Chinese Journal of Blood Purification

12 May 2025, Volume 24 Issue 05 Previous Issue    Next Issue

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Chinese expert consensus on the management of protein-bound uremic toxins in maintenance hemodialysis patients (2025 edition) Work group of Chinese expert consensus on the management of protein-bound uremic toxins in maintenance hemodialysis patients ( edition) 2025, 24 (05):  353-365.  doi: 10.3969/j.issn.1671-4091.2025.05.001 Abstract ( 206 )   Protein-bound uremic toxins (PBUTs) are small molecular weight uremic toxins that easily bind to serum albumin. The accumulation of PBUTs is associated with poor prognosis in patients with maintenance hemodialysis (MHD). Due to their high protein-binding capacity, PBUTs are difficult to remove by routine hemodialysis, which is currently a challenge in clinical practice. This consensus systematically described the definition, classification, metabolism, hazards, and clinical management strategies of PBUTs. Several recommendations were established based on evidence-based medicine and clinical experience. This consensus aims to help the clinicians to better understand PBUTs and develop rational treatment strategies for the management of PBUTs in MHD patients. Metrics

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Low FT3 levels independently associated with sleep disturbance in maintenance hemodialysis patients WEN Luo-na, HE Xiao-jiao, LI Shuang, QIU Zhen-liang, ZHONG Xiao-shi 2025, 24 (05):  366-369,391.  doi: 10.3969/j.issn.1671-4091.2025.05.002 Abstract ( 42 )   Objectives To investigate the association between sleep disturbance and thyroid function in maintenance hemodialysis (MHD) patients. Methods This was a single-center and cross-sectional study. Patients regularly undergoing maintenance hemodialysis at the Blood Purification Center in Guangzhou Red Cross Hospital of Jinan University in November 2023 were enrolled. Demographic data, pre-dialysis laboratory parameters, medication history were collected, and pre-dialysis serum samples were collected for thyroid function tests. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI). Results  In total, 126 patients were enrolled, with 65 (51.6%) patients in the normal sleep group and 61 (48.4%) patients in the sleep disturbance group. Univariate binary logistic regression showed that continuous variables including lower serum free triiodothyronine (FT3) levels (OR=0.332,95% CI:0.178～0.620, P=0.001) and longer dialysis vintage (OR=1.018, 95% CI:1.007～1.030,P=0.001), as well as categorical variables including FT3 ＜3.4 pmol/L (OR=3.201,95% CI:1.222～8.390, P=0.018) and use of sleep medications (OR=5.658,95% CI:2.310～13.861,P＜0.001) were all associated with sleep disturbance. However, there was no significant association between serum free thyroxine, thyroid-stimulating hormone levels, and sleep disturbance. After adjusted for age, sex, dialysis vintage, Kt/V, and use of sleep medications, the multivariate binary logistic regression showed serum FT3＜3.4 pmol/L (OR=3.225，95% CI:1.229～8.464，P=0.017) was still associated with sleep disturbance. Conclusion Lower serum FT3 levels and sleep disturbance were independently associated in MHD patients. However, prospective studies are needed to confirm the results.  Metrics

