BackgroundDiabetes mellitus is a leading cause of end-stage renal disease (ESRD), with up to 35% of patients with diabetes mellitus developing kidney disease. This study aims to monitor protein expression changes in ESRD patients with and without type 2 diabetes mellitus (T2DM).MethodsA total of 186 ESRD patients who underwent arteriovenous fistula creation surgery were enrolled in this study. Of these, 148 patients were classified into the T2DM (n = 73) and non-T2DM (n = 75) groups. Data-independent acquisition proteomic analysis was conducted to analyze differentially expressed proteins. Enzyme-linked immunosorbent assay kits, immunohistochemical staining, Western blotting were employed to validate the differently expressed proteins within the cohort.ResultsProteomic analysis identified 26 upregulated and 15 downregulated proteins in the T2DM group compared with the non-T2DM group. The serum concentrations of 4-hydroxynonenal, malondialdehyde, and glutathione were elevated in the T2DM group. The immunohistochemical staining index for GPX4 and xCT was lower, while α-SMA, IL-6, TNF-α, and TGF-β levels were higher in the T2DM group compared with the non-T2DM group. Western blotting indicated the downregulation of SOD1 and GPX4 as well as upregulation of PTGS2 and ACLS4 in the T2DM group accompanied by increased levels of Fe2+, total iron, and Fe3+.ConclusionThis study underscores oxidoreductase activity-related proteins, including ferroptosis-related proteins to be differentially expressed in ESRD combined with T2DM.

OBJECTIVE:Low primary patency rates represent a major problem of radiocephalic arteriovenous fistula (RC-AVF). No-touch techniques and radial artery deviation and reimplantation (RADAR) were reported and used in RC-AVF creation. To enhance RC-AVF outcomes, we devised a modified RADAR technique and conducted a retrospective study comparing this approach with no-touch and conventional methods for RC-AVF creation. METHODS:We retrospectively reviewed patients undergoing RC-AVF creation for hemodialysis using either the modified RADAR, no-touch, or conventional technique between January 2023 and December 2024. The primary patency, juxta-anastomotic stenosis, and maturation rates of the three techniques were compared and analyzed. RESULTS:In total, 289 patients were included. The incidence of anastomotic stenosis was significantly lower (p = 0.030) in the modified RADAR group (33.33%) than in the no-touch technique (60.32%) and conventional technique groups (50.40%). The AVF maturation rate within 6-8 weeks was significantly higher (p = 0.005) in the modified RADAR group (90.70%) than in the no-touch technique (67.06%) and conventional technique groups (65.84%). At 3, 6, 9 and 12 months postoperatively, the primary patency rates in the modified RADAR group were 90.7%,88.37%, 86.05% and 86.05%, respectively. Significant differences were observed among the three groups (log-rank p = 0.04). CONCLUSION:The modified RADAR technique for RC-AVF creation resulted in higher primary patency, lower juxta-anastomotic stenosis, and improved maturation rates.

BACKGROUND:Subclavian artery stenosis (SAS) in hemodialysis (HD) patients often presents as non-specific arteriovenous access (AVA) dysfunction. Early recognition is critical to preserve access patency. METHODS:This retrospective study included HD patients with newly diagnosed SAS from 2018 to 2024. Clinical features, imaging findings, treatments, and changes in AVA flow after technically successful endovascular therapy were analyzed. RESULTS:Seventeen patients were included. AVA dysfunction (82.4%) and ipsilateral limb ischemia (52.9%) were common. Mean systolic inter-arm pressure difference was 32.5 mm Hg; 69.2% had retrograde or bidirectional vertebral flow. Endovascular treatment achieved 92.3% technical success and increased AVA flow from 570.5 to 1001.2 mL/min (p < 0.001). No recurrent symptoms occurred. CONCLUSIONS:In HD patients, SAS commonly presents with ischemic and AVA-related symptoms. Endovascular revascularization is effective and rapidly improves hemodynamics and symptoms.

