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.

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

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.

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

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

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

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.

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.

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

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

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

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 investigate the symptoms occurred in patients receiving hemodiafiltration (HDF), and to analyze the relationship between the symptoms and HDF dose.  Methods  This was a cross-sectional study. Patients receiving regular maintenance hemodialysis thrice a week as well as post-diluted HDF at least once a week between November 2024 and January 2025 were recruited. Patients’ general data, HDF information and laboratory examinations were collected. Symptom burden was assessed using the Dialysis Symptom Index (DSI). The relationship between symptom burden and HDF dose was analyzed.  Result  A total of 179 patients were included in this study. The total DSI was 12.00 (9.00, 17.00) points. The first 5 most common symptoms were dry skin (89.94%), itching (81.56%), dry mouth (81.01%), feeling irritable (76.53%) and fatigue (68.72%). The first 5 most severe symptoms were irritable feeling [2.00 (1.00, 2.00) points], difficult falling asleep [1.00 (0.00, 2.00) points], dry skin [1.00 (1.00, 2.00) points], itching [1.00 (1.00, 2.00) points], and dry mouth [1.00 (1.00, 2.00) points]. The weekly convective volume of HDF was 41.44 (35.01, 53.76) L. With the increase of HDF frequency, weekly convective volume and β2-microglobulin reduction rate increased (H=122.516 and 24.138, P<0.001), accompanied by the decrease of pre-treatment β2-microglobulin levels (H=20.903, P<0.001). Patients receiving HDF therapy twice weekly(Z=-2.388，P=0.017) or thrice weekly (Z=-2.182, P=0.029) demonstrated lower total DSI scores compared to those receiving therapy once weekly. Locally weighted regression analysis showed that when convection volume is over 51.94 L/week, patients' DSI showed a downward trend.  Conclusion  Patients receiving HDF often experience a considerable symptom burden. The symptom burden can be improved with the increase of HDF dose, which is probably attributed to the clearance of medium molecular toxins. Higher HDF dose may improve patient’s symptom experience and long-term outcomes.

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

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 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.

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.

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

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

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

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

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

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

Objective To evaluate the effects of different non-pharmacological interventions on thirst in patients undergoing maintenance hemodialysis (MHD) via a network meta-analysis, and to provide evidence for clinical nursing.  Methods  Randomized controlled trials about the impact of non-pharmacological interventions on thirst in MHD patients were searched across eight databases: PubMed, Web of Science, the Cochrane Library, Embase, CNKI, Wanfang, VIP, and CBM. The search period was from database inception to July 25, 2025. Two researchers independently conducted literature screening, quality assessment, and data extraction. Network meta-analysis was performed using RevMan 5.4 and Stata 14.0 software.  Results  A total of 14 studies were included, involving 937 MHD patients and 10 non-pharmacological interventions. There was a statistically significant difference between routine care and the following interventions: chewing sugar-free gum (SMD=-3.69, 95% CI: -4.51～-2.86, P＜0.001), rinsing mouth with compound mouthwash (SMD=  -1.48, 95% CI: -2.77～-0.20, P=0.024), comprehensive sodium management (SMD=-3.3, 95% CI: -6.56～     -0.04, P=0.047), and sucking lemon ice cubes (SMD=-1.69, 95% CI: -3.21～-0.17, P=0.029).  Conclusion Chewing sugar-free gum is the most effective intervention for alleviating thirst symptoms. Clinical healthcare providers can develop relevant interventions following patients’ preferences.

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

Objective  This paper aims to reveal the domestic and international research trends in hemodialysis technology from the perspective of patents, to compare the technological differences between domestic and foreign technologies, and to provide references for technological breakthroughs and patent layout of domestic enterprises.  Methods   Based on global patent data, the analysis is conducted from the dimensions of application trends, and applicant distribution. The development and evolution of core technologies such as dialysis membranes, dialysis fluids, and monitoring alarms are also studied.  Results  The annual average growth rates of domestic patent applications during the slow growth, oscillating growth, and rapid growth phases were 19.74%, 30.48%, and 33.56%, respectively. In contrast, foreign applications began to decline gradually starting in 2017 (The annual average growth rate from 2017 to 2021 was -2.01%). Three domestic applicants ranked among the top 20 global patent applicants. Domestically, 38% of patent applications originated from enterprises, while 33% came from hospitals. The key development directions for dialyzer membranes focus on membrane materials, forming processes, and functionalization. Patent technologies for dialysate concentrate on personalized regulation and the addition of therapeutic drugs tailored to different individuals. Dialysate delivery and heating technologies focus on intelligence and safety.  Conclusions  Domestic entities have evolved from technology followers into a significant force driving the global development of hemodialysis technology. The domestic landscape possesses the advantage of collaborative innovation between clinical institutions and enterprises.

