Hyperphosphatemia is a common complication in patients with chronic kidney disease (CKD), particularly those with end-stage kidney disease. It accelerates the progression of CKD, contributes to secondary hyperparathyroidism and abnormal bone metabolism, and serves as an independent risk factor for increased cardiovascular events and mortality. Hyperphosphatemia is highly prevalent but poorly controlled in Chinese CKD patients, which is currently a challenge in clinical practice. In recent years, substantial progress has been made globally in hyperphosphatemia research, with several novel phosphate-lowering agents approved, providing new options for the management of hyperphosphatemia. Based on these advancements, the Chinese Hospital Association Blood Purification Center Branch organized a panel of experts in the field of nephrology and blood purification to develop this consensus document. Integrating evidence-based medicine and clinical expertise, the consensus provided recommendations on key aspects of hyperphosphatemia management, including timing of intervention and target serum phosphate levels. Some practical guidance on dietary phosphate restriction, phosphate-lowering agents use, secondary hyperparathyroidism control, adequate dialysis, and patient education was proposed. The consensus aims to standardize the management of serum phosphate in CKD patients, thereby reducing the incidence of hyperphosphatemia, improving serum phosphate control, and ultimately enhancing patient outcomes.

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.

Objective  This study aimed to investigate the sleep status of maintenance hemodialysis (MHD) patients and explore its influencing factors, to provide a scientific basis for developing targeted interventions to improve sleep quality, and to offer data support for real-world research. Methods  A total of 346 MHD patients treated at multiple hemodialysis centers in Luoyang city between June 2023 and March 2024 were enrolled. Patients were divided into a no-sleep-disorder group and a sleep-disorder group based on their total Pittsburgh Sleep Quality Index (PSQI) score. Standardized questionnaires were used to collect demographic and socio-economic information. Laboratory indicators from the 3 months prior to enrollment, including intact Parathyroid Hormone (iPTH) and C-reactive protein (CRP), were extracted from the electronic medical record system. Differences in indicators between the two groups were compared. Spearman correlation analysis was used to assess the correlation between indicators and sleep disorder occurrence. Multivariate logistic regression models were employed to identify independent risk factors for sleep disorders.  Results  The prevalence of sleep disorders among MHD patients was 75.2% (260/346). Univariate analysis identified significant associations between the two groups in age, type of medical insurance,dialysis vintage, commodities (diabetes,cardiovascular/cerebrovascular diseases), and iPTH and CRP levels (all P＜0.05). Further Spearman correlation analysis showed that patient age (r=0.233, P＜0.001), dialysis vintage (r=0.130, P=0.021), presence of diabetes (r=0.153, P=0.006), presence of cardiovascular/cerebrovascular diseases (r=0.235, P＜0.001), and CRP level (r=0.216, P＜0.001) were significantly positively correlated with sleep disorders (all P＜0.05). Multivariate logistic regression analysis indicated that MHD patient age (OR=1.021, 95% CI: 1.001～1.041, P=0.036), dialysis vintage (OR=1.006, 95% CI: 1.001～1.012, P=0.028), presence of diabetes (OR=1.971, 95% CI:1.127～3.447, P=0.017), and CRP level (OR=1.027, 95% CI: 1.003～1.051, P=0.024) were independent risk factors for sleep disorders (all P＜0.05).   Conclusion  This study found a high prevalence of sleep disorders (75.2%) among MHD patients. Advanced age, longer dialysis vintage, presence of diabetes, and elevated CRP levels were confirmed as independent risk factors. Therefore, special attention is needed in clinical practice for MHD patients who are older, have a longer dialysis vintage, and have underlying comorbidities. Actively managing underlying conditions and conducting regular monitoring may help reduce the incidence of sleep disorders in MHD patients, thereby effectively improving their prognosis and quality of life.