To investigate the association between the triglyceride-glucose-body mass index (TyG-BMI) and chronic kidney disease (CKD) progression in individuals across the cardiovascular-kidney-metabolic spectrum, and to evaluate the potential mediation by biomarkers of oxidative stress, inflammation, and fibrosis. This study included 9265 adults stratified into cardiovascular-kidney-metabolic stages 0 to 4. Logistic regression and restricted cubic splines assessed the relationship between TyG-BMI and CKD progression. Mediation analysis quantified the indirect effects of the uric acid-to-high-density lipoprotein ratio, fibrosis-4 index, and red cell distribution width-to-albumin ratio. The primary finding of this study is that elevated TyG-BMI significantly increases the risk of chronic kidney disease (CKD) progression. Specifically, for each unit increase in TyG-BMI, the risk of CKD progression rose by 16% (OR = 1.16; 95% CI:1.01-1.30). This association was quantitatively and significantly mediated by the uric acid-to-high-density lipoprotein ratio, the fibrosis-4 index, and the red cell distribution width-to-albumin ratio, indicating the involvement of oxidative, fibrotic, and inflammatory pathways. Our analysis suggests that elevated TyG-BMI may be associated with an increased risk of CKD progression, potentially mediated through oxidative, inflammatory, and fibrotic pathways. These findings warrant further investigation to confirm the potential clinical relevance of TyG-BMI and the implicated pathways.

Arterio-arterial grafts (AAG) represent a specialized type of vascular access. However, AAG is associated with a high incidence of thrombotic occlusion, which prompted us to improve this surgical approach. The improved technique involves creating a low-flow autologous arteriovenous fistula (AVF) at the distal end of the AAG, termed improved AAG (IAAG). We report a case of a 65-year-old female patient with recurrent thrombosis of her AAG, who underwent creation of a low-flow autologous arteriovenous fistula (AVF) at the distal end of the AAG. The patient was followed up for 15 months postoperatively, and the intervention frequency was significantly lower than that before the operation. This case demonstrates that the IAAG surgical technique can prolong the patency of AAG.

Arteriovenous graft wall delamination is a rare complication that can compromise vascular patency. Definitive consensus on optimal management strategies for this condition is lacking, and existing strategies are largely empirical. We report the case of a 55-year-old man with end-stage renal disease who presented with upper-extremity early-cannulated arteriovenous graft thrombosis 6 months after implantation. Color Doppler ultrasound study revealed graft wall delamination and false lumen formation. The patient underwent thrombectomy, ultrasound-guided needle aspiration for false lumen volume reduction, and angioplasty. Unobstructed graft function was maintained at the 6-month follow-up. Improper cannulation may cause this structural injury; endovascular angioplasty combined with false lumen reduction yields favorable midterm efficacy.

BACKGROUND:The objective of this study was to investigate the association between cephalic vein fibrosis and the maturation of arteriovenous fistulas (AVF) in hemodialysis patients with type 2 diabetes (T2D). METHODS:A total of 67 patients with end-stage renal disease (ESRD) undergoing AVF creation were divided into diabetic and nondiabetic cohorts. Individuals with type 1 diabetes were excluded from the study. The cephalic vein tissues were collected and detected using Masson's staining. Logistic regression analysis was performed to identify independent risk factors, and receiver operating characteristic (ROC) curve analysis was utilized to evaluate predictive value. RESULTS:The maturation rate was 45.2% in diabetic group (n = 31) and 69.4% in nondiabetic group (n = 36). Preoperative venous diameter did not significantly differ between groups (P > 0.05). The C-reactive protein (CRP) (t = -2.209, P = 0.043) and the collagen volume fraction (CVF)% (t = -5.295, P < 0.001) in the T2D group were significantly elevated compared to the non-T2D group, whereas the internal diameter of cephalic vein at 1-month postoperation and parathyroid hormone (PTH) (t = 2.412, P = 0.019) in the T2D group were significantly reduced relative to the non-T2D group. Logistic regression analysis across multiple models revealed that T2D, CVF%, and the internal diameter of cephalic vein at 1-month postoperation were independent determinants of AVF maturation. Additionally, histopathological analysis demonstrated that the CVF% (t = -5.067, P < 0.001) was significantly higher in the T2D group compared to the non-T2D group. CONCLUSION:The findings indicated that T2D, reduced postoperative venous diameter, and increased cephalic vein fibrosis (CVF%) were significant independent risk factors affecting AVF maturation. Although preoperative venous diameter is a known clinical predictor, it was not an independent factor in our models after adjusting for fibrosis and diabetes status. Diabetes might impair AVF maturation primarily by exacerbating preoperative cephalic vein fibrosis, which likely restricts venous outward remodeling and expansion after fistula creation.