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Study on the relationship between triglyceride glucose body mass index and vascular calcification in patients with diabetic nephropathy WANG Yu-xi, GAO Hong-hua, LU Bing, CHEN Hui 2025, 24 (05):  370-374.  doi: 10.3969/j.issn.1671-4091.2025.05.003 Abstract ( 39 )   Objective  To investigate the relationship between triglyceride glucose body mass index (TyG BMI index) and vascular calcification in patients with diabetic nephropathy (DN).  Method  A retrospective study was conducted among 424 DN patients admitted to our hospital from June 2020 to May 2024. The patients were divided into four groups based on their TyG BMI index at admission (TyG BMI Q1 TyG BMI Q4), and the differences in age, gender, vascular calcification, etc. were compared among the four groups. Logistic regression models were used to analyze the relationship between TyG BMI index and vascular calcification in patients, and conducting trend analysis and stratified analysis. The predictive value of predicting the risk of vascular calcification in DN patients was assessed using restricted cubic spline plot (RCS) analysis of TyG BMI index.  Result  The incidence of vascular calcification in DN patients was 30.90% (131/424). The median TyG-BMI index is 35.87. The incidence of vascular calcification in the TyG BMI Q1, Q2, Q3, and Q4 groups of DN patients was 27.36% (29/106), 15.09% (16/106), 33.96% (36/106) and 47.17% (50/106), respectively, with statistically significant differences (χ2=26.633, P<0.001). When adjusting for all confounding factors, compared with the Q1 group, the risk of vascular calcification increased by 1.893 times in the Q3 group (OR=2.893, 95% CI: 1.485～5.634, P=0.002), and 4.022 times in the Q4 group (OR=5.022, 95% CI:2.610～9.663, P＜0.001). Trend analysis shows that before and after model correction, the OR values of vascular calcification risk in patients with different TyG BMI groups showed an increasing trend (P trend<0.001). RCS analysis showed that there was a nonlinear association between TyG-BMI index and the risk of vascular calcification in DN patients  (Pnonlinearity=0.011).  Conclusion  In patients with DN, TyG-BMI was a risk factor for vascular calcification, and the risk of vascular calcification was significantly higher when TyG-BMI was higher than 35.87. Metrics

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Meta-analysis of risk factors for continuous renal replacement therapy in patients after type A aortic dissection surgery LI Xiao, CAO Rui-yang, WANG Yong, ZHANG Rui-fang 2025, 24 (05):  375-381.  doi: 10.3969/j.issn.1671-4091.2025.05.004 Abstract ( 28 )   Objective To systematically evaluate the risk factors for postoperative continuous renal replacement therapy (CRRT) in patients with type A aortic dissection. Methods  Studies investigating risk factors for CRRT after surgery in patients with type A aortic dissection were retrieved from databases including VIP, Wanfang Medical, China National Knowledge Infrastructure, China Biomedical Literature, China Medical Journal, Web of Science, PubMed, Embase, and Cochrane Library. Meta-analysis of relevant risk factors was performed using RevMan 5.4 software.  Results  A total of 13 case-control studies involving 6,145 patients were included. Meta-analysis revealed the following risk factors significantly associated with postoperative CRRT: age (MD = 1.90, 95% CI:0.50～3.31,P<0.01),history of chronic kidney disease (OR=4.11,95% CI:2.54～6.65,P<0.01), hepatic dysfunction (OR=2.05, 95% CI:1.52～2.78,P <0.01), preoperative cardiac tamponade (OR=2.48, 95% CI:1.16～5.31,P=0.02), preoperative pericardial effusion (OR =3.20, 95% CI:1.23～8.31,P =0.02), renal artery involvement by dissection (OR =2.42, 95% CI:1.28～4.60,P<0.01), left ventricular end-diastolic diameter (MD=-1.23, 95% CI:-2.21～-0.25,P=0.01),platelet count (MD=-14.28,95% CI:-26.35～-2.21,P=0.02), White blood cell count (MD=1.02,95% CI: 0.44～1.61,P <0.01), blood urea nitrogen (MD=0.85, 95% CI:0.71～1.00,P<0.01), albumin (MD=-1.12, 95% CI:-2.07～-0.18,P=0.02),myoglobin (MD=79.64,95% CI:48.02～105.87,P<0.01), serum creatinine (MD=41.59, 95% CI:27.43～55.75,P<0.01), coronary artery bypass grafting (OR=2.60, 95% CI:1.40～4.82,P<0.01), operative duration (MD=50.66, 95% CI:37.59～63.72,P<0.01), cardiopulmonary bypass time (MD=32.08, 95% CI:22.89～41.27,P<0.01), aortic cross-clamp time (MD=15.31, 95% CI:11.63～18.99,P<0.01), extracorporeal circulation time (MD=27.70, 95% CI:13.81～41.58,P<0.01), intraoperative blood loss (MD =128.03, 95% CI:22.52～233.55,P=0.02), platelet transfusion volume (MD=0.78, 95% CI:0.17～1.39, P=0.01),plasma transfusion volume (MD=176.53, 95% CI:6.78～346.29, P<0.01),red blood cell transfusion volume (MD=3.26, 95% CI:1.63～4.89, P<0.01), mechanical ventilation duration (MD=73.77, 95% CI:19.44～128.09, P<0.01), ICU stay duration (MD=3.81, 95% CI:0.84～6.77, P<0.01), re-exploration for bleeding (OR=4.27, 95% CI:2.75～6.63, P<0.01).  Conclusion  Risk factors for postoperative CRRT in patients with type A aortic dissection encompass multiple aspects, including general factors, medical history, preoperative status, preoperative laboratory tests, concurrent surgical procedures, intraoperative variables, and postoperative conditions. Clinicians should conduct targeted risk factor screening, identify high-risk patients early, and initiate CRRT appropriately to improve clinical prognosis. Metrics