Objective To determine the optimal heparinization protocol for hemoperfusion combined with hemodialysis (HP+HD) using a novel perfusion device (HP110) and to establish quality control tools for HP+HD therapy, including HP+HD installation and priming checklist and nursing quality indicators relating to the incidence of extracorporeal circulation coagulation, so as to provide a reference for clinical nursing quality control.  Methods This study enrolled maintenance hemodialysis (MHD) patients undergoing regular HP+HD therapy using heparin-based anticoagulants (unfractionated heparin or low molecular weight heparin) at Peking University People’s Hospital from June to November 2024. The study was divided into two phases: the initial phase (dynamic heparinization for installation and priming) and the improvement phase (closed-loop heparinization 5-step method for installation and priming). A project management team was established to develop the heparinization protocol, the HP+HD installation and priming checklist, and the nursing quality indicators relating to extracorporeal circulation coagulation.  Results   A total of 52 MHD patients were included (33 males and 19 females), aged 34～77 years (mean 56.8±10.2 years). Among 677 HP+HD treatments, 242 were conducted in the initial phase and 435 were in the improvement phase. During the initial phase and the improvement phase, the rates of extracorporeal circulation coagulation of grade II or more were 9.5% (23 treatments) and 0% (P＜0.001) respectively, and the rates of extracorporeal circulation coagulation of grade Ⅲ were 2.07% (5 treatments) and 0% (P＜0.001) respectively. The rate of recurrent coagulation in the same patient was 26.09% (6/23 treatments) in the initial phase. Monthly quality control score for nursing procedures showed no significant differences between the two phases (t=0.708; P=0.482). In the 435 treatments in the improvement phase, prothrombin time (10.2±0.8s), activated partial thromboplastin time (30.6±3.0s) and fibrinogen (314.0±57.2 mg/dl) were in the normal ranges, a total of 1000 mL normal saline and 12 500 IU of heparin (costed 15.16 RMB yuan) could be saved in a single HP+HD treatment, and the manipulation time was 5 minutes less than that reported in the literature.  Conclusion  The use of the closed-loop 5-step method for heparinization during HP+HD installation and priming significantly reduced the incidence of extracorporeal circulation coagulation and optimized the use of heparin and saline compared to the dynamic heparinization method. The nursing quality indicators, including the rates of grade Ⅱ and Ⅲ extracorporeal circulation coagulation and recurrent coagulation in the same patient, and the HP+HD installation and priming checklist are sensitive and effective tools for evaluating nursing quality of HP+HD installation and priming.

Objectives  This study aimed to investigate the effects of online hemodiafiltration (OL-HDF) dilution methods and substitution fluid volume on dialysis quality in maintenance hemodialysis (MHD) patients.  Method  A total of 81 patients with MHD were divided into three groups: group A (predilution, substitution volume 18L), group B (predilution, substitution volume 36L) and group C (postdilution, substitution volume 18L). The solute clearance rates, cardiovascular benefits, quality of life, and incidence of adverse reactions were compared among the three groups after 12 months of treatment.  Results  After treatment, the levels of serum phosphorus (P), serum creatinine (Scr) and cystatin C(Cyst-C) in group B were higher than those in groups A and C (B vs. A：t=-2.056、-4.224、-0.349，P=0.045、＜0.001、0.029；B vs. C：t=3.070、4.633、4.110，P=0.003、＜0.001、＜0.001), while the urea clearance index (Kt/V) was lower than that of groups A and C (Kt/V >1.2; B vs. C:t=-4.932，P＜0.001; A vs.  B:t=2.213，P=0.031). Group B had significantly lower levels of β2-microglobulin (β2-MG), intact parathyroid hormone (iPTH), and C-reactive protein (CRP) than Group A (t=0.775, -2.205, 3.145; P=0.042, 0.032, 0.003). Group B had significantly lower carotid intima-media thickness and left ventricular mass index levels than Groups A and C (A vs. B: t=3.116, 2.934; P=0.003, 0.005; B vs. C: t=-2.126, -0.243; P=0.038, 0.009). Its left ventricular ejection fraction (B vs. C: t=3.429, P=0.001; B vs. A: t=-5.107, P＜0.001) and quality of life scores (B vs. A: t=-3.494, P=0.001; B vs. C: t=2.988, P=0.004) were significantly higher than Groups A and C. The incidence of adverse reactions in Group B was significantly lower than in Group A (t=0.448, P=0.006) and Group C (t=0.687, P=0.009). Conclusion The predilution mode with double the substitution fluid volume (36L) can, while ensuring dialysis adequacy, reduce hospitalization and cardiovascular mortality rates, improve quality of life, and demonstrate a higher safety profile.

