Chinese Journal of Blood Purification

12 October 2024, Volume 23 Issue 10 Previous Issue    Next Issue

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Consensus of Chinese experts on the treatment of secondary hyperparathyroidism in maintenance hemodialysis patients with calcimimetics(2024 edition) Expert consensus working group on the treatment of secondary hyperparathyroidism in maintenance hemodialysis patients with calcimimetics 2024, 23 (10):  721-735.  doi: 10.3969/j.issn.1671-4091.2024.10.001 Abstract ( 402 )   PDF (735KB) ( 95 )   Secondary hyperparathyroidism (SHPT) is a critical clinical manifestation of chronic kidney disease-mineral and bone disorder (CKD-MBD), significantly impacting the prognosis of maintenance hemodialysis patients. Calcimimetics activate the calcium-sensing receptor (CaSR), effectively reducing parathyroid hormone (PTH) levels without increasing the risks of hypercalcemia and vascular calcification. To standardize and optimize the use of calcimimetics in SHPT treatment, this consensus was developed through a systematic literature review, integrating with clinical practices and expert experiences in China, following the principles of ‘evidence-based first, consensus supplementary, experience as reference’. Utilizing the nominal group technique, 14 recommendations were established, covering the timing of drug administration, clinical efficacy, use in special populations, combination therapy, and clinical safety of calcimimetics in SHPT treatment. The consensus also provides detailed guidelines on the utilization, monitoring indicators, and management of adverse reactions of calcimimetics, providing scientific guidance for clinicians in various medical institutions to improve treatment outcomes and patient prognosis. Metrics

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Research on the burden of cardiovascular disease in hemodialysis patients in China WANG Yan, ZHAO Xin-ju, WEI Tao 2024, 23 (10):  736-740.  doi: 10.3969/j.issn.1671-4091.2024.10.002 Abstract ( 172 )   PDF (459KB) ( 21 )   Objective  The aim of this study was to investigate the burden of cardiovascular disease (CVD) in hemodialysis (HD) patients in China, so as to provide evidences for conducting a multicenter study on CVD in the future.  Methods  The HD Working Group of the HD Branch of the Chinese Hospital Association developed a questionnaire, and pushed the questionnaire through Questionnaire Star to the medical staff of HD centers in China from 2024.1.11-2024.1.18 to investigate the prevalence of CVDs and the screening status. Results A total of 186 valid questionnaires were collected, covering 19 provinces, 4 autonomous regions and 4 municipalities. Coronary artery disease and vascular calcification were the most common types of CVD in HD patients, with the proportion of prevalence exceeding 40% in 55.9% and 62.4% of HD centers, respectively; followed by ischemic stroke, with relatively low proportions of atrial fibrillation and cerebral hemorrhage. In 68.6% of HD centers, the annual mortality rate of patients was less than 10%. In terms of CVD screening, 58.6% of HD centers performed echocardiography for patients once a year, but only 25 (13.4%) arranged for lateral abdominal plain films for patients once a year, and only 15 (8.1%) HD centers performed pulse wave velocity for patients once a year. What’s more, 39.8% of HD centers considered patient compliance to be poor, and 83.3% of medical staff were willing to participate in studies related to the burden of CVD in HD patients.  Conclusion  The proportion of HD patients with CVD is high in China, especially coronary artery disease and vascular calcification, but numerous HD centers failed to conduct regular CVD screening, and patient compliance was poor. CVD screening and management should be strengthened in the future to reduce the burden of CVD disease in HD patients. Metrics