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Effect of protein intake on serum phosphorus in peritoneal dialysis patients with different initial solute transport characteristics WANG Xiao-pei, LYU Jing, LIANG Chang-na 2025, 24 (05):  382-386.  doi: 10.3969/j.issn.1671-4091.2025.05.005 Abstract ( 31 )   Objective  To investigate the effects of protein intake on serum phosphorus levels in peritoneal dialysis (PD) patients with different peritoneal solute transport characteristics and to explore appropriate protein intake for preventing hyperphosphatemia in this cross-sectional study.  Method  A cohort of 740 patients with peritoneal dialysis (PD) who had been on dialysis for 1–3 months at a single center was included. Patients were categorized into rapid transporters (4h D/P Cr > 0.65) and non-rapid transporters (4h D/P Cr≤0.65) based on the 4-hour dialysate-to-plasma creatinine ratio (4h D/P Cr) from peritoneal equilibration tests (PET). Serum phosphorus, peritoneal phosphorus clearance, urinary phosphorus clearance, and total daily phosphorus clearance were compared between the two groups. Patients were further stratified by normalized protein catabolic rate (nPCR): Group A [nPCR ＜0.80 g/(kg·d)], Group B [nPCR 0.80～1.0 g/(kg·d)], and Group C [nPCR≥1.0 g/(kg·d)]. Serum phosphorus levels and risk factors for hyperphosphatemia were analyzed across transport categories.  Result  The cohort included 329 rapid transporters and 411 non-rapid transporters. Rapid transporters had lower serum phosphorus (t=6.279, P<0.001) and total urinary phosphorus clearance (t=2.910, P=0.029) but higher peritoneal phosphorus clearance (t=−6.172, P<0.001) and daily dialysate phosphorus removal (t=−3.403, P=0.001) compared to non-rapid transporters. The 4h D/P Cr was positively correlated with peritoneal phosphorus clearance (r=0.393, P<0.001) and inversely correlated with serum phosphorus (r=−0.245, P<0.001). In non-rapid transporters, serum phosphorus positively correlated with nPCR (r=0.237, P<0.001). The area under the ROC curve (AUC) was 0.635 (95% CI:0.581～0.689, P<0.001), with a cutoff nPCR of 0.995 g/(kg·d), yielding a sensitivity of 54.4% and a specificity of 78.5%.  Conclusion  High protein intake increases the risk of hyperphosphatemia in non-rapid transporters. nPCR predicts hyperphosphatemia during the initial months of dialysis in this subgroup. Urinary and peritoneal phosphorus clearance exhibit compensatory effects in maintaining serum phosphorus levels. Metrics

