Chinese Journal of Blood Purification

12 July 2025, Volume 24 Issue 07 Previous Issue   

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Chinese expert consensus on the clinical management of hyperphosphatemia in patients with chronic kidney disease (2025 edition) Work group of Chinese expert consensus on the clinical management of hyperphosphatemia in patients with chronic kidney disease ( edition) 2025, 24 (07):  529-547.  doi: 10.3969/j.issn.1671-4091.2025.07.001 Abstract ( 175 )   Hyperphosphatemia is a common complication in patients with chronic kidney disease (CKD), particularly those with end-stage kidney disease. It accelerates the progression of CKD, contributes to secondary hyperparathyroidism and abnormal bone metabolism, and serves as an independent risk factor for increased cardiovascular events and mortality. Hyperphosphatemia is highly prevalent but poorly controlled in Chinese CKD patients, which is currently a challenge in clinical practice. In recent years, substantial progress has been made globally in hyperphosphatemia research, with several novel phosphate-lowering agents approved, providing new options for the management of hyperphosphatemia. Based on these advancements, the Chinese Hospital Association Blood Purification Center Branch organized a panel of experts in the field of nephrology and blood purification to develop this consensus document. Integrating evidence-based medicine and clinical expertise, the consensus provided recommendations on key aspects of hyperphosphatemia management, including timing of intervention and target serum phosphate levels. Some practical guidance on dietary phosphate restriction, phosphate-lowering agents use, secondary hyperparathyroidism control, adequate dialysis, and patient education was proposed. The consensus aims to standardize the management of serum phosphate in CKD patients, thereby reducing the incidence of hyperphosphatemia, improving serum phosphate control, and ultimately enhancing patient outcomes. Metrics

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Effect of health services accessibility on the clinical adverse outcomes of peritoneal dialysis patients after implementing standardized management combined with telemedicine services WANG Qing-hua, ZHANG Yong, GUO Shan-shan, SHEN Yu-lan, MA Tian-tian, YANG Zhi-kai, FU Gang, DONG Jie 2025, 24 (07):  548-553.  doi: 10.3969/j.issn.1671-4091.2025.07.002 Abstract ( 32 )   Objective To investigate the effect of health services accessibility on the clinical adverse outcomes of peritoneal dialysis (PD) patients after implementing standardized PD management combined with telemedicine services. Methods This study was a multi-center prospective cohort study that included PD patients from three hospitals in Beijing between January 1, 2016, and April 30, 2019. All patients were managed using the Peritoneal Dialysis Telemedicine and Healthcare Management Platform (PDTAP). Univariate and multivariate Cox proportional hazards models or competing risks models were used to explore the effects of three dimensions of health services accessibility on all-cause mortality, hemodialysis transfer, and first-episode PD-related peritonitis. Results A total of 976 patients were enrolled in this study with a median follow-up of 29.0 (IQR 14.3～45.0) months. There were significant differences in all health services accessibility variables among the three PD centers (Z/χ² values: 45.843～165.628, all P＜0.001). In univariate analyses, education level, travel distance and travel time had significant effect on the risk of all-cause mortality, but after multivariate analysis education levels (HR 1.299～1.364, P=0.238～0.468), travel distance (HR 0.999, 95% CI 0.992～1.007, P = 0.831) and travel time (HR 1.011, 95% CI 0.951～1.075, P = 0.727) had no significant association with the risk of all-cause mortality. All health services accessibility variables were not associated with hemodialysis transfer or first-episode PD-related peritonitis. Conclusion This study suggests that there is no clear association between regional health services accessibility and adverse clinical outcomes for PD patients after the implementation of standardized PD management combined with telemedicine services. Metrics