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 investigate the effects of exercise rehabilitation on dialysis adequacy, nutrition, and lipid metabolism in maintenance hemodialysis (MHD) patients.  Methods  A total of 87 patients with inadequate dialysis from the Blood Purification Center of Nantong Second People's Hospital were selected. They were randomly divided into two groups: a control group receiving conventional treatment (including medication and hemodialysis) and an exercise group receiving conventional treatment plus aerobic and resistance exercises. The urea clearance index (Kt/V), nutritional markers, and lipid metabolism markers were compared between the two groups before the intervention, at 12 weeks (12W), and at 24 weeks (24W).  Results After 12 weeks and 24 weeks of intervention, the exercise group showed significantly higher Kt/V (t =-4.282,  -6.535; both P ＜0.001) and serum albumin (Alb) levels (t =-3.603, -5.333; P = 0.001, ＜0.001) compared to the control group. While the exercise group had significantly lower total cholesterol (TC) (t = 4.035, 3.918; both P＜ 0.001) and low-density lipoprotein (LDL) levels (t =2.258, 4.483; P =0.027, ＜0.001) than the control group. At 24 weeks of intervention, C-reactive protein (CRP) in the exercise group was significantly lower than that in the control group (intergroup Z=-4.349, P＜0.001). Compared to pre-intervention levels, the exercise group demonstrated significantly increased high-density lipoprotein (HDL) levels at both 12W and 24W (t =-2.425, -2.085; P=0.020, 0.043).  Conclusion  Aerobic and resistance exercise significantly improves dialysis adequacy, nutritional status, and lipid metabolism in MHD patients.

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.

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 explore the risk factors and prognosis of intracerebral hemorrhage (ICH)  in dialysis dependent end stage renal disease (ESRD) patients.  Methods  We retrospectively analyzed ESRD patients receiving regular maintenance dialysis at Beijing Shunyi District Hospital (January 2021-January 2024). Participants were stratified into ICH and non-ICH groups. Demographic characteristics, medical history, laboratory parameters, imaging findings, and treatment data were compared to identify ICH risk factors.  Results  Among 206 enrolled patients, 42 (20.4%) developed ICH. Compared to non-ICH controls (n=164), the ICH group showed significantly higher proportions of males χ²=4.323, P=0.016), stroke history (χ²=7.621, P=0.000), hemodialysis (vs. peritoneal dialysis; χ²=0.294, P=0.043), elevated mean pre-dialysis systolic blood pressure (SBP) within 3 months (Z=3.532, P=0.030), antiplatelet drug use (χ²=4.021, P=0.026), white matter hyperintensity (χ²=6.202, P=0.002), and cerebral microhemorrhage (χ²=9.282, P＜0.000), along with elevated B-type natriuretic peptide (t=4.326, P=0.024), fibrinogen (t=3.002, P=0.038), serum calcium (t=4.234, P=0.023), and  phosphorus (t=5.203, P=0.006) levels, but decreased platelet count (t=3.469, P=0.032) and serum sodium (t=9.821, P＜0.000) levels. Multivariate Logistic regression analysis identified independent ICH risk factors: stroke history (OR=1.610, 95% CI:1.021～4.320, P=0.041), elevated mean pre-dialysis SBP within 3 months (OR=2.526, 95% CI:1.470～5.323, P=0.004), hemodialysis (OR=3.190, 95% CI: 1.620～6.270, P=0.007), white matter hyperintensity (OR=3.521,95% CI:1.313～6.482, P=0.030), and cerebral microhemorrhage (OR=2.797,95% CI:1.168～6.701, P=0.011). At 3-month follow-up,  31.0% (13/42) of ICH patients had favorable outcomes (modified Rankin scale, mRS ≤2)；while 69.0% (29/42) had poor outcomes (mRS>2), including 4 deaths (9.5%).   Conclusion  ESRD patients face elevated ICH risk with relatively poor prognosis in this population. 