Objective  Based on the data from the medical director survey questionnaire of the 7th phase of the Chinese Dialysis Outcomes and Practice Patterns Study (DOPPS 7), this study analyzed the current treatment practices for chronic kidney disease-mineral and bone disorder (CKD-MBD) and renal anemia in 43 dialysis centers in Beijing, Guangzhou, and Shanghai.  Methods  A cross-sectional survey design was adopted. Data from the medical director surveys of DOPPS 7 (2018 to 2021) were collected and analyzed for practice indicators such as CKD-MBD (phosphate binder use, secondary hyperparathyroidism management) and renal anemia (erythropoiesis-stimulating agents [ESA], iron therapy). Count data were described as percentages, and the χ² test was used for comparisons between groups (P＜0.05 was considered significant).  Results  Regarding the phosphate binder use: most nephrologists choose sevelamer as the long-term first-line treatment option, but calcium-containing phosphate binders are still widely used. When there are no cost limits, most doctors prefer non-calcium-containing phosphate binders mainly due to the risk of hypercalcemia. Concerning the treatment of hyperparathyroidism: most physicians consider a parathyroid hormone (PTH) level of 300 pg/mL as the critical value for initiating vitamin D therapy, and 92.7% prefer oral administration. For the treatment of renal anemia: most physicians concur that a hemoglobin (Hb) level of ＜100 g/L serves as the threshold for initiating erythropoiesis-stimulating agent (ESA) treatment, and a ferritin level of ≤300 ng/mL is regarded as the threshold for commencing iron supplementation. Notably, only 48.8% of centers adopt a ferritin level of ≥500 ng/mL as the cut-off point for discontinuing treatment.  Conclusion  There is room for improvement in the treatment of CKD-MBD and renal anemia in dialysis centers in China's first-tier cities. Although non-calcium-containing binders are the main first-line hypophosphatemia treatment, calcium-containing phosphate binders are still widely used. The administration route of vitamin D and the timing of iron therapy deviate from current guidelines. Standardized practices are needed to narrow the gap with the guidelines.

This report presents a case of hypothyroidism induced by roxadustat, a hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI), for the treatment of renal anemia. The patient was a 93-year-old female undergoing maintenance hemodialysis, and was admitted due to “recurrent dizziness for more than 10 years, chronic kidney disease stage 5 (CKD stage 5), and renal anemia”. She had received regular hemodialysis for over one year and was treated with oral roxadustat for renal anemia. On the third day after roxadustat therapy, the patient developed symptoms of hypothyroidism, accompanied by abnormal laboratory test results. Following consultation with the Department of Endocrinology and comprehensive differential diagnosis, she was confirmed to have central hypothyroidism. Despite treatment with levothyroxine sodium (Euthyrox), her thyroid function failed to improve; however, it gradually returned to normal after discontinuing roxadustat. In view of this case, we recommended that thyroid function should be regularly monitored when the patients receive roxadustat therapy. When necessary, thyroid hormone replacement therapy is initiated or roxadustat is temporarily suspended. 

Objective To compare the clinical efficacy and safety of 2-hour and 4-hour hemoperfusion combined with hemodialysis (HP+HD) in the treatment of patients undergoing maintenance hemodialysis (MHD), and to provide clinical evidence for optimizing toxin clearance strategies in this population. Methods A prospective open-label randomized controlled trial was conducted. Patients receiving MHD at the Blood Purification Center of Zhoupu Hospital Affiliated to Shanghai University of Medicine & Health Sciences from January to December 2025 were enrolled. They were randomly divided into the 2-hour HP+HD group and the 4-hour HP+HD group at a ratio of 1:1 using a random number table. Both groups were treated with SR150 hemoperfusion cartridge in series with HD, with a HP frequency of once every 2 weeks for a continuous 12-week course. The clearance rates of toxins and inflammatory cytokines after a single session, as well as levels of middle-molecular-weight toxins, protein-bound uremic toxins (PBUTs), inflammatory cytokines, dialysis adequacy, and safety parameters after 12 weeks of treatment, were compared between the two groups. Adverse events and cartridge clotting were also recorded. Results Each group enrolled 52 patients. After a single HP+HD session, the 4-hour group showed significantly higher clearance rates than the 2-hour group for indoxyl sulfate (IS) (Z=-1.928, P=0.047), β2‑microglobulin (β2-MG) (Z=2.583, P=0.020), intact parathyroid hormone (iPTH) (Z=2.505, P<0.001), phosphorus (t=-2.726, P=0.009), tumor necrosis factor-α (TNF-α) (Z=-2.931, P=0.003), interleukin-6 (IL-6) (Z=-2.112, P=0.044), and interleukin-1β (IL-1β) (Z=-2.844, P=0.004). After 12 weeks of treatment, the 4-hour group had significantly lower levels of IS,  β2-MG,  iPTH,  TNF-α, IL-6, and IL-1β than the 2-hour group (t=-4.145, P<0.001; t=-2.532, P=0.013; t=-3.312, P=0.030; t=-2.711, P=0.008;  t=-6.858, P<0.001; t=-4.823, P<0.001, respectively). Regarding safety, no statistically significant differences were found between the two groups in post-treatment hemoglobin, red blood cell count, white blood cell count, platelet count, or albumin (t=1.635, P=0.105; t=0.062, P=0.951; t=1.225, P=0.224; t=-0.063, P=0.548; t=0.062, P=0.951). The incidence of cartridge clotting also did not differ significantly between the groups (χ²=0.188, P=0.665).  Conclusion  The 4-hour HP+HD regimen is more effective in clearing middle-and large-molecular-weight toxins and PBUTs in MHD patients, with a favorable safety profile and feasible operation. It may serve as an optimized treatment option for MHD patients.