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Prognosis of patients with sepsis-associated acute kidney injury after cardiac surgery undergoing CRRT LIAO Jun-jie, SONG Li, YIN Yan, ZHANG Yi-ting, CHEN Cheng, QUAN Zi-lin, LIANG Xin-ling, FENG Zhong-lin, YE Zhi-ming 2025, 24 (07):  554-558.  doi: 10.3969/j.issn.1671-4091.2025.07.003 Abstract ( 28 )   Objective  To investigate the 30 day prognosis of adult patients who underwent continuous renal replacement therapy (CRRT) after cardiac surgery and developed sepsis-associated acute kidney injury (SA-AKI).  Methods  A retrospective cohort study was conducted, collecting clinical data from 239 adult patients who underwent CRRT at Guangdong Provincial People's Hospital from March 2023 to May 2024. Patients were divided into two groups based on whether they developed sepsis-associated acute kidney injury within 7 days after cardiac surgery: Acute kidney injury (AKI) group and SA-AKI group.  Results  A total of 239 adult patients who underwent cardiac surgery were included, with an average age of 57.4±13.5 years, and 157 males (65.7%). The Sequential organ failure assessment (SOFA) score was higher in the SA-AKI group compared to the AKI group, 11.0±3.63 vs. 9.45±3.89, (t=-2.534, P=0.014). The overall mortality rate was 31.4% (75/239), with an average treatment time of CRRT and the interquartile range was 8.0 (3.0,17.0) days. The mortality rate of patients in the SA-AKI group was significantly higher than that in the AKI group, 62.8% vs. 24.5%, (χ2=-4.747, P＜0.001). Kaplan-Meier survival analysis log-rank test showed that the cumulative mortality rate in the SA-AKI group was significantly higher than in the AKI group, HR (95%CI) =1.959 (1.220～3.145), (P=0.004). The repeated-measures analysis showed that there was a significant difference in SOFA scores between the SA-AKI group and the AKI group (P=0.004, F=8.135), and a significant time trend was also observed (P＜0.001, F=4.441).  There was a trend towards lower blood lactate levels in both groups, with no significant inter-group differences (P=0.215，F=1.543). There was a significant difference in mean arterial pressure between the SA-AKI group and the AKI group (P=0.002, F=9.028), while the time trend was not significant (P=0.739, F=0.589). Patients in the mortality group had higher SOFA scores than those in the survival group (P＜0.001, F=61.036). The blood lactate levels were higher in the mortality group than that in the survival group (P＜0.001, F=14.853). Additionally, the mean arterial pressure was lower in the mortality group compared with the survival group (P＜0.001, F=45.056).  Conclusion  Patients who developed sepsis-associated acute kidney injury after cardiac surgery have a significantly increased 30-day mortality risk. During the first week of CRRT treatment, it is important to monitor changes in the condition, especially to strengthen monitoring of trends in SOFA scores, lactate levels, and hemodynamic indicators. Metrics

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Molecular mechanism of pramipexole in the treatment of restless legs syndrome: bioinformatics, molecular docking, and clinical validation based on SLC6A3 ZHANG Yu-cai, MA Chen-hong, YAO Shu-ge, ZHENG Hui-xiao, WU Liang, WEN Hui-xin 2025, 24 (07):  559-565.  doi: 10.3969/j.issn.1671-4091.2025.07.004 Abstract ( 26 )   Objective   To explore the potential molecular mechanisms of pramipexole in the treatment of restless legs syndrome (RLS) and provide a basis for clinical therapy.  Methods   RLS and pramipexole-related genes were screened using DisGeNET, GeneCards, and NCBI databases to identify shared genes. Functional enrichment and protein-protein interaction (PPI) analyses were performed via the STRING database, and a hub gene network was constructed using Cytoscape. The expression of key genes was validated in the GEO datasets (GSE54839, GSE37171). Molecular docking and molecular dynamics simulations were used to assess the binding stability between pramipexole and key genes. Finally, the effects of pramipexole were evaluated in maintenance hemodialysis (MHD) patients with RLS based on clinical indicators.  Results  The bioinformatics analysis shows that SLC6A3 is significantly upregulated in the GEO datasets (GSE54839, GSE37171), with high classification performance (GSE54839: AUC =0.755; GSE37171: AUC =0.606). Molecular docking and molecular dynamics analysis revealed that SLC6A3 binds stably with pramipexole and exhibits strong structural stability under dynamic conditions. In the clinical cohort, the relative serum expression level of SLC6A3 in RLS patients is significantly higher compared to the MHD group [(2.29±0.388) vs. (1.30±0.422), t=4.603, P＜0.0001] and the control group [(2.29±0.388) vs. (1.30±0.422), t=4.603,  P＜0.0001]. It is negatively correlated with dopamine levels (R²=0.601, P＜0.001). Pramipexole treatment significantly improves the IRLS (International Restless Legs Syndrome Rating Scale) score in RLS patients [(15.8±1.67) vs. (21.8 ±4.31), t=4.379, P＜0.001], and modulates the expression levels of SLC6A3 [treatment group (1.64±0.41) vs. control group (2.31±0.39), t=4.112, P＜0.001] and dopamine [treatment group (231.50±13.03) vs.control group (195.50±14.09), t=3.461, P＜0.001].   Conclusion  SLC6A3 is a key therapeutic target of pramipexole for RLS and may serve as a potential biomarker, providing new insights for personalized treatment of RLS. Metrics