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Efficacy and safety analysis of ambrisentan treatment for IgA nephropathy LI Bing-zhe, SHI Su-fang, ZHU Li, ZHOU Xu-jie, LIU Li-jun, LYU Ji-cheng, ZHANG Hong 2024, 23 (10):  741-746.  doi: 10.3969/j.issn.1671-4091.2024.10.003 Abstract ( 570 )   PDF (530KB) ( 58 )   Background  The efficacy of endothelin receptor antagonists (ERA) in reducing proteinuria in patients with IgA nephropathy (IgAN) has been validated in phase III clinical trials. Ambrisentan, as a selective ERA receptor antagonist, protects the kidneys by antagonizing endothelin. Our study aimed to investigate the efficacy and safety of ambrisentan in patients with IgAN.  Methods  Medical records and follow-up data of IgAN patients treated with ambrisentan in our hospital from November 2022 to December 2023 were collected. Follow-up assessments were conducted at weeks 4, 8, and 12. The primary outcomes were 24-hour urinary protein, 24-hour urinary protein change rate estimated glomerular filtration rate (eGFR), and drug safety monitoring.  Results  A total of 147 IgAN patients were included in the study. The baseline 24h urinary protein level was 1.16 [0.74,1.99] g/day. Compared to baseline, the urinary protein level was 0.7 (0.38 to 1.32) g/day at week 4, with a reduction of 40.5%, Z=-8.157,P＜0.001. At week 8, the urinary protein level was 0.60 (0.43 to 1.44) g/day, with a reduction of 40.25%, Z=-5.866, P＜0.001. At week 12, the urinary protein level was 0.66 (0.43 to 1.43) g/day, with a reduction of 38.9%, Z=-5.238, P＜0.001.There was no significant difference in the rate of 24h UP reduction among subgroups stratified by gender, eGFR, or concomitant medication including steroids, immunosuppressants, and Renin-Angiotensin-Aldosterone System inhibitor (RAASi). eGFR remained stable during the 12-week follow-up period. Ambrisentan was well tolerated in the follow-up patients, with two patients discontinuing treatment due to edema or impaired liver function. Conclusion Ambrisentan can reduce proteinuria in patients with IgAN and is well tolerated. Metrics

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Analysis of autonomic nervous system function during peritoneal dialysis and hemodialysis CHEN Zhen-ye, WANG Jing, ZHANG Yi-ke, WU Song, CUI Chang, CHEN Hong-wu, REN Hai-bin 2024, 23 (10):  747-752.  doi: 10.3969/j.issn.1671-4091.2024.10.004 Abstract ( 114 )   PDF (633KB) ( 9 )   Objective  To observe the changes of autonomic nervous tone in continuous ambulatory peritoneal dialysis (CAPD) and maintenance hemodialysis (MHD) patients during a single dialysis process using heart rate variability (HRV) and skin sympathetic nerve activity (SKNA).  Methods  From February 2021 to July 2021, CAPD patients and MHD patients from the First Affiliated Hospital of Nanjing Medical University were enrolled. These patients were assigned into two groups: CAPD group and MHD group. High-frequency ECG signals were collected for 4 consecutive hours from the beginning of a single dialysis session. After signal processing, HRV and SKNA were analyzed, and then the average values of each 30 minutes were calculated, respectively. The average voltage of SKNA (aSKNA) and HRV indexes were compared between the two groups.  Results  A total of 30 CAPD patients and 50 MHD patients were included. The mean heart rate and normalized high frequency power (HFn) of 0-30 minutes and 30-60 minutes were different between the two groups (t=-2.210, -2.426, Z=2.226, 2.027, P=0.037, 0.018, 0.026, 0.043), the normalized low frequency power (LFn) of 30-60 minutes was also different (t=-2.548, P=0.013). After dialysis, low frequency power to high frequency power ratio (LF/HF) increased in both groups (Z=3.162, 2.980, P=0.011, 0.020), while changes happened earlier in the MHD group. The mean heart rate increased (q=3.336, P=0.009) and HFn decreased (Z=4.123, P＜0.001) significantly in MHD group. There was no significant difference in aSKNA between two groups (0.010＜|Z|＜1.109, all P＞0.05), but MHD group showed a greater dynamic change (Z＞3.125, P＜0.05).  Conclusion  During a single dialysis session, MHD patients showed a greater change in autonomic system tone compared with CAPD patients.  Metrics