Whether continuous renal replacement therapy (CRRT) should be routinely initiated soon after severe acute kidney injury (AKI) in critically ill adults without urgent dialysis indications remains uncertain. We emulated a target trial using MIMIC-IV among adults in their first ICU stay who newly reached KDIGO stage 3 AKI by creatinine or urine-output criteria, had no prespecified urgent dialysis indication at time zero, and remained alive and in the ICU at 24 h. We compared CRRT initiation within 24 h with initial observation during that window, allowing delayed or rescue CRRT after the landmark. Among 4,538 eligible patients, 275 (6.1%) initiated CRRT within 24 h; among the 4,263 who did not, 419 (9.8%) subsequently received delayed/rescue CRRT. After multiple imputation and overlap weighting, CRRT initiation within 24 h was associated with higher 28-day post-landmark mortality (risk difference, 0.079; 95% CI, 0.014 to 0.145) and shorter restricted mean survival time (difference, -1.666 days; 95% CI, -3.247 to -0.179). The 12-hour analysis was directionally consistent but less precise. These findings do not support a default CRRT strategy based on stage 3 AKI alone, although residual confounding remains possible.

Owing to insufficient understanding of the molecular basis of arteriovenous fistula (AVF) failure, strategies to facilitate maturation and prevent access loss remain limited. This study aimed to identify potential biomarkers for AVF nonmaturation. We enrolled 123 patients with end-stage renal disease who underwent AVF surgery. Finally, 86 were classified into AVF matured (AM; n = 52) and AVF nonmatured (ANM; n = 34) groups following exclusion. Four cephalic vein tissue samples from each group were used for data-independent acquisition–mass spectrometry (DIA–MS) proteomic analysis to identify differently expressed genes. All 86 vein tissue samples were used for histological analysis, and all serum samples were used for ELISA. DIA–MS proteomic analysis identified 17 upregulated and 363 downregulated proteins in the ANM group compared with the AM group. Fibrinogen α (FGA), fibrinogen β (FGB), and fibrinogen γ (FGG) were the most activated proteins. Univariate logistic regression analysis revealed collagen volume fraction (CVF) (odds ratio [OR] = 1.278, 95

