis. Adequate dialysis is essential for reducing morbidity and mortality in maintenance hemodialysis (MHD) patients. However, data from Dialysis Outcomes and Practice Patterns Study (DOPPS) indicate significant international variations in dialysis blood flow rate. Due to the differences in dialysis practice across countries, establishing an optimal dialysis blood flow rate for MHD patients remains controversial. This review examines the current status of dialysis blood flow rate, their relationship with clinical outcomes in MHD patients, and the underlying mechanisms.

Objective Hemodialysis combined with hemoperfusion is a commonly adopted clinical treatment mode, and hemoperfusion cartridge coagulation occurs frequently during treatment. Closed static heparin priming of hemoperfusion cartridge is a widely used method. This study aimed to explore the feasibility of closed dynamic circulation heparin priming for hemoperfusion cartridge and to observe its effect on cartridge coagulation, as compared those with closed static heparin priming. Methods A total of 32 patients undergoing maintenance hemodialysis in the Dialysis Unit of Peking University International Hospital were enrolled. They received hemodialysis 3 times a week, including 1 session of hemodialysis combined with hemoperfusion. A self-controlled before-and-after design was adopted. Every patient underwent 8 sessions of hemodialysis combined with hemoperfusion using closed dynamic circulation heparin priming and 8 sessions using closed static heparin priming. The heparin dosage was recorded for each session of hemodialysis combined with hemoperfusion, and the coagulation status of the hemoperfusion cartridge was evaluated. Results There was no significant difference in heparin dosage during treatment between closed dynamic circulation heparin method and closed static heparin method (58.41±7.23mg vs. 59.24±6.96mg, t=-1.730, P=0.094). The incidence of hemofilter coagulation during priming in closed dynamic circulation heparin method was lower than that in closed static heparin method (χ²=11.633, P=0.009). Specifically, the incidence of grade 2 hemofilter coagulation during priming in closed dynamic circulation heparin method was significantly lower than that in closed static heparin method (χ²=4.552, P=0.033), and the incidence of grade 3 hemofilter coagulation was also significantly lower in closed dynamic circulation heparin method (χ²=4.129, P=0.042). Conclusion In the absence of a difference in heparin dosage, closed dynamic circulation heparin priming for hemoperfusion cartridges is superior to closed static heparin priming in preventing hemoperfusion cartridge coagulation during hemodialysis combined with hemoperfusion. It is worthy of clinical promotion and application.

All-cause mortality in hemodialysis and peritoneal dialysis patients exhibits modality-specific biological mechanisms, while current risk prediction models face challenges in cross-modality validation and temporal treatment parameter integration. Developing machine learning frameworks that dynamically incorporate multidimensional clinical data and dialysis-specific variables could overcome limitations in traditional model construction, ultimately supporting precision decision-making for end-stage renal disease management.

Peritoneal dialysis (PD) has been promoted in many countries due to its advantages of treatment at home, lower cost and better protection of residual renal function. However, PD still faces many constraints including lower patient awareness, medical resource shortages, excessive care pressure, and insufficient professionals. Artificial intelligence (AI) offers a broad prospect of optimizing PD. In this paper, we review the research progresses in AI for PD from four aspects: screening high-risk patients, optimizing PD prescription, predicting prognosis, and management of PD.