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A clinical study on goal-directed model for improving quality of hemodialysis at grassroots level WANG Xin, JIANG Deng-ke, LIU Lin-hao, DENG Ya-nan, MA Xue-ping, WANG Pei, LIANG Xian-hui 2024, 23 (10):  753-757.  doi: 10.3969/j.issn.1671-4091.2024.10.005 Abstract ( 119 )   PDF (508KB) ( 14 )   Objective  To explore the effects of goal-directed model on improving quality of hemodialysis at grassroots level.  Methods  Patients receiving maintenance hemodialysis treatment at the Southern Branch of The First Affiliated Hospital of Zhengzhou University from October 2021 to March 2022 were enrolled in this study. After 6 months of goal-directed management, the improvement of vascular access, clinical indicators, quality of life, and health economics indicators of the patients were evaluated.  Results  A total of 85 cases were included. After 6 months of goal-directed management, proportion of the patients using tunneled-cuffed catheters decreased from 42.35% to 27.06% (χ2=6.303, P=0.043), proportion of the patients with a single-pool Kt/V ＜1.2 decreased to 7.05% (χ2=21.182, P＜0.001), and proportion of the patients with interdialytic weight gain ＜5% of dry weight increased to 70.59% (χ2=43.895, P＜0.001), as compared to the baseline data. The levels of hemoglobin (χ2=15.824, P=0.001), potassium (χ2=4.541, P=0.033), albumin (χ2=31.224, P＜0.001), phosphorus (χ2=17.306, P＜0.001) and intact parathyroid hormone (χ2=17.162, P＜0.001) improved significantly. Satisfaction of the patients increased from 48.24% to 100% (χ2=59.365, P＜0.001), and the quality of life score improved significantly (t=-22.455, P＜0.001). The total direct medical expenses did not increase significantly compared to the baseline (t=1.387, P=0.167).  Conclusion The goal-directed model effectively improves the quality of hemodialysis for grassroots patients, facilitates the management of complications and enhances the quality of life, but does not incur additional medical expenses, which demonstrate its stronger practical value. Metrics

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Comparison of double filtration plasma exchange and plasma adsorption in the treatment of hyperlipidemic acute pancreatitis MA Xi-miao, LIU Shuang, LEI Ming-hua, WANG Ai-ping 2024, 23 (10):  758-762.  doi: 10.3969/j.issn.1671-4091.2024.10.006 Abstract ( 109 )   PDF (487KB) ( 10 )   Objective To compare the clinical effects of two blood purification modalities, dual filtration plasma exchange and plasma adsorption, in the treatment of hyperlipidemic acute pancreatitis (HTG-AP).  Methods  Clinical data of the 75 HTG-AP patients admitted to Sanya People's Hospital or Jilin People's Hospital from May 2021 to April 2023 were retrospectively studied. There were 24 cases in the double filtration plasmapheresis (DFPP) group, 26 cases in the plasma adsorption (PA) group, and 25 cases in the conventional treatment group. Biochemical indexes, fasting time, abdominal pain relief rate after 72h, complications, hospitalization expenses and recurrence rate were compared among the three groups after the treatment.  Results Serum triacylglycerol, cholesterol, hs-CRP and interleukin 6 (IL-6) decreased more in the DFPP group within 24h after the treatment than in the conventional treatment group (t=8.136, 4.577, 3.671 and 2.241 respectively; P＜0.001, ＜0.001, =0.001 and =0.030 respectively). Serum triacylglycerol, cholesterol, hs-CRP, serum amyloid A (SAA) and IL-6 decreased more in the PA group than in the conventional treatment group  (t=10.533, 4.679, 3.347, 3.622 and 2.356 respectively; P＜0.001, ＜0.001, =0.002, =0.001 and =0.023 respectively). However, there were no statistical differences in these biochemical indexes between the DFPP group and the PA group (P＞0.05). The recurrence rate had statistical difference between the DFPP group and the conventional group (χ2=6.050, P=0.049). There were no statistical differences in total hospitalization expenses among the three groups (F=1.787, P=0.175).  Conclusion  DFPP and PA are two blood purification treatment modalities that can rapidly and effectively reduce serum lipids. They are beneficial to block  inflammatory responses, reduce the chance to develop serious illnesses, and obtain better clinical efficacies. Metrics