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Factors affecting peritoneal residual volume after peritoneal dialysis drainage and its impact on dialysis efficiency CHENG Xue-bin, LI Yan, YANG Xiao-yun, JI Tian-rong, KONG Fan-wu 2025, 24 (05):  387-391.  doi: 10.3969/j.issn.1671-4091.2025.05.006 Abstract ( 31 )   Objective  To investigate the factors influencing peritoneal residual volume (PRV) and its impact on dialysis efficiency in patients undergoing peritoneal dialysis.  Methods Data on demographics and clinical biochemistry were collected from patients receiving maintenance peritoneal dialysis between January 2019 and December 2023 at the Second Affiliated Hospital of Harbin Medical University. The position of the peritoneal dialysis catheter tip was recorded via abdominal supine radiography or pelvic CT. PRV after dialysis was calculated using the Twardowski method based on creatinine levels in the dialysate at 0 and 4 hours. Patients were divided into high-PRV and low-PRV groups, and factors influencing PRV were analyzed using t-tests. The impact of PRV on dialysis efficiency was also assessed. Results  A total of 112 patients were included, with 72(64.3%) undergoing ultrasound-guided percutaneous catheter placement and 40(35.7%) undergoing surgical placement. There was no significant difference in catheter tip position between the two methods (r =0.665, P =0.717). PRV was associated with catheter tip position (t=-8.502,P=0.001) but not with abdominal surgery history, BMI, abdominal circumference, or surgical method. Compared to the high-PRV group (n =39), the low-PRV group (n =73) had better post-dialysis blood pressure control (t =-5.019, P=0.001), lower NT-proBNP (t=-3.537, P=0.001), and higher dialysis Kt/V (t = 4.430, P=0.001), Ccr (t =2.786, P=0.001), and prealbumin levels (t=2.057, P=0.031).  Conclusions The position of the peritoneal dialysis catheter tip in the abdomen affects PRV, and high PRV reduces peritoneal dialysis efficiency. Metrics

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The relationship between CRP clearance and vascular calcification in native arteriovenous fistulas in maintenance hemodialysis patients FENG Wei-xun, JIA Yong-pan, YU Hai-yuan, HAN Wei 2025, 24 (05):  392-397.  doi: 10.3969/j.issn.1671-4091.2025.05.007 Abstract ( 35 )   Objective  To explore the relationship between C-reactive protein (CRP) clearance and vascular calcification (VC) in native arteriovenous fistulas (AVF) in maintenance hemodialysis (HD) patients.  Methods A total of 136 patients who underwent fistula repair or primary fistula creation for chronic kidney disease (CKD) stages 4-5 at Dingzhou People's Hospital between February 2019 and April 2023 was studied. Patients were grouped into no VC (54 cases), mild-moderate VC (52 cases), and severe VC (30 cases). Clinical features were screened using LASSO regression. Multifactorial logistic regression identified risk factors, built a predictive model, and evaluated its performance. Correlations were analyzed with multiple linear regression, and dose-response relationships were assessed using restricted cubic splines (RCS) and threshold effect analysis. Results  LASSO regression identified age, diabetes, stage 2 hypertension, 24-hour urine volume, calcium-phosphate product, CRP clearance, vascular smooth muscle cell (VSMC) calcium content, and alkaline phosphatase (ALP) activity as predictive factors. Multifactorial logistic regression showed that age (OR=3.062,95% CI:1.131～9.120, P<0.001), diabetes (OR=1.851,95% CI:1.023～3.447, P=0.022), calcium-phosphate product (OR=2.341, 95% CI:1.052～6.076, P=0.005), CRP clearance (OR=0.356, 95% CI:0.123～0.507, P=0.001), VSMC calcium content (OR=1.904, 95% CI: 1.264～5.213, P=0.014), and ALP activity (OR=2.197, 95% CI:1.347～4.280, P=0.010) were independent risk factors for severe VC. The model demonstrated good discrimination (post-validation sensitivity 90.00%, specificity 80.19%), with an accuracy of 82.35% and Youden index 0.702. CRP clearance was negatively correlated with VSMC calcium content  (β=   -0.332, P=0.008) and ALP activity (β=-0.303, P=0.012). A nonlinear relationship was found between CRP clearance and severe VC risk (nonlinearity test P<0.001), with a CRP clearance inflection point at 24.5%.  Conclusion  CRP clearance is associated with AVF-VC in maintenance HD patients and can serve as a biomarker for monitoring AVF-VC. Metrics