Introduction Delivering requisite anesthesia for endovascular treatment of dysfunctional arteriovenous fistulas (AVFs) under a targeted nerve block can achieve reasonable analgesia. We evaluated the efficacy and safety of ultrasound-guided selective nerve block during percutaneous transluminal angioplasty (PTA) of dysfunctional arteriovenous access. Methods 246 patients with dysfunctional radiocephalic arteriovenous fistula undergoing PTA were enrolled in this prospective, randomized controlled trial at the Department of Nephrology, Haidian Hospital, Peking University Third Hospital from June 1, 2022 to August 31, 2023. The patients were randomized into either the selective nerve block group (SNB group, n=123) or the local anesthesia group (LA group, n=123) . A visual analogue scale(VAS) from no pain (= 0) to worst pain possible (= 10) was used to assess the pain intensity. Patient and operator satisfaction were graded from 0 to 2: 0, not satisfied at all; 1, partially satisfied; 2, satisfied. The arteriovenous fistula patency at 1 and 3 months after PTA was also evaluated. Results Compared with the local anesthesia group, the selective nerve block group had significantly lower VAS scores (Z = -7.193, p < 0.001) and required fewer additional anesthetics during the operation (² = -4.847, p = 0.028). Patient and operator satisfaction were significantly higher in the selective nerve block group (p < 0.05). Eight patients in the selective nerve block group encountered grade 3 motor paralysis after the operation and they all recovered within 60 minutes. There was no significant difference in primary patency rates of the fistula between the two groups either at 1 month or 3 months after the operation (p > 0.05). Conclusion Compared with local anesthesia, ultrasound-guided selective nerve block has advantages over the local anesthesia during endovascular treatment of dysfunctional hemodialysis fistulas. It can provide safe and efficient analgesia with excellent procedural satisfaction in hemodialysis patients.

Arteriovenous fistula (AVF) is regarded as the most effective vascular access for hemodialysis in patients with end-stage renal disease (ESRD).However, research investigating the relationships between the systemic inflammation response index (SIRI), the triglyceride-glucose index combined with body mass index (TyG-BMI), and the high-sensitivity C-reactive protein to albumin ratio (HRR) with AVF maturation is still limited. We included all ESRD patients undergoing first-time AVF creation between March and August 2024 at Haidian Hospital, Beijing (n = 249). To evaluate predictors of AVF maturation failure, we analyzed preoperative clinical/laboratory data and follow-up ultrasound assessments using restricted cubic spline models for dose-response relationships (SIRI, TyG-BMI, HRR). Multivariable Cox models identified independent risk factors, and a predictive nomogram was developed and validated through C-index and calibration plots. This study included 249 patients (73.5

Peritoneal dialysis catheter (PDC) dysfunction significantly impacts patient survival. While individual risk factors are known, a practical tool that integrates multi-dimensional predictors—including surgical, anatomical, and postoperative parameters—for early risk stratification is lacking. This study evaluates open versus laparoscopic catheterization techniques and aims to develop such a predictive model. A retrospective cohort study analyzed 462 end-stage renal disease patients undergoing first PDC implantation (2022–2024). Data included clinical characteristics, surgical method (open/laparoscopic), and dysfunction events. Multivariate COX regression identified independent risk factors, and a nomogram was developed. Model performance was assessed via ROC and calibration curves, with Bootstrap validation. Among 462 patients (324 modeling, 138 validation) with a median follow-up of 30.7 months, laparoscopic catheterization was associated with a significantly lower risk of dysfunction compared to the open approach (18

This report describes a novel and effective salvage strategy for managing perigraft seroma complicated by a small-caliber expanded polytetrafluoroethylene arteriovenous graft (AVG). Our patient developed a persistent seroma near the arterial anastomosis following AVG placement. The patient underwent successful seroma removal and delayed graft recanalization after 1 week of spontaneous graft thrombosis, which permitted partial tissue incorporation. The treatment was successful, achieving complete resolution of the seroma and restoration of graft function. The patient has remained free of recurrence for 40 months of follow-up. This approach represents an effective strategy for treating perigraft seromas of hemodialysis grafts.

