The "Expert Consensus on the Selection of Blood Purification Modalities" was first published in 2019. After six years of accumulating evidence-based medical updates and clinical practice validation, and to accommodate advancements in blood purification technology and evolving diagnostic and treatment standards, a comprehensively revised edition is now formally released. This updated consensus, authored by 39 nephrology and blood purification experts, integrates evidence-based medicine and clinical experience to propose 26 recommendations providing guidance for selecting blood purification modalities. It     covers the assessment of hemodialysis adequacy and details the indications, advantages, limitations, and precautions for various commonly used blood purification modalities, including low-efficiency hemodialysis, low-flux hemodialysis, high-flux hemodialysis, hemodiafiltration, hemofiltration, isolated ultrafiltration, and hemoadsorption. This consensus offers comprehensive and systematic guidance for blood purification practitioners, aiming to further standardize hemodialysis management, enhance quality control, and improve long-term patient outcomes.

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.

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.

This article analyzes the differences between the standard YY/T 0793.4-2022 and the international standard (the International Organization for Standardization, ISO) 23500-5:2019, and provides an interpretation of key clauses. Through in-depth analysis of the standards, it aims to help clinical institutions further improve the quality of dialysis fluids used in hemodialysis and related therapies, which playing a crucial role in ensuring patient clinical safety.

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. 

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

Objective  To 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 construct a nomogram model for predicting the risk of heart failure in patients undergoing maintenance hemodialysis (MHD). Methods  The medical records of MHD patients at the Third People's Hospital of Henan Province from September 2020 to July 2023 were retrospectively analyzed. The patients were divided into a model group and a validation group in a 2:1 ratio. The model group was further categprized into concurrent group and non-concurrent group based on the occurrence of heart failure. Risk factors for heart failure was screened through Logistic regression analysis, and a risk prediction nomogram model was constructed and validated.  Results  A total of 312 patients were included, and they were including 208 in the model group and 104 in the validation group. Among the patients in the model group, 68 cases had concurrent heart failure (32.69%). Logistic regression analysis of the model group data showed that hypertension (OR=2.046, 95% CI: 1.229～3.406, P=0.007), dialysis age (OR=2.809, 95% CI: 1.524～5.179, P＜0.001), N-terminal pro-brain natriuretic peptide (NT-proBNP) (OR=3.572, 95% CI: 1.852～6.887, P＜0.001), creatine kinase isoenzyme (CK-MB) (OR=3.384, 95% CI: 1.786～6.411, P＜0.001), hemoglobin (Hb) (OR=0.446, 95% CI: 0.256～0.777, P=0.005), red cell volume distribution width (RDW) (OR=2.989, 95% CI: 1.603～5.575, P＜0.001), blood phosphorus (OR=2.438, 95% CI: 1.359～4.371, P=0.003), C-reactive protein (CRP) (OR=3.174, 95% CI: 1.685～5.978, P＜0.001), uric acid (UA) (OR=2.591, 95% CI: 1.419～4.729, P＜0.001) and procalcitonin (PCT) (OR=3.951, 95% CI: 2.021～7.724, P＜0.001) were all independent risk factors for heart failure in MHD patients. In the nomogram model, the calibration curves of the model group and validation group showed that the calibration curve of this model had good consistency with the ideal curve, and the consistency index of them were 0.836 (95% CI:0.783～0.882) and 0.827 (95% CI:0.764～0.873), respectively. The area under the curve for predicting heart failure in the model group and validation group were 0.843 (95% CI:0.786～0.889) and 0.835 (95% CI:0.750～0.901), respectively. The model group and the validation group could obtain net benefits when the threshold probability were 0～0.88 and 0～0.90.  Conclusion  Hypertension, dialysis vintage, NT-proBNP, CK-MB, hemoglobin, RDW, serum phosphorus, CRP, uric acid and PCT are independent risk factors for heart failure in MHD patients. The Nomogram model incorporating these factors exhibits strong predictive accuracy and clinical applicability.

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.

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 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.

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.

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.

Objective  Laparoscopic catheterization has the advantages of directly exploring the abdominal cavity and correcting the catheter position. However, conventional techniques typically require 2-3 ports, which may increase the risk of complications such as abdominal wall hernia and dialysate leakage. To address this, we designed a simplified single-port laparoscopic catheterization (SLC) technique.  Methods  30 patients with end-stage renal disease who underwent peritoneal dialysis catheterization at the Department of Nephrology, the First Affiliated Hospital of Harbin Medical University from March 2023 to September 2023 were selected and divided into a SLC group (n=15) and an open surgical catheterization (OSC) group (n=15). The baseline data before surgery, perioperative conditions, postoperative complications, and long-term catheter prognosis of the two groups were compared.  Results  No statistical differences in the baseline data between the two groups of patients. All patients underwent successfully peritoneal dialysis catheters inserted, with good intraoperative status. Compared with the OSC group, the SLC group had a shorter operation time (t=-4.227, P＜0.001) and postoperative hospital stays (Z=-3.124, P=0.001), smaller incisions (Z=-4.864, P＜0.001), and less postoperative pain (t=-3.786, P=0.001), but higher hospitalization costs (t=2.662, P=0.018). By the end of follow-up, 5 cases in the OSC group had bloody peritoneal dialysis fluid, 1 case had early peritonitis with catheter displacement, 1 case had dialysate leakage, and 1 case had catheter blockage, while the SLC group only had 3 cases of bloody peritoneal dialysis fluid, and no other catheter-related complications or infections occurred. The 1-year catheter survival rates for the two groups were 93.3% for the SLC group and 86.7% for the OSC group, respectively.  Conclusion   Single-port laparoscopic peritoneal dialysis catheterization is a feasible and safe technique with advantages including reduced operative time, shorter hospital stays, and fewer complications compared to open surgery.

