血液透析(hemodialysis,HD)治疗是一种挽救终末期肾病(end stage renal disease,ESRD)患者生命和维持生命的方法。2016年我国透析患者约57.8万名。据报道，至2020年底，我国仅HD患者已增至69万余例。高钾血症是慢性肾脏病患者临床常见的并发症，与患者肾功能减退密切相关。随着肾小球滤过率逐渐下降，患者肾脏排泄钾离子的能力下降，高钾血症的发生风险增加。即使是已经进入维持性透析治疗，仍有较高比例的ESRD患者发生或反复发生高钾血症。高钾血症是透析患者出现恶性心律失常、心源性猝死的主要原因之一，研究表明高钾血症导致ESRD患者的死亡风险是冠状动脉疾病患者的2倍。此外，HD治疗本身的非生理性特点，也会导致治疗过程中患者体内血钾浓度发生大幅度波动，可能增加患者心律失常，甚至恶性心律失常的风险。因此，加强对维持性血液透析(maintenance hemodialysis，MHD)患者高钾血症的管理有着十分重要的临床意义。然而，当前国内外尚无聚焦于MHD患者高钾血症管理的指导性意见。因此，本指南工作组成员基于现有的相关指南性和共识性的推荐，结合中国血液透析的临床实践，撰写了《中国维持性血液透析患者高钾血症管理指南》。指南系统的介绍了MHD患者高钾血症的高危因素、诊断分层、检测治疗、透析处方制定、达标范围、合并用药等内容，体现了MHD患者高钾血症管理的新趋势、新观点，以期对临床医生更好地管理HD患者的高钾血症有所帮助。

我国慢性肾脏病贫血患者存在铁缺乏患病率高、诊断不足、铁代谢指标达标率低、监测手段及治疗不规范等问题。基于当前诊疗现状，本指南由肾脏病、血液净化、血液病、药学、公共卫生、统计学专家组成的指南编写委员会共同编写，结合循证医学证据及临床使用经验，系统介绍了慢性肾脏病患者铁缺乏的诊断与鉴别诊断、铁状态的目标与铁剂治疗的时机、铁剂的选择与应用，以及铁剂在合并几种特殊情况时的应用等。目的在于指导、规范铁剂在慢性肾脏病贫血患者中的应用，提高临床诊疗水平。

【Abstract】In April 2020, the American National Kidney Foundation made a major update to the Kidney Disease Outcomes Quality Initiative (KDOQI) Clinical Practice Guideline for Vascular Access, and carried out various treatments for the survival plan of end-stage renal disease patients, including the life plan of end-stage renal disease patients, the selection of vascular access, and the new methods for handling specific complications. This article interprets this guideline according to the conditions of our country, helps doctors and patients make decisions on the treatment mode and vascular access for end-stage renal disease, and brings
directional suggestions for subsequent research.

The incidence of syphilis has gradually increased in recent years, laboratory test is important for the correct diagnosis of syphilis .This paper has reviewed the clinical characteristics and laboratory test progress in syphilis diagnosis, especially in Nontreponemal tests and treponemal tests for syphilis infection diagnosis
and laboratory test results interpretation for clinical use.

Chronic kidney disease- mineral and bone disorder (CKD-MBD) is a common complication during the progression of CKD, closely relating to the hospitalization rate, poor quality of life, cardiovascular calcification and cardiovascular or all- cause mortality in CKD patients. It is an important issue for clinical workers to identify the CKD-MBD related control targets of serum calcium, phosphorus and PTH values, and a series of clinical guidelines and consensus have been provided in the past years. The target values for serum calcium and phosphorus are basically consistent, i.e. to achieve and maintain the values in the normal reference ranges when possible. The calcium-phosphorus product is mainly affected by the phosphorus concentration and has less significance. The target value for PTH is quite broad. The suggestion in KDIGO guidelines that intact PTH (iPTH) should be controlled in 2-9 times of the upper normal limit is widely mentioned but is controversial. However, a narrow range for iPTH cannot be defined in the published results so far. Clinically, the dynamic changes of CKD-MBD parameters are more valuable than a single value of one parameter.