Acute kidney injury (AKI) is a common complication that affects the outcomes of patients undergoing percutaneous coronary intervention (PCI). The triglyceride–glucose (TyG) index, a metric computed from fasting blood triglyceride and glucose levels, is closely associated with poor PCI outcomes. This study examined the association between the TyG index and incidence of AKI in patients undergoing PCI. Clinical information was obtained from the Medical Information Mart for Intensive Care IV database, which contains clinical data on 70,000 patients admitted to the intensive care unit at Beth Israel Deaconess Medical Center from 2008 to 2019. In total, 435 patients who underwent PCI were enrolled in this retrospective study, and they were categorized according to their AKI status, TyG quartiles, and diabetes mellitus (DM) history to analyze their baseline characteristics. The association of the TyG index with the risk of AKI was assessed using restricted cubic spline regression and logistic regression models. Subgroup analyses were also performed in patients with and without DM. Compared with the non-AKI population, patients with AKI who underwent PCI had a higher mean TyG index (p = 0.004). The restricted cubic spline regression model revealed a linear correlation between the TyG index and AKI risk (p for nonlinear = 0.123) in patients undergoing PCI. A high TyG index was a risk factor for AKI in non-DM subgroup, as well as in patients with BMI < 28 (odds ratio [OR] = 1.77; p = 0.050) and those with no history of diabetes (OR = 1.83; p = 0.047) or COPD (OR = 1.56; p = 0.030). This study highlighted the role of the TyG index as a predictive biomarker for AKI in patients without DM undergoing PCI, providing clinicians with a tool for identifying high-risk individuals for early intervention.

BACKGROUND For patients with end-stage renal disease, arteriovenous fistulas (AVFs) are often used for hemodialysis, but stenosis can impair their function. Traditional inpatient procedures to address AVF stenosis are effective but resource-intensive, prompting the need for alternative approaches like day surgery to optimize care and reduce costs. This study evaluated the feasibility of a day surgery model for AVF stenosis treatment in maintenance hemodialysis (MHD) patients, aiming to develop a cost-effective and high-quality care model. MATERIAL AND METHODS A prospective cohort study was conducted with 186 MHD patients undergoing AVF stenosis intervention between July 2022 and May, 2023. Patients were divided into a day surgery group (n=112) and a ward group (n=74). Various preoperative, intraoperative, and postoperative parameters were recorded, including AVF patency, complications, and rehospitalization rates. Follow-up assessments were conducted on postoperative days 1, 3, 7, and 30, with long-term patency evaluated at 6 and 12 months. RESULTS The day surgery group achieved a technical success rate of 99.11% and a complication rate of 3.57%, compared to 97.30% and 1.35% in the ward group. The day surgery group also had significantly shorter waiting times for beds, shorter hospital stays, and lower hospitalization costs (P<0.01). No significant differences were found between the groups in preoperative or postoperative parameters. CONCLUSIONS The day surgery model for AVF stenosis intervention in MHD patients is a viable option, showing comparable success and complication rates to inpatient surgery while significantly reducing hospital stays and costs.

Arteriovenous fistula (AVF) and arteriovenous graft (AVG) stenosis are common complications among hemodialysis patients, necessitating repeated interventions due to neointimal hyperplasia and restenosis. Percutaneous transluminal angioplasty (PTA), while a standard treatment, faces challenges in long-term efficacy. The DKutting Scoring Balloon, a novel advancement in scoring balloon technology, incorporates triangular scoring elements and non-compliant balloon material to create controlled micro-incisions in the vessel wall, aiming to enhance procedural precision, reduce vessel trauma, and lower restenosis rates. In the largest study of its kind, this retrospective analysis conducted at Beijing Haidian Hospital evaluated the device’s performance across 428 patients with significant AVF and AVG stenosis. The findings indicate primary patency rates of 98.1%, 90.8%, and 78.0% at 1, 3, and 6 months, respectively. Subgroup analyses revealed patency rates of 79.9% for AVF and 75.4% for AVG at 6 months, demonstrating its effectiveness even in resistant and recurrent cases. Importantly, no major adverse events were reported, underscoring the device’s safety profile. These observational findings suggest that the DKutting Scoring Balloon may offer favorable outcomes compared to those typically reported with conventional PTA, though these results should be interpreted as hypothesis-generating and further randomized controlled trials are recommended to corroborate these findings and optimize its integration into clinical practice.