Objective To investigate the effect of health services accessibility on the clinical adverse outcomes of peritoneal dialysis (PD) patients after implementing standardized PD management combined with telemedicine services. Methods This study was a multi-center prospective cohort study that included PD patients from three hospitals in Beijing between January 1, 2016, and April 30, 2019. All patients were managed using the Peritoneal Dialysis Telemedicine and Healthcare Management Platform (PDTAP). Univariate and multivariate Cox proportional hazards models or competing risks models were used to explore the effects of three dimensions of health services accessibility on all-cause mortality, hemodialysis transfer, and first-episode PD-related peritonitis. Results A total of 976 patients were enrolled in this study with a median follow-up of 29.0 (IQR 14.3～45.0) months. There were significant differences in all health services accessibility variables among the three PD centers (Z/χ² values: 45.843～165.628, all P＜0.001). In univariate analyses, education level, travel distance and travel time had significant effect on the risk of all-cause mortality, but after multivariate analysis education levels (HR 1.299～1.364, P=0.238～0.468), travel distance (HR 0.999, 95% CI 0.992～1.007, P = 0.831) and travel time (HR 1.011, 95% CI 0.951～1.075, P = 0.727) had no significant association with the risk of all-cause mortality. All health services accessibility variables were not associated with hemodialysis transfer or first-episode PD-related peritonitis. Conclusion This study suggests that there is no clear association between regional health services accessibility and adverse clinical outcomes for PD patients after the implementation of standardized PD management combined with telemedicine services.

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 explore the effect of the interaction between red blood cell distribution width (RDW) and high-sensitivity C-reactive protein (hsCRP) on cardiovascular events in  maintenance hemodialysis (MHD) patients.  Methods   Patients who received MHD at the Second Affiliated Hospital of Kunming Medical University from January 2020 to June 2022 were enrolled. Based on median RDW levels, patients were divided into a high-RDW (RDW≥4.75%, n=102) and a low-RDW group (RDW＜14.75%, n=102). According to hsCRP level, patients were divided into a high-hsCRP (hsCRP＞3 mg/L, n=127) and a low-hsCRP group (hsCRP≤3 mg/L, n=77). Kaplan-Meier survival curves and COX regression models were used to explore correlations between RDW and cardiovascular events across hsCRP strata and their interaction effect. A restricted cubic spline regression model was used to analyze the dose-response relationship between RDW levels and cardiovascular events.  Results   A total of 204 MHD patients were included in this study, and there were 76 cases (37.3%) of cardiovascular events during the follow-up period. Kaplan-Meier analysis revealed a significantly higher cardiovascular event incidence in the high-RDW versus low-RDW group within the high-hsCRP stratum (χ²=12.831, P＜0.001), but not in the low-hsCRP group (χ²=0.072, P=0.788).  Multivariate Cox regression analysis revealed a significant interaction between RDW and hsCRP on cardiovascular events (HR=1.001, 95% CI:1.000～1.001, P=0.014). Compared with the low-hsCRP-low RDW group，the high-hsCRP-high RDW group had a significantly higher risk of cardiovascular events (HR=2.215, 95% CI: 1.108～4.427, P=0.024). The restricted cubic spline plot showed a linear dose-response relationship between RDW levels and the risk of cardiovascular events (P＜0.001, Pnonlinea r=0.853).  Conclusion   RDW and hsCRP levels have a significant interaction on cardiovascular events, and the coexistence of high RDW and high hsCRP significantly increases the risk of cardiovascular events in MHD patients. 

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.

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 review the research status, evaluation tools, and influencing factors of post-dialysis fatigue in maintenance hemodialysis (MHD) patients, aiming to provide references for clinical workers to improve their prognosis and quality of life.  Methods  We searched the databases of PubMed, Web of science, Cochrane library, Science Direct, Embase, CINAHL, CNKI, Wanfang, VIP and SinoMed for post-dialysis fatigue in MHD patients from inception to September 2024.  Results  A total of 22 articles were included. The commonly used evaluation tool was the open-ended assessment questionnaire for post-dialysis fatigue. The incidence and severity of post-dialysis fatigue were different among the research series. The main influencing factors included sociodemographic factors, dialysis related factors, disease-related factors, physical factors, and psychological factors.  Conclusions  The incidence of post-dialysis fatigue is high in MHD patients. Various tools were available for the assessment of post-dialysis fatigue, but multidimensional and specific assessment tools are yet absent. A diverse of influencing factors are present for the post-dialysis fatigue in MHD patients.

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.

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.