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Exploration of the relationship between prognostic nutritional index and treatment failure in peritoneal dialysis related peritonitis patients ZHANG Jin-jin, MA Ya-nan, YAN Qi-qi, LI Dan-dan, CHENG Xiao-li, LIU Gui-ling 2025, 24 (07):  566-570.  doi: 10.3969/j.issn.1671-4091.2025.07.005 Abstract ( 36 )   Objective  To investigate the relationship between prognostic nutritional index (PNI) and treatment failure in patients with peritoneal dialysis-associated peritonitis (PDAP).  Methods  A total of 205 PDAP patients hospitalized in the Department of Nephrology from January 2016 to August 2024 were enrolled. Based on treatment outcomes, patients were divided into a cured group (n=170) and a treatment failure group (n=35). Clinical data were compared between the two groups.  Results  Compared with the cured group, the treatment failure group had longer dialysis vintage (Z=-3.422, P=0.001),  higher peritoneal effluent white blood cell (WBC) count on day 3 (Z=-5.219, P＜0.001),higher levels of C-reactive protein (CRP) (Z=    -3.044, P=0.002) , but lower body mass index (BMI) (Z=-2.032, P=0.042) and PNI (t=6.707, P＜0.001). Univariate logistic regression analysis showed that self-administered antibiotic use before admission (OR =4.592, 95% CI:2.118～9.957, P＜0.001), longer dialysis vintage (OR=1.250, 95% CI:1.105～1.414, P＜0.001), higher day 3 peritoneal effluent WBC count (OR=1.021, 95% CI:1.007～1.035, P=0.003), higher CRP (OR= 1.006, 95% CI:1.002～1.010, P=0.002),  lower BMI (OR =0.886, 95% CI:0.796～0.987, P=0.028), and lower PNI (OR=0.833, 95% CI:0.771～0.898, P＜0.001) were risk factors for treatment failure in PDAP patients. Multivariate logistic regression analysis confirmed that longer dialysis vintage (OR=1.179, 95% CI:1.018～1.363, P=0.027), higher day 3 WBC count (OR=1.028, 95% CI:1.010～1.046, P=0.002), and lower PNI (OR=0.853, 95% CI :0.771～0.937, P=0.001) were independent risk factors for treatment failure. Receiver operating characteristic (ROC) curve analysis showed that PNI had the highest predictive value for treatment failure (AUC=0.776), and its predictive performance further improved when combined with dialysis vintage (AUC=0.816).  Conclusion  PNI reflects the nutritional and immune status of the body and is associated with PDAP treatment failure. It demonstrates good predictive ability for treatment outcomes, and its predictive power increases when combined with dialysis vintage. Metrics