Objective To investigate the clinical efficacy, safety, and economic benefits of two vascular
accesses: autologous arteriovenous fistula (AVF) and temporary central venous catheter (CVC), in prolonged
intermittent renal replacement therapy (PIRRT) for critically ill maintenance hemodialysis (MHD) patients.
Methods Sixty critically ill MHD patients requiring PIRRT and admitted to the Fifth People's Hospital of
Chengdu between January and May 2025 were enrolled in this study. Using a random number table, they were
randomly assigned to AVF group (undergoing plastic trocar puncture, n=30) or CVC group (n=30). The two
groups were compared in terms of dialysis adequacy (Kt/V value), incidence of access- related complications
(infection, thrombosis and bleeding), length of hospital stay, total treatment expenses, and prognosis. Results
The average Kt/V value in the AVF group was higher than that in the CVC group (1.39±0.17 vs. 1.29±0.17, t=
2.146, P=0.036). The incidence of access-related complications was significantly lower in the AVF group than
in the CVC group (3.33% vs. 36.67%, χ² =8.440, P＜0.001). In particular, the incidence of catheter- related
complications (catheter-related infection, central venous thrombosis, and bleeding) was as high as 36.67% in
the CVC group. The length of hospital stay in the AVF group was shorter than that in the CVC group (10.83±
3.84 vs. 12.93±3.56 days, t=-2.308, P=0.025), and the total treatment expenses in the AVF group was lower
than that in the CVC group (24 394.48±11 953.48 yuan vs. 32 339.92±17 950.68 yuan, t=-2.018, P=0.048).
There was no significant difference in the 28-day survival rate between the two groups (93.33% vs. 90.00%,
χ²=0.209, P=0.648). Conclusion For critically ill MHD patients undergoing PIRRT, selecting AVF as the vascular access can improve treatment efficacy, reduce access- related complications (e.g., infection) and lower
medical expenses, being worthy of further clinical application and exploration.

Objective  To analyze the needs of peritoneal dialysis (PD) patients for medical institutions, in order to provide ideas for optimizing resource allocation and improving PD home management.  Methods  Purposive sampling method was used to select PD patients who were followed up at Renji Hospital, Shanghai JiaoTong University School of Medicine in June 2024, and the recruitment was stopped based on the principle of information saturation. Semi-structured interviews were conducted with the PD patients. The Colaizzi's 7-step analysis method was adopted for data analysis.  Results  A total of fifteen PD patients were ultimately included. Based on the interview results, 3 themes and 8 sub-themes were extracted: self-management difficulties (information perception difficulties; limited work and life; poor accessibility to follow-up; disease and emotional distress), phased change characteristics of needs (hospitalization management needs; home self-management needs), hierarchical needs for medical treatment in medical institutions (hospital treatment needs; community service needs).  Conclusions  During the self-management of home PD, patients encounter multiple obstacles and the service needs present differentiated stages. Medical staff should strengthen the accessibility of medical resources and improve the support systems.

Arteriovenous fistula (AVF) stenosis is a leading cause of vascular access dysfunction in hemodialysis patients. Early and accurate diagnosis is crucial for reducing thrombotic risk and prolonging access lifespan. Traditional diagnostic methods have the limitation of invasiveness and the dependence of specific equipment. Machine learning enables non-invasive and objective diagnosis of AVF stenosis through extracting and quantifying acoustic features of normal and abnormal blood flow signals to establish recognition criteria. This article integrates machine learning with other four diagnostic tools to explain their principles, advantages and challenges, contributing to the shift toward precision medicine in vascular access management.

Objective  To compare the patency rates and complications of brachiobasilic arteriovenous fistula (BBAVF) and upper extremity arteriovenous graft (AVG) as vascular access options, providing evidence to optimize tertiary vascular access selection.  Methods  We searched PubMed, the Cochrane Library, Embase, and ScienceDirect databases and manually screened the references. The Newcastle-Ottawa Scale was used to assess study quality. Data were extracted and a meta-analysis was performed to compare the one- and two-year patency rates and complication rates between BBAVF and AVG.  Results  A total of 24 studies were included. The BBAVF group demonstrated superior outcomes compared to the AVG group in terms of one-year primary (OR=1.837, 95% CI: 1.332～2.533, P＜0.001), assisted (OR=2.242, 95% CI: 1.439～3.494, P＜0.001), secondary (OR=1.465, 95% CI: 1.029～2.088, P=0.034), and cumulative patency rates (OR=1.739, 95% CI: 1.052～2.875, P=0.031). The BBAVF group also had better two-year primary (OR=2.140, 95% CI: 1.469～3.118, P＜0.001), assisted (OR=2.529, 95% CI: 1.789～3.575, P＜0.001), secondary (OR=1.748, 95% CI: 1.371～2.229, P＜0.001), and cumulative patency rates (OR=2.002, 95% CI: 1.234～3.249, P=0.005). Regarding complications, the AVG group had a higher risk of postoperative infection (OR=0.207,  95% CI: 0.128～0.334, P＜0.001), thrombosis (OR=0.285, 95% CI: 0.207～0.392, P＜0.001), and steal syndrome (OR=0.628, 95% CI: 0.396～0.996, P=0.048), while the BBAVF group had a higher risk of bleeding (OR=2.725, 95% CI: 1.549～4.793, P=0.001). There were no significant differences between the two groups in the incidence of aneurysm (OR=0.849, 95% CI: 0.457～1.577, P=0.605), anastomotic stenosis (OR=0.471, 95% CI: 0.133～1.666, P=0.243), or overall complications (OR=0.924, 95% CI: 0.502～1.701, P=0.799).  Conclusion  BBAVF is superior in terms of patency rate and control of infection and thrombosis, and is recommended as the first choice for patients with good vascular conditions. AVG is more suitable for urgent dialysis or for patients with poor vascular conditions.