Objective To analyze the risk factors for sarcopenia in patients with maintenance hemodialysis (MHD), so as to explore the preventive measures and the basis for reducing the incidence of sarcopenia in MHD patients.  Methods A total of 312 MHD patients admitted to the Sixth People's Hospital Affiliated to Shanghai Jiaotong University from December 2020 to September 2023 were included in this study. According to the presence and absence of sarcopenia, they were divided into the concurrent group (82 cases) and the non-concurrent group (230 cases). Univariate and multivariate logistic regression analyses were used to screen the risk factors for sarcopenia in MHD patients.  Results Univariate and multivariate logistic analyses showed that age ≥65 years (OR=1.998, 95% CI: 1.188～3.358, P=0.009), body mass index (BMI) ＜21 kg/m2 (OR=1.870, 95% CI: 1.037～3.374, P=0.038), glomerular filtration rate ＜1 mL/min (OR=2.036, 95% CI: 1.120～3.702, P=0.020), higher total body moisture (OR=1.881, 95% CI: 1.013～3.495, P=0.046), higher serum high sensitivity C-reactive protein (hs-CRP) level (OR=1.802, 95% CI: 1.013～3.495, P=0.031), low grip strength (OR=1.749, 95% CI: 1.082～2.827, P=0.023) and low skeletal muscle mass index (ASMI) (OR=1.944, 95% CI: 1.271～2.977, P=0.002) were the risk factors for sarcopenia in MHD patients.  Conclusion  There are many risk factors for sarcopenia in MHD patients. Clinically, the incidence of sarcopenia in MHD patients can be reduced by prevention and detection of the risk factors.

Intrahospital transfer is often required among patients on  blood purification due to differences in disease characteristics, disease progression and treatment needs. How to carry out effective handover during intrahospital transfer to ensure the continuity of care has become critical issues to be solved. This paper reviews the handover management, handover models, handover tools and handover implementation of hemodialysis patients, with the aim of reducing the risk of adverse events during intrahospital transfer and providing reference basis for the safe transfer.

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.

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.

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 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 investigate the 30 day prognosis of adult patients who underwent continuous renal replacement therapy (CRRT) after cardiac surgery and developed sepsis-associated acute kidney injury (SA-AKI).  Methods  A retrospective cohort study was conducted, collecting clinical data from 239 adult patients who underwent CRRT at Guangdong Provincial People's Hospital from March 2023 to May 2024. Patients were divided into two groups based on whether they developed sepsis-associated acute kidney injury within 7 days after cardiac surgery: Acute kidney injury (AKI) group and SA-AKI group.  Results  A total of 239 adult patients who underwent cardiac surgery were included, with an average age of 57.4±13.5 years, and 157 males (65.7%). The Sequential organ failure assessment (SOFA) score was higher in the SA-AKI group compared to the AKI group, 11.0±3.63 vs. 9.45±3.89, (t=-2.534, P=0.014). The overall mortality rate was 31.4% (75/239), with an average treatment time of CRRT and the interquartile range was 8.0 (3.0,17.0) days. The mortality rate of patients in the SA-AKI group was significantly higher than that in the AKI group, 62.8% vs. 24.5%, (χ2=-4.747, P＜0.001). Kaplan-Meier survival analysis log-rank test showed that the cumulative mortality rate in the SA-AKI group was significantly higher than in the AKI group, HR (95%CI) =1.959 (1.220～3.145), (P=0.004). The repeated-measures analysis showed that there was a significant difference in SOFA scores between the SA-AKI group and the AKI group (P=0.004, F=8.135), and a significant time trend was also observed (P＜0.001, F=4.441).  There was a trend towards lower blood lactate levels in both groups, with no significant inter-group differences (P=0.215，F=1.543). There was a significant difference in mean arterial pressure between the SA-AKI group and the AKI group (P=0.002, F=9.028), while the time trend was not significant (P=0.739, F=0.589). Patients in the mortality group had higher SOFA scores than those in the survival group (P＜0.001, F=61.036). The blood lactate levels were higher in the mortality group than that in the survival group (P＜0.001, F=14.853). Additionally, the mean arterial pressure was lower in the mortality group compared with the survival group (P＜0.001, F=45.056).  Conclusion  Patients who developed sepsis-associated acute kidney injury after cardiac surgery have a significantly increased 30-day mortality risk. During the first week of CRRT treatment, it is important to monitor changes in the condition, especially to strengthen monitoring of trends in SOFA scores, lactate levels, and hemodynamic indicators.