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Correlation between serum Nod-like receptor protein 3, bone morphogenetic protein 2 levels and left ventricular hypertrophy in patients with chronic kidney disease CHEN Jing, ZHANG Ya-pu, ZHENG Xi-jie, GUO Shan-shan, CHEN Hang 2025, 24 (07):  571-575,589.  doi: 10.3969/j.issn.1671-4091.2025.07.006 Abstract ( 30 )   Objective  To investigate the correlation between serum levels of serum Nod-like receptor protein 3 (NLRP3) and bone morphogenetic protein 2 (BMP2) and the left ventricular hypertrophy (LVH) in patients with chronic kidney disease (CKD).  Methods  A total of 102 patients with CKD were collected and categorized into CKD stage 3 group (n=31), stage 4 group (n=27) and stage 5 group (n=44). According to the presence of LVH, patients were further divided into LVH group (n=40) and non-LVH group (n=62). Serum NLRP3 and BMP2 were measured by enzyme-linked immunosorbent assay (ELISA). LVH was detected by color Doppler ultrasound. The correlation between serum NLRP3 and BMP2 levels and LVH was analyzed. Results   As CKD progressed, serum BMP2 and NLRP3 levels showed an upward trend (H=69.424, 49.945; both P＜0.001). Correlation analysis showed that serum NLRP3 level was positively correlated with BMP2 and left ventricular mass index in CKD patients (rs=0.661, 0.495; both P＜0.001). Compared with the non-LVH group, the LVH group exhibited significantly higher serum BMP2 and NLRP3 levels (Z=-3.555, -5.737; both  P＜0.001). Logistic regression analysis showed that elevated serum BMP2 (OR=1.039, 95% CI:1.013～1.066, P=0.003) and NLRP3 (OR=1.007, 95% CI:1.004～1.010, P＜0.001) levels were risk factors for LVH in CKD patients , with NLRP3 being an independent risk factor (OR=1.006, 95% CI:1.003～1.010, P=0.001). Receiver operating characteristic (ROC) curve analysis demonstrated that NLRP3 predicted LVH in stage 3～5 CKD patients with an area under the curve (AUC) of 0.838, sensitivity of 77.42%, specificity of 82.50%, and an optimal cutoff value of 881.80 ng/L. Conclusions  Elevated serum BMP2 level is an important risk factor for LVH in CKD patients, while elevated NLRP3 level serves as an independent risk factor. Metrics

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Comparative analysis of the therapeutic effects of different dilution methods and substitution fluid volumes in online hemodiafiltration YANG Ying, TANG Jian-ying, MOU Jiao 2025, 24 (07):  576-580.  doi: 10.3969/j.issn.1671-4091.2025.07.007 Abstract ( 34 )   Objectives  This study aimed to investigate the effects of online hemodiafiltration (OL-HDF) dilution methods and substitution fluid volume on dialysis quality in maintenance hemodialysis (MHD) patients.  Method  A total of 81 patients with MHD were divided into three groups: group A (predilution, substitution volume 18L), group B (predilution, substitution volume 36L) and group C (postdilution, substitution volume 18L). The solute clearance rates, cardiovascular benefits, quality of life, and incidence of adverse reactions were compared among the three groups after 12 months of treatment.  Results  After treatment, the levels of serum phosphorus (P), serum creatinine (Scr) and cystatin C(Cyst-C) in group B were higher than those in groups A and C (B vs. A：t=-2.056、-4.224、-0.349，P=0.045、＜0.001、0.029；B vs. C：t=3.070、4.633、4.110，P=0.003、＜0.001、＜0.001), while the urea clearance index (Kt/V) was lower than that of groups A and C (Kt/V >1.2; B vs. C:t=-4.932，P＜0.001; A vs.  B:t=2.213，P=0.031). Group B had significantly lower levels of β2-microglobulin (β2-MG), intact parathyroid hormone (iPTH), and C-reactive protein (CRP) than Group A (t=0.775, -2.205, 3.145; P=0.042, 0.032, 0.003). Group B had significantly lower carotid intima-media thickness and left ventricular mass index levels than Groups A and C (A vs. B: t=3.116, 2.934; P=0.003, 0.005; B vs. C: t=-2.126, -0.243; P=0.038, 0.009). Its left ventricular ejection fraction (B vs. C: t=3.429, P=0.001; B vs. A: t=-5.107, P＜0.001) and quality of life scores (B vs. A: t=-3.494, P=0.001; B vs. C: t=2.988, P=0.004) were significantly higher than Groups A and C. The incidence of adverse reactions in Group B was significantly lower than in Group A (t=0.448, P=0.006) and Group C (t=0.687, P=0.009). Conclusion The predilution mode with double the substitution fluid volume (36L) can, while ensuring dialysis adequacy, reduce hospitalization and cardiovascular mortality rates, improve quality of life, and demonstrate a higher safety profile. Metrics