【Abstract】This paper analyzes the causes of transmembrane pressure change and its unfavorable effects. We focuse on the principle of transmembrane pressure monitoring in dialysis machine. We particularly emphasize the training for medical staffs about the importance of transmembrane pressure monitoring and the manipulation of relevant preventive measures to achieve safe and efficient use of dialysis.

【摘要】尿毒症皮肤瘙痒是终末期肾脏病患者最常见的和最令人不适的症状之一。尿毒症皮肤瘙痒患者常伴有不同程度的抑郁和睡眠障碍，严重影响患者的生活质量，增加死亡率。因此，准确测量尿毒症皮肤瘙痒程度及其影响，对提高患者的生活质量、评估治疗效果都具有重要意义。目前，国外已开发和验证了一些可用于尿毒症皮肤瘙痒的测量工具，而国内该领域相对空白。本文将对这些测量工具进行介绍，分析它们的优缺点，供临床参考使用。

【Abstract】Plasma exchange (PE) is a blood purification method aiming at removing circulating pathogenic proteins or protein-bound substances, which has been widely applied in treating various diseases, including autoimmune diseases. It has two technical forms: membrane separation(MPE) and centrifugal separation (CPE). The technical issues include prescription of treatment dose and frequency, choice of plasma separator, setup of treatment parameters including blood flow rate, plasma separation rate, choice of replacement fluid, anticoagulation, prevention of clinical and technical complications. In this paper, we reviewed all of the issues mentioned above in detail.

功能良好的血管通路是血液透析顺利进行的前提，并直接影响病死率、住院时间及医疗费用。HeRO（the Hemodialysis Reliable Outflow）血管通路的出现为依赖TDC（Tunneled dialysis catheter）行维持性血液透析的病人提供了一个新的选择。HeRO血管通路与TDC相比具有以下几点优势：①直接将较快流速的动脉血引入静脉系统，减少了血栓及蛋白鞘形成等并发症，在透析效果上明显优于TDC，且可以同AVG（arteriovenous graft）相媲美；②可以通过一定程度狭窄的中心静脉进入右心房，缓解部分中心静脉狭窄所带来的症状；③全部位于皮下，降低了移植物感染的风险；④同时在一定程度上降低了医疗费用。但HeRO血管通路目前仍存在以下不足：①置管需在全麻下进行，有麻醉风险；②对于严重的中心静脉狭窄，HeRO无法通过；③管腔内可能发生血栓形成；④术后可能发生窃血综合症。而且，目前缺乏对HeRO并发症分析及处理的相关经验报道，所以HeRO血管通路的临床应用有待于进一步的循证医学支持，前景可期。

【Abstract】Anticoagulation is of major importance for successful performance of blood purification. Currently, the classic anticoagulation methods are heparin and low molecular weight heparin. Regional anticoagulation of citrate (RCA) is now widely used for continuous blood purification due to its safety, effectiveness, wider application range and better biocompatibility. RCA has been recommended in domestic and foreign guidelines. Citrate anticoagulation is an ideal method, which has been confirmed by a large number of studies in different blood purification modalities. However, citrate has several drawbacks found in clinical practice, including complicated monitoring and adjustment and many potential side effects. Optimized protocols of citrate anticoagulation are therefore explored and recommended in order to provide new ways for the better use of citrate as an anticoagulation agent in blood purification. In this paper, we review the progress in monitoring and adjusting RCA in different blood purification modalities.

【Abstract】Objective To retrieve, evaluate and integrate the best evidence for central venous catheterization in hemodialysis patients, and to summarize the best evidence. Methods A computer search of the Cochrane Library, PubMed, Embase, Medline, Wanfang, China Knowledge Network, Weipu and other databases and Yimaitong Clinical Guide Network, JBI EvidencEbased Nursing Database and Chinese database CNKI was performed. The searched evidence and results of randomized controlled experiments were summarized. The search period was from the time of construction to March 1, 2020. Results A total of 10 articles were enrolled, including 2 guidelines, 3 systematic reviews, 1 expert consensus, and 4 randomized controlled trials. Conclusion The best evidence of central venous catheterization for hemodialysis patients was summarized and specific recommendations were formed, which provide evidencEbased nursing for clinical medical staff, and instructive significance for scientific nursing of central venous catheterization in hemodialysis patients.