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Research progress on factors affecting the maturation of autologous arteriovenous fistulas WU Yi-ting , DING Dan-dan, YANG Bing, ZUO Li 2025, 24 (05):  398-401.  doi: 10.3969/j.issn.1671-4091.2025.05.008 Abstract ( 44 )   Native arteriovenous fistula (AVF) is a lifeline for end-stage renal disease patients, crucial for extending survival and improving quality of life. In China, about 80% of maintenance hemodialysis patients use AVF, yet 20% to 60% of newly created AVFs fail to mature. AVF maturation is influenced by patient factors, surgical techniques, postoperative exercise, and medical support. Many scholars have studied factors affecting AVF maturation to improve maturation rates. This review covers research progress on factors influencing AVF maturation. Metrics

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Research progresses in artificial intelligence for hemodialysis complication prediction and patient management ONG Ming-yang, HOU Zuo-xian, WANG Ying, CHEN Li-meng 2025, 24 (05):  402-405.  doi: 10.3969/j.issn.1671-4091.2025.05.009 Abstract ( 63 )   Hemodialysis is one of the crucial treatments for end stage renal disease. However, there are still issues to be solved, such as higher mortality, various dialysis-related complications and increased demands for chronic disease management. These situations highlight urgent necessities to enhance risk prediction,  precise diagnosis of complication, and comprehensive management of the patients. The rapid development of artificial intelligence and its gradual integration into hemodialysis have provided great potentials to address the existing issues. This review aims to outline the current application status of artificial intelligence in prediction and diagnosis of hemodialysis complications and to elaborate its development directions in patient management based on existed achievements and trends. Metrics

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Research progress in cerebral vascular disease in patients with chronic kidney disease ZHAO Peng-ming, MA Si-yuan, WANG Xiao-ling 2025, 24 (05):  406-409.  doi: 10.3969/j.issn.1671-4091.2025.05.010 Abstract ( 39 )   Chronic kidney disease (CKD) is frequently associated with a variety of cerebral vascular diseases including ischemic and hemorrhagic stroke, and small vessel disease. Conventional vascular risk factors such as hypertension and diabetes mellitus account for many of the cerebral vascular diseases in CKD patients, and renal-specific risk factors such as uremic toxin, endothelial dysfunction and abnormal calcium and phosphate metabolism also play important roles in the pathogenesis of the diseases. In this paper we introduce the types and risk factors of cerebral vascular diseases in CKD patients, in order to prevent the occurrence and to improve the prognosis of cerebral vascular diseases in the patients. Metrics

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Risk factors for hypotension during continuous renal replacement therapy MAO Ren-li, YANG Ying-ying, ZHANG Ling 2025, 24 (05):  410-413.  doi: 10.3969/j.issn.1671-4091.2025.05.011 Abstract ( 49 )   Continuous renal replacement therapy (CRRT) is a slow and continuous bedside blood purification therapy method that has the advantage of more stable hemodynamics compared to conventional hemodialysis. However, many studies have shown that hypotension is still one of the common complications of CRRT. It has been reported that the incidence of hypotension within the first hour of CRRT is as high as 43~64.6%, and is independently associated with in-hospital mortality. However, the risk factors affecting the occurrence of hypotension during CRRT have not been further studied. This article mainly elaborates on the risk factors for hypotension during CRRT, aiming to further guide clinical practice to effectively prevent the occurrence of hypotension and improve the prognosis of the patients. Metrics