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The effects of exercise rehabilitation on dialysis adequacy, nutrition and lipid metabolism in maintenance hemodialysis patients DING Fen-fen, JIANG Xia 2025, 24 (07):  581-585.  doi: 10.3969/j.issn.1671-4091.2025.07.008 Abstract ( 30 )   Objective  To investigate the effects of exercise rehabilitation on dialysis adequacy, nutrition, and lipid metabolism in maintenance hemodialysis (MHD) patients.  Methods  A total of 87 patients with inadequate dialysis from the Blood Purification Center of Nantong Second People's Hospital were selected. They were randomly divided into two groups: a control group receiving conventional treatment (including medication and hemodialysis) and an exercise group receiving conventional treatment plus aerobic and resistance exercises. The urea clearance index (Kt/V), nutritional markers, and lipid metabolism markers were compared between the two groups before the intervention, at 12 weeks (12W), and at 24 weeks (24W).  Results After 12 weeks and 24 weeks of intervention, the exercise group showed significantly higher Kt/V (t =-4.282,  -6.535; both P ＜0.001) and serum albumin (Alb) levels (t =-3.603, -5.333; P = 0.001, ＜0.001) compared to the control group. While the exercise group had significantly lower total cholesterol (TC) (t = 4.035, 3.918; both P＜ 0.001) and low-density lipoprotein (LDL) levels (t =2.258, 4.483; P =0.027, ＜0.001) than the control group. At 24 weeks of intervention, C-reactive protein (CRP) in the exercise group was significantly lower than that in the control group (intergroup Z=-4.349, P＜0.001). Compared to pre-intervention levels, the exercise group demonstrated significantly increased high-density lipoprotein (HDL) levels at both 12W and 24W (t =-2.425, -2.085; P=0.020, 0.043).  Conclusion  Aerobic and resistance exercise significantly improves dialysis adequacy, nutritional status, and lipid metabolism in MHD patients. Metrics

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Research progress in the identification of arteriovenous fistula dysfunction mechanism based on multiomics LI Xin, QIN Xin-fang 2025, 24 (07):  586-589.  doi: 10.3969/j.issn.1671-4091.2025.07.009 Abstract ( 33 )   Arteriovenous fistula (AVF) has the advantages of lower infection and complication rates than other access methods, and is currently the preferable vascular access method for hemodialysis patients. However, delayed maturity rate and dysfunction of AVF are frequently concerned by clinicians. Early diagnosis of dysfunctional AVF usually depends on the advanced imaging techniques, and methods in terms of effective clinical diagnosis, treatment, and prognostic evaluation are virtually rare. The mechanistic role of molecular biology in the pathogenesis of AVF dysfunction is incompletely understood. Currently, the development of genomics, transcriptomics, proteomics, and metabolomics technologies have played great roles in insight into the pathological features and clinical diagnosis of AVF dysfunction. This article summarizes and reviews the molecular biology mechanisms underlying the AVF dysfunction based on multiomics. Metrics

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Research progress in the use of anticoagulants during continuous renal replacement therapy for shock patients with low tissue perfusion and high risk of bleeding ONG Chun-yan, LI Rong, TANG Si-yan, TANG Si-wei, BAI Ming, ZHANG Peng 2025, 24 (07):  590-593.  doi: 10.3969/j.issn.1671-4091.2025.07.010 Abstract ( 31 )   Continuous renal replacement therapy (CRRT) is a common treatment for acute kidney injury (AKI), especially for patients with shock and tissue hypoperfusion. CRRT can effectively remove various kinds of toxins, maintain the balance of water and electrolytes, and stabilize hemodynamics in these patients. However, due to the continuous blood circulation and filtration during CRRT, the risk of thrombosis is increased, and anticoagulation is therefore necessary. Anticoagulation strategy is particularly complex in patients with shock combined with tissue hypoperfusion and high risk of bleeding, which needs to consider the balance between the effect of anticoagulants and the risks of bleeding and thrombosis. In this article the authors summarize the feasibility and safety of non-anticoagulation, citrate, nafamostat mesylate, argatroban and other common anticoagulation regimens used in CRRT for shock patients with low tissue perfusion and high risk of bleeding. Metrics