Objective To systematically evaluate the effect of bundle arm compression exercise on maturation of arteriovenous fistulas (AVF) after surgery.  Methods  A systematic search in CNKI, Wanfang, VIP, SinoMed, PubMed, Embase, Cochrane Library, and Web of Science databases was conducted for randomized controlled trials (RCTs) and quasi-experimental studies to evaluate bundle arm compression exercise on maturation of AVF after surgery. Data were analyzed using RevMan 5.4.1 software.  Results  A total of 10 studies involving 1,737 patients were included. Meta-analysis results showed that compared with the routine exercise group, bundle arm compression exercise significantly increased ultrasound AVF maturation rate (OR=2.50, 95% CI:1.94～3.22, P＜0.001), clinical AVF maturation rate (OR=2.85, 95% CI:1.73～5.68, P＜0.001) and first successful AVF puncture rate (OR=3.95, 95% CI:1.67～9.36, P=0.002), and decreased AVF-related complication rate (OR=0.21, 95% CI:0.10～0.44, P＜0.001). It also significantly increased AVF diameter (MD=2.50, 95% CI:1.94～3.22, P＜0.001) and AVF blood flow (MD=84.98, 95% CI:(60.87～109.09, P＜0.001), and decreased AVF maturation time (MD=-1.56, 95% CI:-1.97～-1.15, P＜0.001). There were no significant differences between the subgroups based on the time to initiate the exercise (3 days, 1 week, and 2 weeks after surgery), but the effective degree was the biggest in patients to initiate the exercise 3 days after surgery in terms of ultrasound AVF maturation rate, clinical AVF maturation rate, first successful AVF puncture rate and AVF maturation time.  Conclusion  Bundle arm compression exercise can promote AVF maturation and decrease the risks of AVF complications. We recommend the inclusion of bundle arm compression exercise beginning from 3rd days after AVF surgery in the routine nursing program.

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.

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.

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 develop and compare three machine learning prediction models for predicting vascular calcification in patients with maintenance hemodialysis (MHD).  Methods  A total of 300 MHD patients were enrolled and randomly divided into a training set (n=210) and a validation set (n=90) in a 7:3 ratio. Based on the presence or absence of vascular calcification, the training set was further categorized into a calcification group (n=124) and a non-calcification group (n=86). Logistic Regression (LR), Random Forest (RF), and Support Vector Machine (SVM) models were developed to predict vascular calcification. The predictive performance of these models was evaluated using the validation set.  Results  In the training set, the area under curve (AUC) values for the LR, RF, and SVM models were 0.835, 0.886, and 0.872, respectively. In the validation set, the AUC values were 0.823, 0.879, and 0.866, respectively. DeLong's test showed significant differences in the AUC values among the three models (Z=2.663, 2.751; P=0.003, 0.001). All three models demonstrated good goodness-of-fit (χ²=4.018, 4.661, 3.892; P=0.642, 0.887, 0.739).  Conclusion  The LR, RF, and SVM machine learning models demonstrated good predictive performance for vascular calcification in MHD patients, with the Random Forest model showing superior performance.

Objective  To explore the diagnosis and treatment of a rare Benacovirus infection in a patient with peritoneal dialysis-associated peritonitis.  Methods  A case of refractory peritoneal dialysis-related peritonitis caused by Benacovirus infection was retrospectively analyzed, and the related literature was reviewed.  Results  The pathogen of Benacovirus was identified by high-throughput sequencing of MetaCAP microbial nucleic acids from patient's peritoneal drainage fluid. Continuous peritoneal lavage and drainage using double-lumen tubes combined with oral administration of doxycycline gradually clarified the peritoneal drainage fluid and reduced white blood cell counts in the fluid. Follow-up for 2 months after removal of the drainage tube showed no recurrence.  Conclusion  When conventional methods fail to detect the pathogen, MetaCAP sequencing can be helpful to provide etiological evidence and treatment strategy for the peritoneal dialysis-associated peritonitis. Coxiella burnetii is a rare pathogen causing peritoneal dialysis-associated peritonitis, requiring prompt recognition and appropriate treatment.