Continuous renal replacement therapy (CRRT) is a extracorporeal blood purification method to continuously and slowly clear water and solute from blood, and has become a critical life-support technology for critically ill patients. With the advances of technology and the accumulation of clinical experience, the assessment of CRRT "adequacy" has expanded beyond traditional issue of solute clearance dosage to include multiple dimensions such as treatment timing, fluid management, anticoagulation strategies, and circuit monitoring. Based on the latest evidence-based medical research, this article reviews key elements of CRRT adequacy assessment, including selection of initial time, CRRT dosage, surveillance of solute clearance, volume management strategies, anticoagulation protocols, management of specific patients, and quality control system, in order to optimize CRRT practice and improve patient outcomes.

Objective  To investigate the effect of resistance exercise on bone mineral density (BMD) in maintenance hemodialysis (MHD) patients by implementing lower limb resistance exercise rehabilitation training. Methods  MHD patients on regular dialysis at Shanghai Jing 'an District Zhabei Central Hospital from October 2022 to November 2023 were selected as the study subjects. Patients were randomly divided into either an exercise rehabilitation group or a control group. The control group received routine treatment, while the exercise rehabilitation group received additional intra-dialytic lower limb resistance exercise training based on routine treatment. The follow-up period was 6 months. Changes in BMD, skeletal muscle index (SMI), calcium, phosphorus, parathyroid hormone, osteocalcin (OC), N-terminal propeptide of type I procollagen (PINP), and beta C-terminal telopeptide of type I collagen (β-CTX) were compared between the two groups.  Results  A total of 90 patients were enrolled, with 45 patients in each group. Before the study, there were no statistically significant differences in SMI and BMD between the two groups (t=0.759, P=0.450; t=0.003, P=0.997). After 6 months of treatment, both SMI [(7.73 ± 1.01) kg/m²] and BMD [(0.470 ± 0.089) g/cm²] in the exercise rehabilitation group increased compared to pre-study levels [SMI(7.03±1.20)kg/m2, BMD (0.419±0.098)g/cm2], and the comparative differences were statistically significant (t=-2.615, P=0.002; t=-0.867, P=0.012). Compared to the control group during the same period (SMI 7.19±1.13 kg/m2, BMD 0.418±0.098 g/cm2)，the differences were also statistically significant (t=-2.390, P=0.019, t=-2.598, P=0.011). Before the study, there were no statistically significant differences in OC, β-CTX, and PINP between the two groups (Z=-0.105, P=0.292; Z=-1.126, P=0.260; Z=-0.195, P=0.846). After 6 months of treatment, the differences in OC, β-CTX, and PINP between the exercise rehabilitation group and the control group were statistically significant (Z=-3.531, P＜0.001; Z=-2.841, P=0.005; Z=-3.635, P＜0.001).  Conclusion   A 6-month lower limb resistance exercise rehabilitation program for MHD patients is safe and effective, improving muscle mass, increasing bone mineral density, and reducing the risk of osteoporosis.