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Application of regional citrate anticoagulation in pediatric single plasma exchange XUN Mai, ZHANG Liang, LI Zhi-hui, ZHANG Yi 2024, 23 (10):  763-766,789.  doi: 10.3969/j.issn.1671-4091.2024.10.007 Abstract ( 92 )   PDF (618KB) ( 11 )   Objective  To explore the efficacy and safety of regional citrate anticoagulation (RCA) method for plasma exchange (PE) in children. Method  Eighteen children received PE treatment in a total of 48 times at the Department of Nephrology, Rheumatology and Immunology, Hunan Children's Hospital from February 2021 to June 2023 were enrolled in this study; they were used RCA for PE because they had medium or above medium bleeding risk after a bleeding risk assessment. The control group consisted of 28 children using heparin anticoagulation for PE in a total of 84 times in the same period. Blood calcium ion and bicarbonate ion were compared before and after the treatment in RCA group.  Bleeding and clotting in filters were compared between RCA group and control group.  Result  In RCA group, calcium ion in peripheral blood decreased significantly on PE for 1h and after PE as compared to the blood calcium ion before PE (1.00±0.10 vs. 1.18±0.09, t=9.543, P＜0.001; 0.88±0.13 vs. 1.18±0.09, t=15.948, P＜0.001), but no patients had blood calcium ion ＜0.7mmol/L after PE; blood bicarbonate ion after PE increased significantly as compared to the level before PE (32.53±4.44 vs. 28.29±4.53, t=9.942, P＜0.001); the rate of metabolic alkalosis was higher after PE than before PE (83.33% vs. 45.83%, c2=10.723, P＜0.001). All patients had no extracorporeal circulation coagulation events that interrupted the treatment. The rate of clotting in filters had no significant difference between RCA group and control group (4.17% vs. 7.14%, c2=0.475, P=0.488). In RCA group, the effective anticoagulation rate was higher in the patients with the after filter calcium ion concentration ＜0.45mmol/L than in those with the concentration ≥0.45mmol/L (97.73% vs. 75.00%, P=0.005). There was no significant difference in bleeding between the two groups. The symptoms of hypocalcemia such as limb numbness, muscle twitching or arrhythmia during PE were not found in all of the patients.  Conclusion  The use of RCA for pediatric plasma exchange therapy is relatively simple and safe. This method can be effectively used for pediatric plasma exchange therapy. Metrics

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The characteristics and management of hyperkalemia in patients on maintenance hemodialysis WANG Yu-rou, GUO Sheng-jie, YUAN Li-ying 2024, 23 (10):  767-770.  doi: 10.3969/j.issn.1671-4091.2024.10.008 Abstract ( 197 )   PDF (443KB) ( 33 )   Hyperkalemia is frequently seen in patients on maintenance hemodialysis (MHD). Patients with slight hyperkalemia may have no obvious symptoms, but severe hyperkalemia can cause cardiac arrest, fatal arrhythmia, ventilator paralysis and other complications, seriously affecting survival and prognosis of the MHD patients. This article aims to review the characteristics and management of hyperkalemia in MHD patients. Metrics

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Recent advances in coagulation mechanism and anticoagulation strategy of extracorporeal circulation in blood purification HE Xi-mei, WAN Li-ping, LI Tian, WANG Xue-liang, YUAN Shu-ting, XI Chun-sheng 2024, 23 (10):  771-774.  doi: 10.3969/j.issn.1671-4091.2024.10.009 Abstract ( 196 )   PDF (622KB) ( 54 )   Blood purification is an important treatment modality to clear toxins and other wastes from the body and to maintain electrolyte and acid-base balance, critical for patients’ survival and quality of life. However, blood quickly develops a coagulation reaction when it contacts filters and tubes, which lowers the adequacy of hemodialysis or even interrupts the hemodialysis. This reaction may also trigger the activation of coagulation system, leading to consumption of clotting factors, immune-inflammatory reactions, filter blockage, bleeding, thrombus formation, and other coagulation-related complications. With the advances of blood purification technology, the mechanisms of coagulation in the extracorporeal circulation and the effective anticoagulation strategies have been widely investigated. This review comprehensively summarizes the recent advances in the mechanisms of blood coagulation on equipment surfaces, and also briefly reviews the recent advances in inhibition of coagulation pathways, modification or engineering of membrane surfaces, and improvement of extracorporeal circuits. Metrics

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The effect of formula prediction method on the design of end-to-side anastomosis of arteriovenous fistula LONG Huang-zhe, MO Xiong, YANG Peng, LI Mei 2024, 23 (10):  775-778.  doi: 10.3969/j.issn.1671-4091.2024.10.010 Abstract ( 89 )   PDF (515KB) ( 10 )   Objective  To explore how to improve the maturation rate of the first arteriovenous fistula (AVF) through rational design of arteriovenous anastomosis.  Methods  The control group was treated with traditional end-to-side anastomosis of AVF, and the observation group used the formula prediction method to design the end-to-side anastomosis of AVF. The preoperative cephalic vein diameter and radial artery diameter, radial artery incision length, postoperative anastomotic diameter, postoperative cephalic vein outflow tract diameter, postoperative brachial artery blood flow, and AVF maturity rate were compared between the two groups.  Results  There were no significant differences in preoperative cephalic vein diameter (F=2.516, P=0.794) and postoperative radial artery diameter (F=0.381, P=0.861) between control group and observation group. The radial artery incision length was shorter in control group than in observation group (F=0.099, P＜0.001). In control group after the operation for 14, 28 and 42 days, the anastomotic diameter was smaller (F=3.812, 1.735 and 1.487 respectively; P＜0.001), the cephalic vein diameter was narrower (F=0.233, 1.442 and 0.002 respectively; P=0.012, 0.024 and ＜0.001 respectively), and the brachial artery blood flow was lower (F=2.287, 1.121 and 0.019 respectively; P＜0.001, =0.008 and =0.001 respectively), as compared with those in observation group. The fistula maturation rate was lower in control group than in observation group after operation for 28 and 42 days (c2=4.167 and 3.990, P=0.041 and 0.046).  Conclusions The design of fistula anastomosis using the formula prediction method is beneficial to improve the maturation rate of the first AVF. Metrics