OBJECTIVE:To compare the dialysis efficiency parameters between new single-needle dialysis and conventional double-needle dialysis and to explore the optimal prescription parameters for single-needle hemodialysis. METHODS:This study involved a prospective, cross-over design. Eight patients were randomly divided into two cohorts, which received the appropriate treatment. Relevant clinical data and dialysis-related parameters were collected for further analysis. RESULTS:Each of the patients enrolled in this study underwent nine sessions of single-needle dialysis and three sessions of double-needle dialysis. The average blood flow after 4, 4.5, and 5 h of single-needle dialysis was significantly lower (p < 0.001) than that with double-needle dialysis for the equivalent times. The online Kt/V value measured after 4 h of single-needle dialysis was significantly lower than that with 4 h of double-needle dialysis (p < 0.001). When replacing the dialyzer with a high-flux dialyzer (FX800) and extending the dialysis time to 5 h, there was no difference in the online Kt/V values (p = 0.341). There was also no difference in the ultrafiltration volume between single-needle and double-needle dialysis for the equivalent times. The calculation of the Kt/V and urea reduction rate (URR) showed that there was no difference between 5 h of single-needle dialysis and conventional double-needle dialysis (p > 0.05). CONCLUSIONS:The new modified single-needle system is safe and effective to support the dialysis treatment of maintenance hemodialysis patients. When adjusting the dialysis prescription to a high-flux dialyzer and extending the dialysis time to 5 h, it can achieve dialysis efficiency equivalent to that of conventional 4 h double-needle dialysis.

The prognosis and quality of life for patients undergoing hemodialysis (HD) are significantly compromised by dysfunctions in arteriovenous grafts (AVG). This study aimed to develop and validate a risk prediction model for factors influencing both short- and long-term primary patency rates in HD patients with AVG. The single-center retrospective study comprised 354 HD patients who had undergone AVG creation. Using Kaplan–Meier survival analysis and Cox regression models, we evaluated the patency rates of AVG and identified associated independent risk factors based on retrospectively collected clinical data. The primary patency rates of the patients with AVG at 6 months, 1 year, and 2 years were 82.49

Pathogens detected by metagenomic next-generation sequencing (mNGS) and the laboratory blood culture flask method were compared to understand the advantages and clinical significance of mNGS assays in the etiological diagnosis of peritoneal dialysis-associated peritonitis (PDAP). The study involved a total of 37 patients from the hospital's peritoneal dialysis centre, six of whom were patients with non-peritoneal dialysis-associated peritonitis. Peritoneal dialysis samples were collected from the 37 patients, who were divided into two groups. One group's samples were cultured using conventional blood culture flasks, and the other samples underwent pathogen testing using mNGS. The results showed that the positive rate of mNGS was 96.77%, while that of the blood culture flask method was 70.97% (p < 0.05). A total of 29 pathogens were detected by mNGS, namely 24 bacteria, one fungus, and four viruses. A total of 10 pathogens were detected using the bacterial blood culture method, namely nine bacteria and one fungus. The final judgment of the PDAP's causative pathogenic microorganism was made by combining the clinical condition, response to therapy, and the whole-genome sequencing findings. For mNGS, the sensitivity was 96.77%, the specificity was 83.33%, the positive predictive value was 96.77%, and the negative predictive value was 83.33%. For the blood culture flask method, the sensitivity was 70.97%, the specificity was 100%, the positive predictive value was 100%, and the negative predictive value was 0%. In conclusion, mNGS had a shorter detection time for diagnosing peritoneal dialysis-related peritonitis pathogens, with a higher positive rate than traditional bacterial cultures, providing significant advantages in diagnosing rare pathogens.

Successful hemodialysis (HD) treatment depends on well-functioning arteriovenous access. Thrombosis and stenosis are the main causes of access failure. The current report describes the successful establishment of an arteriovenous graft for HD using a previously placed stent graft in an HD patient who developed multiple episodes of access stenosis and thrombosis.