Objective  Indoxyl sulfate (IS) is a typical uremic toxin accumulated in chronic kidney disease (CKD) patients, and higher IS level is closely associated with cardiovascular complications. Accurate evaluation of IS adsorption performance of hemoperfusion devices is essential for their clinical effectiveness. This study systematically compares the applicability of ultra-performance liquid chromatography-tandem mass spectrometry (LC-MS/MS) and ultraviolet-visible spectrophotometry (UV-Vis) in evaluating IS adsorption by hemoperfusion devices, and clarifies the impact of IS concentration on adsorption efficiency.  Method  LC-MS/MS: bovine plasma containing IS was treated with acetonitrile for protein precipitation. IS concentrations pre-/post-adsorption were quantified, establishing a linear model of 0.0850～1.3080μg/mL (Y=36045.242X + 763.841, R²=0.9987). UV-Vis: IS in bovine serum albumin solution was detected, demonstrating dual linear relationships of 3.75～120μg/mL (Y=77.337X - 0.5316, R²=0.9977; Y=93.014X - 0.4991, R²=0.9996). Both methods showed precision of RSD ＜5% and recovery rates of 86～110% (LC-MS/MS) and 91～110% (UV-Vis).  Result  LC-MS/MS has the advantages of high sensitivity (LOQ=0.0212μg/mL), strong anti-matrix interference, and suitability for batch plasma testing. UV-Vis is applicable for rapid screening of high-concentration IS (＞3.75μg/mL) but is significantly interfered by protein binding. For adsorption dynamics: at low IS concentrations (＜30μg/mL), insufficient molecular diffusion kinetics reduced efficiency; at high concentrations (＞100μg/mL), saturation of active sites decreased binding efficiency per molecule. Peak efficiency occurred at ～60μg/mL, balancing diffusion kinetics and site competition.  Conclusion LC-MS/MS serves as the core method for evaluating IS adsorption performance in hemoperfusion devices, providing a basis for quality standards. UV-Vis is limited to preliminary high-concentration screening during adsorbent development. This study offers critical technical support for optimizing clinical protocols and establishing industry standards.

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.

Autogenous arteriovenous fistula for vascular access is recommended by the guidelines and expert consensus. Activity and exercise are beneficial for improving the quality of life of maintenance hemodialysis patients, but are controversial for postoperative maturation of arteriovenous fistula. This article summarizes relevant viewpoints on postoperative exercise for autologous arteriovenous fistula, providing references for further improving the guidelines and expert consensus.

Objective To understand the current nursing status of continuous renal replacement therapy (CRRT) in hospitals, and provide a reference for further improving the quality of specialized nursing. Methods A convenience sampling method was used. From August to December 2023, a self- designed questionnaire was used to investigate the nursing status of CRRT in 101 hospitals. Results A total of 115 questionnaires were distributed and 106 valid responses from 106 nursing units in 101 hospitals were collected, with an effective recovery rate of 92.17%. In terms of infection prevention and control management, 91 (85.85%) nursing units used disposable ready-made hemodialysis kits, 74 (69.81%) nursing units used disposable sterile rubber gloves for operations, 89 (83.96%) nursing units used ready-made replacement fluid, and 80 (75.47%) nursing units used disposable dedicated waste fluid collection bags. In terms of nursing operations, 57
(53.77%) nursing units directly connected the circuit after priming, 60 (56.6%) nursing units used a medical three-way stopcock to connect 5% sodium bicarbonate injection to the venous end of the extracorporeal circulation circuit during treatment, and 103 (97.17%) nursing units used closed blood return technology when disconnecting the machine. In terms of nursing management, 78 (73.58%) nursing units regularly conducted theoretical and operational assessments, 51 (48.11% ) nursing units have already carried out related in- hospital nursing consultations, and 36 (33.96%) nursing units have already used information-based specialized nursing record sheets. Conclusion There are several differences in the nursing care of CRRT among hospitals. It is recommended to further standardize and unify the clinical nursing standards for CRRT to promote the improvement of specialized nursing quality. 