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 relationship between prognostic nutritional index (PNI) and treatment failure in patients with peritoneal dialysis-associated peritonitis (PDAP).  Methods  A total of 205 PDAP patients hospitalized in the Department of Nephrology from January 2016 to August 2024 were enrolled. Based on treatment outcomes, patients were divided into a cured group (n=170) and a treatment failure group (n=35). Clinical data were compared between the two groups.  Results  Compared with the cured group, the treatment failure group had longer dialysis vintage (Z=-3.422, P=0.001),  higher peritoneal effluent white blood cell (WBC) count on day 3 (Z=-5.219, P＜0.001),higher levels of C-reactive protein (CRP) (Z=    -3.044, P=0.002) , but lower body mass index (BMI) (Z=-2.032, P=0.042) and PNI (t=6.707, P＜0.001). Univariate logistic regression analysis showed that self-administered antibiotic use before admission (OR =4.592, 95% CI:2.118～9.957, P＜0.001), longer dialysis vintage (OR=1.250, 95% CI:1.105～1.414, P＜0.001), higher day 3 peritoneal effluent WBC count (OR=1.021, 95% CI:1.007～1.035, P=0.003), higher CRP (OR= 1.006, 95% CI:1.002～1.010, P=0.002),  lower BMI (OR =0.886, 95% CI:0.796～0.987, P=0.028), and lower PNI (OR=0.833, 95% CI:0.771～0.898, P＜0.001) were risk factors for treatment failure in PDAP patients. Multivariate logistic regression analysis confirmed that longer dialysis vintage (OR=1.179, 95% CI:1.018～1.363, P=0.027), higher day 3 WBC count (OR=1.028, 95% CI:1.010～1.046, P=0.002), and lower PNI (OR=0.853, 95% CI :0.771～0.937, P=0.001) were independent risk factors for treatment failure. Receiver operating characteristic (ROC) curve analysis showed that PNI had the highest predictive value for treatment failure (AUC=0.776), and its predictive performance further improved when combined with dialysis vintage (AUC=0.816).  Conclusion  PNI reflects the nutritional and immune status of the body and is associated with PDAP treatment failure. It demonstrates good predictive ability for treatment outcomes, and its predictive power increases when combined with dialysis vintage.

Arteriovenous fistula (AVF) has the advantages of lower infection and complication rates than other access methods, and is currently the preferable vascular access method for hemodialysis patients. However, delayed maturity rate and dysfunction of AVF are frequently concerned by clinicians. Early diagnosis of dysfunctional AVF usually depends on the advanced imaging techniques, and methods in terms of effective clinical diagnosis, treatment, and prognostic evaluation are virtually rare. The mechanistic role of molecular biology in the pathogenesis of AVF dysfunction is incompletely understood. Currently, the development of genomics, transcriptomics, proteomics, and metabolomics technologies have played great roles in insight into the pathological features and clinical diagnosis of AVF dysfunction. This article summarizes and reviews the molecular biology mechanisms underlying the AVF dysfunction based on multiomics.

Objective  To evaluate the efficacy and safety of oral adsorbent agents in patients with chronic kidney disease (CKD) or chronic renal insufficiency.   Methods   A systematic search of randomized controlled trials (RCTs) was conducted in The Cochrane Library, PubMed, Web of Science, Embase, CNKI, Wanfang, VIP, and SinoMed databases. Quality of the included studies was assessed using the Cochrane Risk of Bias tool (RoB2). Meta-analysis was performed using Stata 15.0 and Stata 16.0 software.  Results  A total of 27 RCTs involving 2,569 patients were included. Compared to the control group, the treatment group showed significantly better outcomes in terms of overall efficacy (RR=1.643, 95% CI:1.405～1.920, P＜0.001), serum creatinine (SMD=-0.545, 95% CI: -0.643～-0.448, P＜0.001), and blood urea nitrogen (SMD=-0.756, 95% CI: -0.972～-0.541, P＜0.001), without an increased incidence of adverse reactions (RR=0.741, 95% CI: 0.512～1.073, P=0.113). Pre-specified subgroup analysis (short-term vs. long-term intervention) revealed that in the short-term (＜2 months) indicators such as serum creatinine, blood urea nitrogen, 24-hour urinary protein quantification, and creatinine clearance improved significantly. In contrast in long-term intervention (≥2 months), oral adsorbents mainly served to maintain efficacy without further therapeutic improvement.   Conclusion  Compared with conventional treatment alone, oral adsorbent agents may help delay renal function deterioration in patients with chronic kidney disease or chronic renal insufficiency, without increasing the incidence of drug-related adverse events.

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.