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 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.

The rising prevalence of end-stage renal disease (ESRD) promotes the application of peritoneal dialysis (PD), a therapeutic option to conveniently conduct at home. However, PD-associated infectious and non-infectious complications occur frequently. Early and precise prediction and management of PD-associated complications are therefore critical to quality of life and outcome of the patients. The risk prediction models based on machine learning can evaluate the complication risk of a patient; while its branch, the deep machine learning, can automatically extract hierarchical features from raw data with higher accuracy and efficiency through multi-layer neural network structures. This review summarizes the basic concepts of machine learning and its branch deep machine learning, their utility in PD complication prediction and recent research advances to provide references for complication management in PD patients.

Objective   To conduct a meta-analysis on the incidence and risk factors of restless legs syndrome (RLS) in patients undergoing maintenance hemodialysis (MHD).  Methods  We searched the databases including PubMed, Web of Science, EMbase, the Cochrane Library, SinoMed, CNKI, Wanfang Data, and VIP from inception of the databases to December 2024. Stata 17.0 statistical software was employed for the meta-analysis.  Results  A total of 43 studies were included, with a total sample size of 12,333 patients among whom 2,519 were diagnosed with RLS. Twelve risk factors were identified. Meta-analysis revealed that the incidence of RLS in MHD patients was 24.8% (95% CI:21.1～28.5%). Risk factors for RLS included female gender (OR=1.332, 95% CI:1.231～1.441, P＜0.001), duration of dialysis (OR=1.037, 95% CI: 1.014～1.060, P=0.001), β2-microglobulin (OR=1.160, 95% CI:1.019～1.320, P=0.025), serum phosphorus (OR=1.591, 95% CI: 1.238～2.044, P＜0.001) and serum homocysteine (OR=1.252, 95% CI: 1.135～1.381, P＜0.001). High level of serum vitamin D (OR=0.909, 95% CI: 0.831～0.995, P=0.038) was a protective factor.  Conclusion  The incidence of RLS is relatively high in MHD patients. Healthcare professionals should identify RLS early based on risk factors and implement corresponding preventive measures and intervention strategies to reduce the incidence of RLS to improve patients' quality of life.

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.

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.

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.

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.

Objective  To explore the implementation effect and existing problems of multi-dimensional intervention measures for nursing quality management in peritoneal dialysis centers in Beijing, and to provide a basis for optimizing quality control strategies.  Methods   A retrospective analysis was conducted on the quality control data of 26 randomly selected peritoneal dialysis centers from 2023 to 2024. The changes in total scores, patient training, and patient follow-up deduction rates were analyzed using t-test and chi-square test. The management effectiveness was evaluated in combination with the intervention measures of the Beijing Quality Control Center (such as experience sharing, information technology construction and hierarchical supervision).  Results The total quality control scores in 2023 and 2024 were 95.00 (91.00, 100.00) and 96.00 (94.00, 99.00) respectively (U=302.000, P=0.506), with the lowest score rising from 60.00 to 90.50. In 2024, the number of hospitals that were deducted points in patient training and follow-up was lower than that in 2023 (χ2=6.718 and13.499; P=0.010 and ＜0.001).  Conclusion  The Beijing Nephrology and Blood Purification Quality Control Center has significantly improved the quality of patient training and follow-up in peritoneal dialysis through measures such as benchmarking, information technology empowerment, and hierarchical supervision. It is recommended to establish a "dynamic quality control - resource matching" linkage mechanism to promote the homogenization development of peritoneal dialysis nursing quality.

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 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 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.

Objective  To summarize relevant evidence on non-pharmacological interventions for sleep disorders in maintenance hemodialysis patients, and to provide practical guidance for improving their sleep quality.  Methods  A systematic search and evaluation were conducted on domestic and international databases and relevant guideline websites to identify evidence related to non-pharmacological interventions for sleep disorders in hemodialysis patients.  Results  A total of 17 articles were included, comprising 4 clinical decision-making papers, 2 guidelines, 10 systematic reviews, and one best evidence summary. From the two domains, screening and assessment of sleep disorders and non-pharmacological interventions in maintenance hemodialysis patients, 14 best evidence items were extracted. The evidence covers the use of sleep disorder screening and assessment tools, as well as the application details of various non-pharmaceutical therapies for sleep disorders.  Conclusion  This study systematically summarizes the best available evidence for the assessment and non-pharmacological intervention of sleep disorders in maintenance hemodialysis patients. It provides guidance for clinical healthcare professionals to implement evidence-based management of sleep disorders in this population.