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Predictive value of fibrinogen/albumin ratio for restenosis after percutaneous transluminal angioplasty of arteriovenous fistula DENG Jie, QIN Xin-fang, PENG Jia-jia, LIAN Xi, XIE Yi-Ting, BI Hui-xin 2025, 24 (05):  414-419.  doi: 10.3969/j.issn.1671-4091.2025.05.012 Abstract ( 27 )   Objective To explore the predictive value of fibrinogen to albumin ratio (FAR) for restenosis after percutaneous transluminal angioplasty (PTA) of the autologous arteriovenous fistula (AVF) in maintenance hemodialysis (MHD) patients.  Methods A total of 101 MHD patients undergoing color Doppler ultrasound-guided PTA for the first time at the Department of Nephrology, the Affiliated Hospital of Guilin Medical University from January 2019 to December 2020 were included in this study. According to the presence or absence of restenosis after PTA in the follow-up period, they were divided into restenosis group and patency group. Clinical data were compared between the two groups. Receiver operating characteristic (ROC) curve was made to evaluate the predictive value of FAR for restenosis after PTA. The optimal cut-off value of FAR was determined by ROC curve analysis. The patients were then divided into low FAR group and high FAR group. Patency rate of the AVF in the two groups was analyzed by Kaplan-Meier curve. Cox proportional hazards regression model was used to explore the independent risk factors affecting restenosis after PTA.  Results  ①Multivariate Cox regression analysis showed that higher FAR (HR=2.455, 95% CI:1.299～4.639, P=0.006) was an independent risk factor for restenosis of the AVF after first PTA. ② The area under the curve (AUC) of FAR for predicting restenosis of the AVF after PTA was 0.735 (P<0.001, 95% CI:0.638～0.818). ③ Kaplan-Meier curve survival analysis showed that the patency rate after PTA was significantly lower in high FAR group than in low FAR group (log rank test, χ²=15.470, P<0.001).  Conclusions   ①Higher FAR is an independent risk factor for restenosis after PTA. ②FAR can be used as a biomarker to predict restenosis after the first PTA, useful for early prevention and treatment of restenosis after PTA. Metrics

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Construction of structured education courses for patients during initial hemodialysis period LIU Li, CHEN Lin, ZHANG Ying-jun, HE Li, CHEN Hui, ZHENG Hao-tian, TANG Si-kai 2025, 24 (05):  420-424.  doi: 10.3969/j.issn.1671-4091.2025.05.013 Abstract ( 36 )   Objective  To develop a structured educational curriculum suitable for patients during initial hemodialysis period in China.  Methods  From June 2023 to June 2024, a survey was conducted through literature analysis and on patients using the self-made "Structured Education Needs Questionnaire for Initial Hemodialysis Patients". Based on existed structured education models, a preliminary draft of structured education courses for initial hemodialysis patients was formed. Further revision and improvement of the draft were made through expert meetings.  Results The final draft of the structured education course for patients in the initial stage of hemodialysis was collectively implemented by medical staff. The course includes teaching objectives, content, and evaluation. The preliminary application of the course on 38 patients in the initial hemodialysis period showed that after implementation, the patients' awareness level (Z=-5.402, P<0.001), self-management (t=-5.065, P<0.001), emotional state (t=-7.477, P<0.001), hemoglobin (t=-5.637, P<0.001), albumin (t=-3.314, P=0.002), total protein (t=-4.958, P<0.001) and serum calcium (t=-2.683, P=0.011) were all higher than those before implementation, and patient satisfaction was relatively high.  Conclusion The structured education curriculum for patients during initial hemodialysis period is scientific, accurate, standardized, vivid, easy to understand, and worthy of further clinical promotion. Metrics