Objective To investigate the impact of different blood purification modalities on serum β2-microglobulin (β2-MG) level, lipid profile, and vascular calcification in patients undergoing maintenance hemodialysis (MHD).  Method  A retrospective analysis was conducted on clinical data of the 174 patients admitted to Puyang People’s Hospital between January 2019 and December 2022 for MHD. According to the blood purification modality they used, the patients were divided into three groups: conventional hemodialysis (HD) group (n=58), hemodialysis combined with hemodiafiltration (HD+HDF) group (n=58), and hemodialysis plus hemodiafiltration and hemoperfusion (HD+HDF+HP) group (n=58). Serum β2-microglobulin, lipid profile, and the extent of vascular calcification were compared among the three groups. Logistic regression was employed to identify risk factors for vascular calcification.  Result  After dialysis, blood phosphorus, intact parathyroid hormone (iPTH), β2-MG, total cholesterol (TC), triglycerides (TG) and low-density lipoprotein cholesterol (LDL-C) in HD group were higher than those in HD+HDF group and HD+HDF+HP group (F/χ²=12.753, 12.552, 6.524, 5.873, 10.908 and 17.272 respectively; P＜0.001), while high-density lipoprotein cholesterol (HDL-C) in HD group was lower than that in HD+HDF group and HD+HDF+HP group (F=17.148，P＜0.001). Blood phosphorus iPTH, β2-MG, TC, TG and LDL-C in HG group were higher than those in HD+HDF group (t=12.963, 13.630, 5.648, 5.242, 11.044 and 18.632 respectively; P＜0.001), while HDL-C in HD group was lower than that in HD+HDF group (t=17.031, P＜0.001). Blood phosphorus iPTH, β2-MG, TC, TG, LDL-C in HG group were higher than those in HD+HDF+HP group (t=13.921, 14.567, 6.853, 6.320, 9.282 and 16.041 respectively; P＜0.001), while HDL-C in HD group was lower than that in HD+HDF+HP group (t=18.242, P＜0.001). Vascular calcification rate in HD group was higher than that in HD+HDF+HP group (t=5.570, P＜0.001). Age, dialysis age, blood calcium, blood phosphorus, iPTH, TC, LDL-C, and β2-MG in vascular calcification group were higher than those in non-calcification group (t=8.630, 6.205, 6.073, 4.598, 4.617, 3.562, 4.648 and 5.673 respectively; P＜0.001). Logistic regression showed that age, dialysis age, blood calcium, blood phosphorus, iPTH, and β2-MG were the independent risk factors for vascular calcification (OR=1.123, 1.087, 4.582, 3.874, 2.034 and 2.402 respectively; 95% CI:1.034～1.346, 0.012～1.298, 452～15.224, 1.376～13.302, 1.173～8.375 and 1.256～11.408 respectively; P=0.004,＜0.001,          ＜0.001, ＜0.001, ＜0.001 and ＜0.001 respectively).   Conclusion   The occurrence of vascular calcification in MHD patients is related to multiple factors. Clinical monitoring and timely intervention are needed to reduce the risk of vascular calcification.

【Abstract】Objective To analyze the effect of hydrogen and oxygen inhalation on nutrition and microinflammation in maintenance hemodialysis (MHD) patients. Methods The stable MHD patients who underwent regular hemodialysis in the Hemodialysis Center of Beijing Taikang Yanyuan Rehabilitation Hospital were enrolled in this study. Every subject inhaled hydrogen and oxygen gases (3L/min, hydrogen: oxygen=2: 1) for 120 min during hemodialysis session for one month, and the subjects were observed and followed up for 6 months. Results A total of 37 patients were enrolled in this study, and 32 patients (25 males and 7 females) completed the trial. Their mean age was 64.4±12.2 years, and mean dialysis age was 60.1±49.5 months. In the first month after the start of treatment, serum albumin increased significantly compared to the baseline value (t=2.362, P=0.025). Serum albumin increased further in the second month (t=6.813, P＜0.001). Platelet/albumin (PAR) began to decline in the first month after treatment (t=0.252, P=0.802), and decreased further in the second month (t=2.906, P=0.007). Conclusion Inhalation of hydrogen and oxygen may improve nutrition and microinflammation status in MHD patients.