Objective   To implement evidence-based practice based on the evidences from exercise rehabilitation in maintenance hemodialysis (MHD) patients, and to validate the role of exercise rehabilitation in improving physical function, exercise tolerance, and quality of life in MHD patients.  Methods  The evidence-based continuous quality improvement model was used as the research framework, and an evidence-based program for exercise rehabilitation in MHD patients was conducted from January to December 2021 through evidence acquisition, status review and evidence introduction. A total of 80 MHD patients hospitalized in the Department of Nephrology, Jiangsu Provincial Hospital of Traditional Chinese Medicine from January to March 2022 were then recruited and randomly divided into experimental group (n=40) and control group (n=40). After the exercise intervention, the muscle mass, muscle strength, 6-minute walking test, and quality of life were compared between the two groups. The awareness of sport rehabilitation evidence in medical staff was also compared before and after the evidence-based practice.  Results   Nine pieces of evidences were finally included, with a total of seven reviewed indicators. After exercise intervention, muscle mass (t=-3.302, P<0.01), muscle strength (t=-2.825, P<0.001), and 6-minute walking (t=-5.529, P<0.001) increased more in experimental group than in control group. The total scores of each dimension in the Health Survey Short Form increased more in experimental group than in control group (P<0.05). The awareness rate of sport rehabilitation evidence among medical staff increased by 40.74% before and after evidence-based practice, which has a statistical significance (P<0.001).  Conclusion  The evidence-based exercise rehabilitation practice can improve the body function, exercise endurance and quality of life in MHD patients.

Objective To study the effect of midodrine to prevent the hemodialysis-related hypotension (IDH) in maintained-hemodialysis (MHD) patients. Methods 27 MHD patients who had usually showed IDH were involved. These patients received hemodialysis with the same hemodialysis prescription, but took orally Midodrine 7.5～15mg for three times every day, and took orally another 5mg at 30 minutes before hemodialysis or onset of IDH. Blood pressure and IDH were observed during hemodialysis. Results Ultrafiltration rate, pre-hemodialysis blood pressure, temperature and sodium concentration of dialysate were no significant difference between before and after Midodrine treatment in 27 cases (P＞0.05). After Midodrine treatment, total ultrafiltrated volumes, the lowest intrahemodialysis blood pressure, and post-hemodialysis blood pressure were increased significantly (P＜0.05), and the cases showed IDH, symptomatic IDH were reduced(P ＜0.01). Midodrine treatment showed significant effect in 11 cases (40.7% ), showed effect in 9 (33.3%), and showed no effect in 7 (26.0%). Conclusion We suggest that Midodrine treatment can effectively prevent hemodialysis-related hypotension in MHD patients.

【Abstract】Objective To obtain the data supporting standardized treatment and continuously improving the quality of hemodialysis, we investigated the current treatment status and epidemiology of maintenance hemodialysis (MHD) patients in our hemodialysis center. Methods We retrospectively reviewed the clinical records of 513 MHD patients treated for more than 3 months in the Blood Purification Center, the Second Hospital of Shanxi Medical University between Jan. 2010 and Dec. 2014. Gender, onset age, medical expense type, primary renal disease, the first vascular access type, complications, changes of treatment, cause of death, and survival rate were analyzed. All related data were collected through the Chinese National Renal Data System. Results ①In our hemodialysis center, the number of hemodialysis patients increased annually. Among the 513 MHD patients, 291 were males and 222 were females with a male/female ratio of 1.3 to 1. ②Most patients with end stage renal disease (ESRD) were in the age of 40 to 49 years and 50 to 59 years. ③In the 431 patients with defined causes of ESRD, the top 3 primary causes were glomerulonephritis (48.0%), diabetic nephropathy (25.9%), and hypertensive nephrosclerosis (10.7%). ④The first used vascular access at the beginning of hemodialysis was temporary central venous catheter (76.8% ), and primary arteriovenous fistula (21.5%). ⑤Anemia was the most common complication, followed by hypertension, bone and mineral disorders. The rates achieved to the recommended levels of hemoglobin, blood pressure, blood calcium, blood phosphorus and IPTH were less than 50%. ⑥Among 513 MHD patients, 12 received renal transplantation, 11 changed to peritoneal dialysis, 385 transferred to other hospitals for hemodialysis, 5 got rid of dialysis, 9 gave up the treatment, 24 died, and 67 were still hospitalized in our unit. Cardiovascular and cerebrovascular incidences were the leading causes of death. ⑦The survival rate of MHD patients was different: 93.3% in one
year, 75.3% in five years, 14.6% in ten years, and one for more than 228 months and still under regular dialysis. Conclusion In our dialysis center, the majority of the MHD patients were middle aged and elderly males. The first three primary causes leading to ESRD were glomerulonephritis, diabetic nephropathy, and hypertensive nephrosclerosis. The major vascular access at the beginning of hemodialysis was temporary central venous catheter, suggesting that timely hemodialysis should be emphasized. The incidence rate of anemia, hypertension, bone and mineral disorders were high, but the control rates were low. Cardiovascular and cerebrovascular incidences were the leading cause of death. As the hemodialysis treatment was prolonged, the longterm survival rate of MHD patients was gradually reduced.