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Application of informational walking exercise intervention based on the ICF framework in maintenance hemodialysis patients LIU Cai-fei, CHEN Si-jie, LONG Zhuo, XIN Xia, CHI Wei-hua, LIU Xiao-min, GAO Ju-lin 2025, 24 (05):  425-430.  doi: 10.3969/j.issn.1671-4091.2025.05.014 Abstract ( 32 )   Objective  To evaluate the effects of informational walking exercise intervention based on the International Classification of Functioning, Disability and Health (ICF) on maintenance hemodialysis (MHD) patients.  Methods  A total of 90 MHD patients treated at Xi’an Jiaotong University First Hospital from March to September 2023 were randomly assigned into intervention group (n=45) or control group (n=45). The control group received routine care, while the intervention group received the ICF-based digital walking exercise intervention plus routine care for 6 months. Six-minute walking distance (6MWD), physical function, number of weekly steps, grip strength, exercise self-efficacy, social support, quality of life, and biochemical indicators were compared before and after the intervention.  Results  A total of 82 patients (41 in each group) completed the study. After 6 months of walking exercise intervention, the intervention group showed significant improvements in 6MWD (t=-2.173, P=0.033), physical function (t=-3.605, P<0.001), average weekly steps (t=-7.704, P<0.001), exercise self-efficacy (t=-3.365, P<0.001), social support (t=-5.255, P<0.001), and quality of life (t=-3.263, P=0.002) as compared those to the control group. However, no significant changes were observed in grip strength (t=-1.914, P=0.059) and biochemical parameters including hemoglobin (t=-1.050, P=0.147), albumin (t=-1.243, P=0.537), calcium (t=0.575, P=0.405), and phosphorus (t=0.238, P=0.896).  Conclusion The ICF-based informational walking intervention significantly improved physical function, exercise self-efficacy, and quality of life in MHD patients. Metrics

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Systematic review of frailty risk prediction models for maintenance hemodialysis patients XIAO Yu, HU Wan-yue, XING Xin-yue, WANG Chen-qi, WU Ya-xuan, XIAO Hong-ling 2025, 24 (05):  431-436.  doi: 10.3969/j.issn.1671-4091.2025.05.015 Abstract ( 38 )   Objective To systematically evaluate the frailty risk prediction model for maintenance hemodialysis patient.  Methods  PubMed, Embase, CINAHL, Web of Science, Cochrane Library, CNKI, Wanfang, VIP, and SinoMed were systematically searched with a timeframe from establishment of the database to August 29, 2024. Two investigators screened the literature, extracted data, and evaluated bias risk and suitability of the included studies.  Results  Twelve literatures were included, including 16 risk prediction models. Eleven models were validated, and 9 models were calibrated. There were 7～24 candidate variables. Thirteen models reported the area under the curve (AUC) of 0.66～0.998 at the establishment of the models; 4 models reported the AUC of 0.828～0.939 by internal validation, and 2 models reported the AUC of 0.865～0.904 by external validation. There were 4～10 predictors; age, charlson comorbidity index (CCI), gender applicability and depression were the common predictors with the highest frequency. Twelve studies had high risks of bias. Eleven studies showed better applicability to study population, predictors, outcomes and overall subjects.  Conclusions  The frailty risk prediction models for maintenance hemodialysis patients have better predictive performance and clinical value. However, these predictive models have higher bias, limiting their extrapolation. A variety of machine learning algorithms can be used for modeling in the future. We should pay attention to the predictors with higher frequencies in the model and carry out external validation of multiple regions, multiple centers, and large samples for these predictors, to develop predictive models with better prediction performance, more clinical utility, and higher generalized suitability.  Metrics

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Successful repair of tunnel-cuffed catheter luer interface leakage: report of a case GU Xiao-xia, ZHOU You-chang, LI Jia-min, LI Qiu-yan, PENG Hui, CHEN Yan-ru 2025, 24 (05):  437-439.  doi: 10.3969/j.issn.1671-4091.2025.05.016 Abstract ( 36 )   This article reports a case of a tunnel-cuffed catheter for hemodialysis with compromised integrity of the Luer interface, which was successfully repaired by replacing the Luer interface to restore function of the catheter. This case provides a new approach for clinical medical staff to deal with complications related to the extracorporeal extension segment of hemodialysis catheters. Metrics