Objective To investigate the efficacy of different nutritional assessment tools in evaluating the nutritional status of elderly patients undergoing maintenance hemodialysis (MHD) and analyze their correlation with frailty and adverse outcomes. Methods A total of 146 elderly patients (aged ≥65 years) undergoing MHD were enrolled. Nutritional status was assessed using the Nutritional Risk Screening 2002 (NRS2002), Mini-Nutritional Assessment-Short Form (MNA-SF), and Malnutrition Inflammation Score (MIS), followed by consistency analysis. Patients were divided into frailty and non-frailty groups, as well as survival and death groups, based on the FRAIL scale (Fatigue, Resistance, Ambulation, Illness, Loss of Weight) and adverse outcomes. Differences in clinical data and nutritional status between groups were compared. Multivariate logistic regression was used to analyze the relationship between NRS2002, MNA-SF, MIS, and frailty. Kaplan-Meier survival analysis and multivariate Cox regression were employed to evaluate the relationship between NRS2002, MNA-SF, MIS, and prognosis.  Results The incidence of malnutrition assessed by NRS2002, MNA-SF, and MIS was 41.78%, 43.84%, and 52.74%, respectively. MIS showed good consistency with NRS2002 and MNA-SF (Kappa=0.701, 0.714), while NRS2002 and MNA-SF had low consistency (Kappa=0.427). The proportion of malnutrition assessed by NRS2002 (χ²=5.385, P=0.020), MNA-SF (χ²=5.023, P=0.025), and MIS (χ²=8.119, P=0.004) was significantly higher in the frailty group than in the non-frailty group. Multivariate logistic regression revealed that NRS2002 (OR=3.903, 95%CI: 1.393～10.937, P=0.010) and MIS (OR=4.574, 95%CI: 1.435～14.585, P=0.010) were independent risk factors for frailty. The proportion of malnutrition assessed by NRS2002 (χ²=10.905, P＜0.001), MNA-SF (χ²=6.837, P=0.009), and MIS (χ²=12.296, P＜0.001) was significantly higher in the death group than in the survival group. Kaplan-Meier analysis showed that the cumulative survival rate of malnourished patients (assessed by NRS2002, MNA-SF, MIS) was significantly lower than that of patients with normal nutrition (χ²=7.375, 9.681, 12.252, P=0.007, 0.002, <0.001, respectively). Multivariate Cox regression indicated that NRS2002 (HR=2.587, 95%CI: 1.210～5.533, P=0.014), MNA-SF (HR=2.663, 95%CI: 1.218～5.821, P=0.014), and MIS (HR=3.697, 95%CI: 1.494～9.147, P=0.005) were independent risk factors for adverse outcomes.  Conclusion  MIS shows good consistency with NRS2002 and MNA-SF in assessing nutritional status in elderly MHD patients. Both MIS and NRS2002 are risk factors for frailty and adverse outcomes and may be more suitable for clinical prognosis evaluation..

nfection is the second leading cause of hospitalization and death, and ranks only behind cardiovascular diseases in hemodialysis patients owing to impaired immunity and the dialysis involving frequent extracorporeal circulation. Multi-drug resistant bacteria (MDROs) are microorganisms resistant to most antibacterial drugs and have higher survival ability and transmissibility. MDROs are easily colonized in human body but are difficult to be eliminated. Maintenance hemodialysis patients are susceptible to MDROs, resulting in serious consequences that threaten medical safety of the patients and consume more medical resources. Blood purification centers are the key places that spread MDROs and require strictly preventive strategies. In addition to the standard preventive measures, effective system support, personnel training, appropriate use of antibiotics, microbiological monitoring, etc are critical to the control of MDRO infections. This paper reviews the prevalence and control measures of MDROs, the impact of preventive measures on patients, current situation and obstructions in blood purification centers, in order to provide references for effective prevention and control of MDRO infections in different levels of blood purification centers. In view of current fact that most blood purification centers do not have the environment to strictly isolate MDRO infected hemodialysis patients, future investigations should be focused on the standardized MDRO preventive protocols.