动静脉内瘘穿刺技术直接影响动静脉内瘘的寿命。通过对动静脉内瘘穿刺前的消毒， 穿刺针的选择，穿刺的角度，穿刺针的斜面方向，穿刺点的选择方法，穿刺的技巧等方面对动静脉内瘘穿刺技术及进展进行综述，旨在提高穿刺成功率，减少医源性损伤，延长内瘘使用寿命，实现最佳实践标准。

【Abstract】End stage renal disease (ESRD) has become an important public health problem worldwide. The insidious progress of ESRD often leads to the requirement of urgent-start dialysis when admitted to hospitals. Currently, hemodialysis with central vein catheterization is still the most commonly used method of urgent-start dialysis. However, this method has the risks of catheter- related infection, bacteremia, thrombosis and other complications with higher medical expenses. Due to the continuous progress of automated peritoneal dialysis technology, the interest to urgent-start peritoneal dialysis(PD) increases in recent years. Most studies show that urgent-start PD is safe, effective, favorable to health economics, and worthy of widely used.

【Abstract】Objectives The aim of this study was to evaluate the proportion of hyperkalemia, rates of the diagnosis and treatment, and rate of retesting for hyperkalemia among outpatients in China. Methods Data were derived from Beijing Data Center for Rational Use of Drugs. Patients who accessed outpatient services (aged ≥18 years old) with record(s) of serum potassium (S-K) between Jan. 1st, 2015 and Dec. 31st, 2017 were included. The data about laboratory test, diagnosis and treatment were analyzed. The main outcomes including proportion of hyperkalemia patients, diagnosis rate, treatment rate and S-K retesting rate were analyzed. The geographic and seasonal distributions of the outcomes were examined. Results A total of 2,997,634 patients with at least one S-K record were analyzed. Among these patients, 115,826 (3.86%) experienced hyperkalemia (S-K＞5.0mmol/L). In patients with chronic kidney disease, heart failure, diabetes mellitus and hypertension, the rates of patients who experienced hyperkalemia were 22.89%, 12.54%, 7.11% and 6.51%, respectively. In outpatients, the overall rate of hyperkalemia was 2.53%. In patients with hyperkalemia, the overall hyperkalemia treatment rate was 8.69%, and the overall retesting rate within 7 days was 11.41%. Conclusions Hyperkalemia is an abnormality not rare in adult outpatients in China. The rate and severity of hyperkalemia were higher in patients with chronic kidney disease, heart failure, hypertension and diabetes
compared to those in the overall outpatients. However, the rates of diagnosis, treatment and retesting for hyperkalemia in outpatients were insufficient, suggesting that the recognition and management of hyperkalemia in outpatients should be emphasized.

【Abstract】skin pruritus is a common symptom in end-stage renal disease patients undergoing maintenance hemodialysis (MHD). Pruritus affects the quality of life, causes anxiety, depression, sleep disorders, and unfavorable prognosis of the patients. Although many kinds of treatment can be used clinically, the curative effect is limited. The pathogenesis of pruritus is complicated. This paper expounds the pathogenesis of skin pruritus in MHD patients from the perspectives of dry skin, immune inflammation hypothesis, histamine, bivalent ions, opioid hypothesis, parathyroid hormone, peripheral neuropathy, dialysis adequacy and mode, and glycosylation hypothesis.