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Study on the influencing factors of autogenous arteriovenous fistula failure in peritoneal dialysis patients JIANG Zuan-hong, ZHANG Hong, ZHOU Ling-ling, SHAO Song-hua, WANG Ying, XU Li-yun 2024, 23 (10):  779-783.  doi: 10.3969/j.issn.1671-4091.2024.10.011 Abstract ( 104 )   PDF (480KB) ( 6 )   Objective To investigate the maturation rate of autologous arteriovenous fistula (AVF) in peritoneal dialysis (PD) patients, and to explore the influencing factors for AVF failure in PD patients.  Methods  Patients on PD undergoing AVF surgery for the first time in the hospital between January 1,2018 and June 30, 2023 were enrolled in this study. According to whether the AVF maturation with assistance, the patients were divided into the non-assisted AVF maturation group and the non-assisted AVF failure group. Baseline data were compared between the two groups. Multivariate logistic regression was used to analyze the influencing factors for AVF failure.  Results  A total of 116 PD patients were enrolled in this study. The non-assisted AVF maturation rate was 76% and the assisted AVF maturation rate was 93%. In the non-assisted AVF failure group, female proportion was higher (χ²=10.830, P=0.001), mean arterial pressure was lower (t=3.106, P=0.002), ratio of diabetes as the primary disease was higher (χ²=4.087, P=0.043), and preoperative hemoglobin level was higher (t=-2.376, P=0.019). Multivariate logistic regression showed that female (OR=4.813, 95% CI: 1.736～13.339, P=0.003) and mean arterial pressure (OR=0.960, 95% CI: 0.927～0.995, P=0.024) were the independent risk factors for AVF failure in PD patients.  Conclusions  The maturation rate of the first AVF in PD patients is similar to that in general population. Females and lower preoperative mean arterial pressure are associated with poor AVF maturation in PD patients. Metrics

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A review on the total chlorine in dialysis water XIE Hui-le, WANG Xu-kai 2024, 23 (10):  784-789.  doi: 10.3969/j.issn.1671-4091.2024.10.012 Abstract ( 91 )   PDF (556KB) ( 13 )   Chlorine and chloramines are the most commonly used disinfectants for tap water, which are strictly controlled in dialysis water, and the maximum allowable concentrations are specified in industry standards. However, the consideration of hemodialysis industry is mainly focused on the daily monitoring of the concentration. The source, composition, hazards, removal and detection methods of total chlorine in dialysis water are poorly understood, and are only partially involved in the literature. This paper comprehensively and systematically compiles and summarizes the knowledge of the sources, effects, detection and removal of total chlorine in dialysis water with reference to the domestic and international literature, so as to provide detailed references and guidelines for the study and work in the industry practitioners. Metrics