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Research progress in the effect of nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3) in the pathogenesis of peritoneal fibrosis QIN Fu-sheng, ZHANG Lin 2025, 24 (07):  594-597.  doi: 10.3969/j.issn.1671-4091.2025.07.011 Abstract ( 19 )   Peritoneal dialysis (PD) has become one of the critical treatment options for patients with end-stage renal disease (ESRD). However, peritoneal fibrosis caused by peritonitis remains a key factor leading to discontinuation of PD. During the progression of peritoneal fibrosis, nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3), a pivotal sensor in the innate immune system, recognizes exogenous pathogen invasion and endogenous cellular damage, and activation of NLRP3 promotes the maturation and release of interleukin-1β (IL-1β) and IL-18, triggering robust inflammatory responses and playing a central role in various non-bacterial inflammatory processes. In-depth investigation into the regulatory mechanisms of NLRP3 activation provides a theoretical foundation for controlling peritoneal fibrosis in PD patients. Metrics

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A meta analysis about the effect of bundle arm compression exercise on maturation of arteriovenous fistula after surgery WANG Li-Sheng, ZHANG Zhong-Hua, ZHU Yan, MA Jun, WU Hui-Jun, YANG Jian-Guo, YAN Jian-Jun 2025, 24 (07):  598-602.  doi: 10.3969/j.issn.1671-4091.2025.07.012 Abstract ( 41 )   Objective To systematically evaluate the effect of bundle arm compression exercise on maturation of arteriovenous fistulas (AVF) after surgery.  Methods  A systematic search in CNKI, Wanfang, VIP, SinoMed, PubMed, Embase, Cochrane Library, and Web of Science databases was conducted for randomized controlled trials (RCTs) and quasi-experimental studies to evaluate bundle arm compression exercise on maturation of AVF after surgery. Data were analyzed using RevMan 5.4.1 software.  Results  A total of 10 studies involving 1,737 patients were included. Meta-analysis results showed that compared with the routine exercise group, bundle arm compression exercise significantly increased ultrasound AVF maturation rate (OR=2.50, 95% CI:1.94～3.22, P＜0.001), clinical AVF maturation rate (OR=2.85, 95% CI:1.73～5.68, P＜0.001) and first successful AVF puncture rate (OR=3.95, 95% CI:1.67～9.36, P=0.002), and decreased AVF-related complication rate (OR=0.21, 95% CI:0.10～0.44, P＜0.001). It also significantly increased AVF diameter (MD=2.50, 95% CI:1.94～3.22, P＜0.001) and AVF blood flow (MD=84.98, 95% CI:(60.87～109.09, P＜0.001), and decreased AVF maturation time (MD=-1.56, 95% CI:-1.97～-1.15, P＜0.001). There were no significant differences between the subgroups based on the time to initiate the exercise (3 days, 1 week, and 2 weeks after surgery), but the effective degree was the biggest in patients to initiate the exercise 3 days after surgery in terms of ultrasound AVF maturation rate, clinical AVF maturation rate, first successful AVF puncture rate and AVF maturation time.  Conclusion  Bundle arm compression exercise can promote AVF maturation and decrease the risks of AVF complications. We recommend the inclusion of bundle arm compression exercise beginning from 3rd days after AVF surgery in the routine nursing program. Metrics