Objective  To explore the effects of different urokinase thrombolysis methods on the four-year patency rate of tunneled-cuffed catheters (TCC).  Methods  Clinical data of the 96 patients undergoing maintenance hemodialysis using TCC in the Blood Purification Center of Guangdong Provincial People's Hospital from June 2021 to May 2024 were retrospectively analyzed. According to the method of urokinase thrombolysis therapy when the patients first showed insufficient flow or embolism in TCC, they were divided into two groups: the lock-tube thrombolysis group and the pre-hemodialysis intravenous bolus thrombolysis group. In the lock-tube thrombolysis group, each side of the catheter was configured with 1 ml of normal saline + 125,000 units of urokinase + 1 ml (6,250 units) of heparin sodium, and locked according to the lumen volume. In the pre-hemodialysis intravenous bolus thrombolysis group, each side of the catheter was treated with 10 ml of normal saline + 125,000 units of urokinase, and pumped in at a constant speed of 30-60 minutes with a constant speed pump before hemodialysis. The four-year secondary patency rate of TCC was observed in the two groups.  Results  We collected the data of urokinase thrombolysis therapies for TCC in 96 patients, including 11 cases (14.5%) in the pre-hemodialysis intravenous bolus thrombolysis group and 85 cases (85.5%) in the lock-tube thrombolysis group. COX univariate Kaplan-Meier survival analysis showed that there was no statistically significant difference in the four-year secondary patency rate of TCC between the two groups (HR=0.333, 95% CI: 0.044～2.530, P=0.239). The one-year, two-year, three-year, and four-year secondary patency rates of TCC were 90.9%, 72.7%, 54.5%, and 27.3% respectively in the pre-hemodialysis intravenous bolus thrombolysis group, and were 64.7%, 42.4%, 22.4%, and 15.3% respectively in the lock-tube thrombolysis group.  Conclusion  There is no significant difference in the secondary patency rate between the lock-tube thrombolysis group and the pre-hemodialysis intravenous bolus thrombolysis group. Survival curve analysis shows that the pre-hemodialysis intravenous bolus thrombolysis method using 10 ml of normal saline+125,000 units of urokinase has a tendency of better secondary patency rate of TCC, but no statistical significance existed between the two groups probably due to insufficient sample size. Further verification of this hypothesis requires prospective research in the future.

Objective  To explore the influencing factors of constipation in maintenance hemodialysis (MHD) patients and to construct a column chart prediction model.  Methods  A total of 135 patients who underwent MHD in Huai’an Second People's Hospital from April 2021 to June 2023 were regarded as the modeling group. A total of 58 MHD patients from July 2023 to November 2024 were recruited as the validation group. According to the occurrence of constipation during MHD, the modeling group was assigned into constipation group (n=56) and non-constipation group (n=79). The influencing factors of constipation in the MHD patients were analyzed using multivariate logistic regression. A column chart prediction model for constipation risk in MHD patients was then constructed using the R software. Predictive performance of the model was evaluated through receiver operating characteristic (ROC) curve, Hosmer-Lemeshow test, and calibration curve.  Results Among the 193 MHD patients, a total of 78 cases experienced constipation, with an incidence rate of 40.41%. Compared with the non-constipation group, the constipation group had higher rates of diabetes nephropathy, dialysis age≥5 years, and lying in bed in most daytime (c2=5.539, 5.053 and 4.293; P=0.019, 0.025 and 0.038), while plasma albumin was lower (t=4.161, P＜0.001). Multivariate logistic regression found that diabetes nephropathy (OR=5.739, 95% CI: 2.089～15.767, P=0.001), dialysis age ≥5 years (OR=6.287, 95% CI: 2.246～17.598, P＜0.001), and lying in bed in most daytime (OR=8.396, 95% CI: 2.348～30.022, P=0.001) were the independent risk factors for constipation in MHD patients (P＜0.05), and plasma albumin was a protective factor for constipation in MHD patients (OR=0.865, 95% CI: 0.788～0.950, P=0.002). The column chart showed that the higher the total score of MHD patients, the higher the risk of constipation. ROC curve showed that the area under the curve (AUC) of the modeling group and the validation group were 0.806 (95% CI: 0.733～0.879) and 0.879 (95% CI: 0.796～0.963) respectively, indicating higher predictive discrimination of the column chart. Hosmer-Lemeshow test and calibration curve indicated that the model had higher prediction consistency.  Conclusion   The risk of constipation in MHD patients is related to primary disease, dialysis age, daily living conditions and plasma albumin level. The nomogram model established based on the four risk factors has good efficacy in predicting the risk of constipation in MHD patients and is helpful for clinical prediction and prevention of constipation.