Peritoneal dialysis (PD) patients often have the risks of unfavorable outcomes due to longer treatment period and complicated disease conditions, presenting many challenges to disease management. The risk prediction model of outcomes based on the application of artificial intelligence (AI) can help PD medical team early and precisely manage the high risk PD patients, being valuable to increase the technological survival rate of PD patients. This paper reviews AI-based risk prediction models for clinical outcomes of PD patients from a PD medical care team perspective. Meanwhile, this paper also analyzes the existed challenges and prospects, aiming to provide a reference for precise management of PD with the aid of AI.

Objective  To explore the symptom experiences in patients undergoing peritoneal dialysis (PD) at home in order to provide the bases for improvement of symptomatic management.    Methods  Phenomenological study was conducted, involving semi-structured interviews with 11 PD patients. The Colaizzi's 7-step method was used for data analysis and theme extraction.  Results  The symptom experiences of home-based PD patients are summarized into 3 themes and 7 sub-themes: multi-faceted symptom perception (physiological, psychological, social); symptom evaluation (inadequate understanding of symptom causes, identification and assessment; insufficient self-management in medication, diet, fluid volume and exercise); symptom coping (problem-oriented coping, avoidant coping).  Conclusion  The dialysis care team should pay attention to the symptom experiences of PD patients, implement targeted and precise nursing care, and improve patients' symptom burden and quality of life.

Patient-reported outcomes (PROs) with regarding to health situation and treatment responses
directly collected from the patients are valuable in nephrology and particularly in hemodialysis (HD), reflecting physical and mental status and helping reform treatment strategies. The comparison of high-dose hemodiafiltration (HDF) with high-flux hemodialysis trial (2018) (CONVINCE) compared high-dose HDF with highflux HD and incorporated PROs for the first time. This review summarizes PRO applications in HDF research
and discusses future clinical implementation.

Objective This study aims to investigate the prevalence of depressive symptoms and their influencing factors in patients undergoing maintenance hemodialysis (MHD). Methods A multicenter design was adopted, and a total of 397 MHD patients were included. Data on sociodemographic characteristics, laboratory test indicators, and scores from the Patient Health Questionnaire-9 (PHQ-9) were collected. Univariate analysis, logistic regression, and Chi-squared Automatic Interaction Detector (CHAID) decision tree analysis were used to determine the influencing factors.  Results The prevalence of depressive symptoms in MHD patients was 21.91%. Logistic regression analysis indicated that insomnia (OR=2.583，95%CI: 1.472～4.533，P＜0.001), diabetes (OR=1.796，95%CI: 1.026～3.144，P = 0.040), and hepatitis B (OR=3.996，95%CI: 1.786～8.942, P＜0.001) were independent influencing factors of depressive symptoms in MHD patients. CHAID decision tree analysis showed that insomnia (χ2=20.046, P＜0.001), diabetes (χ2=5.543, P=0.019), hypoproteinemia (χ2=19.198, P＜0.001), and β2-microglobulin (β2-MG) (χ2 =10.969, P=0.008) were the main factors affecting depressive symptoms.  Conclusion  Insomnia, diabetes, hepatitis B, hypoalbuminemia, and β2-MG are closely associated with depressive symptoms in MHD patients. This study provides a scientific basis for the early identification and intervention of depressive symptoms in MHD patients.

High volume hemodiafiltration (HVHDF) has been proven to reduce the risk of death in dialysis patients, but the existing evidence mainly comes from the European population. Recent clinical data from Fresenius Kidney Care (FKC) Singapore demonstrated consistent achievement of convection volume targets across diverse ethnic groups. Patients with Chinese ethnicity, representing the majority, achieved outcomes comparable to global benchmarks. Moreover, HVHDF may offer reduced hospitalization burden compared to conventional HD, and better symptom control as adjudged by patient reported outcomes. Singapore’s experience affirms that HVHDF can be safely and effectively integrated into routine care, in a multi-ethnic group, offering a scalable model for improving dialysis outcomes in Asia. This review explores the institutional, operational, and clinical enablers that supported the implementation of HVHDF in Singapore to distil practical lessons applicable for broader HDF implementation across Asia.