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Construction of a palliative care intervention plan for end-stage renal disease patients ZHANG Hui, YANG Wei, CUI Ying, NING Xiao-hong, ZHOU Zi-juan 2025, 24 (07):  603-608.  doi: 10.3969/j.issn.1671-4091.2025.07.013 Abstract ( 20 )   Objective  To construct a palliative care intervention plan for patients with end-stage renal disease.  Method  A preliminary palliative care intervention plan for end-stage renal disease patients was developed through literature analysis. The final palliative care intervention plan was then established through Delphi expert consultation.  Result  The effective response rates of the two rounds of expert consultation questionnaires were 90.91% and 100.00%, respectively. The expert authority coefficients were 0.87 and 0.85, respectively. The final decision on the palliative care intervention plan for end-stage renal disease patients includes 3 primary indicators (pre dialysis, during dialysis, and post dialysis), 17 secondary indicators, and 81 tertiary indicators.  Conclusion  The palliative care intervention plan for end-stage renal disease patients developed in this study is scientific and reliable, and can provide reference and inspiration for the implementation of palliative care intervention measures for end-stage renal disease patients. Metrics

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Analysis of the risk factors for sarcopenia in maintenance hemodialysis patients based on the bioelectrical impedance principle TENG Yan-juan, YANG Li-na, WANG Nian-song, GUO Yong-ping 2025, 24 (07):  609-613.  doi: 10.3969/j.issn.1671-4091.2025.07.014 Abstract ( 28 )   Objective To analyze the risk factors for sarcopenia in patients with maintenance hemodialysis (MHD), so as to explore the preventive measures and the basis for reducing the incidence of sarcopenia in MHD patients.  Methods A total of 312 MHD patients admitted to the Sixth People's Hospital Affiliated to Shanghai Jiaotong University from December 2020 to September 2023 were included in this study. According to the presence and absence of sarcopenia, they were divided into the concurrent group (82 cases) and the non-concurrent group (230 cases). Univariate and multivariate logistic regression analyses were used to screen the risk factors for sarcopenia in MHD patients.  Results Univariate and multivariate logistic analyses showed that age ≥65 years (OR=1.998, 95% CI: 1.188～3.358, P=0.009), body mass index (BMI) ＜21 kg/m2 (OR=1.870, 95% CI: 1.037～3.374, P=0.038), glomerular filtration rate ＜1 mL/min (OR=2.036, 95% CI: 1.120～3.702, P=0.020), higher total body moisture (OR=1.881, 95% CI: 1.013～3.495, P=0.046), higher serum high sensitivity C-reactive protein (hs-CRP) level (OR=1.802, 95% CI: 1.013～3.495, P=0.031), low grip strength (OR=1.749, 95% CI: 1.082～2.827, P=0.023) and low skeletal muscle mass index (ASMI) (OR=1.944, 95% CI: 1.271～2.977, P=0.002) were the risk factors for sarcopenia in MHD patients.  Conclusion  There are many risk factors for sarcopenia in MHD patients. Clinically, the incidence of sarcopenia in MHD patients can be reduced by prevention and detection of the risk factors. Metrics

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Refractory peritoneal dialysis-related peritonitis caused by Berneroxus infection: report of a case and review of the literature FU Bi-ling, SUI Xiao-lu, HOU Jie, LIU Yu-hong, CHEN Ji-hong 2025, 24 (07):  614-616.  doi: 10.3969/j.issn.1671-4091.2025.07.015 Abstract ( 24 )   Objective  To explore the diagnosis and treatment of a rare Benacovirus infection in a patient with peritoneal dialysis-associated peritonitis.  Methods  A case of refractory peritoneal dialysis-related peritonitis caused by Benacovirus infection was retrospectively analyzed, and the related literature was reviewed.  Results  The pathogen of Benacovirus was identified by high-throughput sequencing of MetaCAP microbial nucleic acids from patient's peritoneal drainage fluid. Continuous peritoneal lavage and drainage using double-lumen tubes combined with oral administration of doxycycline gradually clarified the peritoneal drainage fluid and reduced white blood cell counts in the fluid. Follow-up for 2 months after removal of the drainage tube showed no recurrence.  Conclusion  When conventional methods fail to detect the pathogen, MetaCAP sequencing can be helpful to provide etiological evidence and treatment strategy for the peritoneal dialysis-associated peritonitis. Coxiella burnetii is a rare pathogen causing peritoneal dialysis-associated peritonitis, requiring prompt recognition and appropriate treatment. Metrics