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Effects of intradialytic aerobic exercise on survival status and quality of life in patients undergoing maintenance hemodialysis: a meta-analysis GUO Zhuang-zhuang, YU Liang, YANG Jia-hui, LI Ling-ling, XU Wei, ZHU Ya-mei 2024, 23 (10):  790-794.  doi: 10.3969/j.issn.1671-4091.2024.10.013 Abstract ( 125 )   PDF (517KB) ( 22 )   Objective  To assess the impact of intradialytic aerobic exercise on survival status and quality of life among maintenance hemodialysis patients. Methods  A systematic literature search for randomized controlled trials on intradialytic aerobic exercise was performed in PubMed, EMBASE, MEDLINE, Google Scholar, Cochrane Library, Wanfang, VIP and China National Knowledge Infrastructure (CNKI) from inception until October first, 2023. The Jadad scale was used to perform quality assessment. The Stata 12.0 software was used to perform meta-analysis.  Results  A total of 30 studies were included. Meta-analysis showed that intradialytic hypotension (OR=0.410, 95% CI:0.181～0.930, P=0.033), restless legs syndrome (WMD= -4.661, 95% CI:-5.331～-3.992, P＜0.001), 60-second sit-to-stand test (WMD=3.075, 95% CI:1.367～4.783, P＜0.001), 5-repetition sit-to-stand test (WMD=-1.447, 95% CI:-2.716～-0.237, P=0.020), 10-repetition sit-to-stand test (WMD=-4.630, 95% CI:-7.41～-1.849, P=0.001), 6-minute walk distance (WMD=44.903, 95% CI:32.651～57.155, P＜0.001), hand grip strength (WMD=6.207, 95% CI:3.368～9.046, P＜0.001), single pool clearance index (WMD=0.095, 95% CI:0.051～0.140, P＜0.001), urea reduction ratio (WMD=4.820, 95% CI:3.565～6.075, P＜0.001) and life quality scores were improved in the patients with intradialytic aerobic exercise group as compared to the patients using conventional care group. Subgroup analysis suggested that the dialysis adequacy, 60-second sit-to-stand test and 6-minute walking distance improved more in the long-term intervention group than in the short-term intervention group.  Conclusions  Intradialytic aerobic exercise can improve survival status and quality of life in hemodialysis patients, and the effectiveness becomes better in the patients with longer term of the intervention. Metrics

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A multi-center survey on the ability against infectious disease emergencies and its influencing factors among blood purification nursing staff in Jiangsu province  JIA Mei-rong, ZHANG Shan, ZHANG Si-yuan, ZHANG Meng-ya, DING Ming-mei, KONG Ling 2024, 23 (10):  795-798.  doi: 10.3969/j.issn.1671-4091.2024.10.014 Abstract ( 93 )   PDF (510KB) ( 10 )   Objective To investigate the current status of the capacity against infectious disease emergencies in nursing staff of blood purification centers in the 14 hospitals in Jiangsu province, and to analyze its influencing factors.  Methods  A cross-sectional survey on nursing staff of blood purification centers in the 14 hospitals of different classes in Jiangsu province was conducted using the questionnaire of infectious disease emergency response ability.  Results  ①The mean score of the ability against infectious disease emergencies was 3.63±0.64 in a total of 331 hemodialysis nursing staff.  ②Univariate analysis showed that rescue experience (t=-3.396, P=0.001), number of emergency exercises (F=8.509, P＜0.001), number of theoretical trainings (F=8.905, P＜0.001), type of working unit (F=3.278, P=0.021), job title (F=2.748, P=0.043), working years (F=6.205, P=0.002) were related to the ability against infectious disease emergencies in nursing staff.   ③Multivariate linear regression showed that rescue experience (β=0.132, P=0.013), emergency response exercises (β=0.128, P=0.042), theoretical trainings (β=0.132, P=0.037), type of working unit (β=-0.119, P=0.022), and working years (β=0.131, P=0.017) were the influencing factors for the ability against infectious disease emergencies in nursing staff.   Conclusion  The ability against infectious disease emergencies in nursing staff of blood purification centers is insufficient and only at a medium level. The training of infectious disease related knowledge for nursing staff of blood purification centers must be emphasized in the administration of hospitals to enhance their ability to the emergencies.  Metrics

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Nursing care of a patient with continuous renal replacement therapy during allogeneic liver transplantation CAO Pei-ye, WANG Lei, DU Hui-ming, CHEN Na 2024, 23 (10):  799-780.  doi: 10.3969/j.issn.1671-4091.2024.10.015 Abstract ( 96 )   PDF (379KB) ( 15 )   To summarize the nursing experience of a patient with end-stage liver disease and renal insufficiency who underwent continuous renal replacement therapy (CRRT) during allogeneic liver transplantation. The nursing key points include operating the machine compliant with the aseptic requirements in operating room, adopting a nursing plan for pre-flushing with anticoagulant and treatment without anticoagulant, timely adjusting treatment parameters according to the changes of key monitoring indicators during anhepatic phase, and analyzing the type of alarms and establishing a procedure for preprocessing an alarm. The patient underwent a liver transplantation surgery for 7 hours, and the total treatment time for CRRT was 9 hours with a smooth disease course. Metrics