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.

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.

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 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.

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.

Objective  To analyze the risk factors for unplanned extubation in patients with temporary dialysis catheters and construct a risk prediction model, so as to provide a reference for early warning of unplanned extubation.  Methods  A total of 250 patients with temporary dialysis catheters admitted to Huzhou First People's Hospital from January 2021 to August 2022 were retrospectively reviewed and randomly divided into a training group and a validation group at a ratio of 7:3. Risk factors were screened by univariate and multivariate logistic regression, and a prediction model was constructed and validated.  Results  The risk prediction model was Y=6.392×age+4.088×first dialysis+6.679×hypertension+5.749×indwelling time ≥ 12 days. In the training group, the area under the receiver operating characteristic curve (AUC) was 0.872 (95% CI: 0.813～0.931), with a sensitivity of 83.3% and a specificity of 83.5%, indicating that the model can effectively distinguish high-risk and low-risk patients for unplanned extubation in the training group. In the validation group, the AUC was 0.979 (95% CI: 0.934～1.000), with a sensitivity of 93.8% and a specificity of 92.6%, indicating that the model has excellent predictive performance in independent samples.  Conclusion  Age ≥60 years, first dialysis, hypertension, and catheter indwelling time ≥ 12 days are independent risk factors for unplanned extubation. The nomogram model constructed based on the above risk factors can effectively guide the risk prevention and control.

Objective  To analyze the relationship between blood vitamin D levels, neutrophil-to-lymphocyte ratio (NLR), and erythropoietin (EPO) hypo-responsiveness in patients undergoing maintenance hemodialysis (MHD).  Methods  The clinical data of 160 patients who underwent MHD in Suzhou Hospital of Integrated Traditional Chinese and Western Medicine were reviewed.  The efficacy of blood vitamin D and NLR in predicting EPO hypo-responsiveness and their dose-response relationship were evaluated.  Results  Compared with the non-EPO hypo-responsive group, the EPO hypo-responsive group had significantly lower 25(OH)D (t =7.671, P<0.001) and hemoglobin levels (t=8.601, P<0.001), and significantly longer dialysis vintage, higher weekly recombinant human erythropoietin (rhuEPO) dosage, higher parathyroid hormone, C-reactive protein (CRP), and NLR levels (t=2.153, P=0.033; t=12.685, P<0.001; t=3.330, P=0.001; t=3.004, P= 0.003; t=4.148, P<0.001). Logistic regression analysis showed that dialysis vintage, NLR, and parathyroid hormone were risk factors for EPO hypo-responsiveness (OR=1.813, 95% CI： 1.354～2.272; OR=2.724, 95% CI ：2.379～3.068; OR=1.416, 95% CI ：1.001～2.246; all P<0.001), while 25(OH)D was a protective factor (OR =0.413, 95% CI：0.404～2.379, P<0.001). Receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) for the combined prediction of 25(OH)D and NLR was 0.920, indicating higher predictive efficacy (95% CI ：0.859～0.960, P = 0.005). A nonlinear dose-response relationship was observed between 25(OH)D, NLR, and EPO hypo-responsiveness.  Conclusion  The combination of 25(OH)D and NLR demonstrates high predictive efficacy for EPO hypo-responsiveness, and a dose-response relationship exists between them.

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 prevalence and determinants of social frailty among maintenance hemodialysis (MHD) patients, and to establish a theoretical framework for its prevention. Methods  From November 2023 to April 2024, MHD patients from the hemodialysis centers of Binzhou Medical University Hospital and Shanghai East Hospital were selected as study subjects. Variables were screened based on univariate analysis, and an optimized eXtreme Gradient Boosting (XGBoost) tree model was constructed using the XGBoost library to predict the degree of social frailty.  Results  A total of 354 patients were included, with a social frailty prevalence of 26.27% (93/354). Based on the optimal feature subset, an optimized XGBoost classification model was constructed. The Shapley Additive exPlanations (SHAP) importance ranking (mean absolute SHAP values) was as follows: physical exercise（0.447）, social participation(0.358), sleep conditions (0.328), among others. Conclusion  The prevalence of social frailty among MHD patients in this study was relatively high. Clinical healthcare providers can early identify high-risk groups and implement effective interventions based on the factors influencing social frailty in MHD patients.

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.

Cardiorenal syndrome type 1 (CRS-1) refers to the pathophysiological syndrome of acute kidney injury (AKI) caused by acute deterioration of cardiac function. It is more common in acute decompensated heart failure (ADHF). AKI in the development of CRS-1 is also known as worsening renal function (WRF). This article reviews the definition, diagnostic criteria, pathogenesis, clinical significance and etiology of WRF in CRS-1, as well as therapeutic strategies for WRF. The aim is to enhance recognition of AKI in CRS-1 and deepen understanding of its pathophysiology, thereby providing a theoretical basis for improving CRS-1 management and patient prognosis.