Cardiac valve calcification is a common complication in patients undergoing maintenance hemodialysis, and is closely linked to adverse clinical outcomes. P-cresyl sulfate, a typical protein-bound uremic toxin, has been implicated in the pathogenesis of vascular and valvular calcification. However, the relationships of p-cresyl sulfate with cardiac valve calcification and its prognostic value in maintenance hemodialysis patients remain poorly elucidated. This study aimed to investigate the correlations among serum p-cresyl sulfate level, cardiac valve calcification and clinical prognosis in this patient population. A total of 79 consecutive patients receiving regular maintenance hemodialysis were recruited in this single-center observational cohort study and divided into the cardiac valve calcification group (n = 25) and non-cardiac valve calcification group (n = 54) according to transthoracic echocardiographic results. All patients were followed prospectively for 12 months, with all-cause mortality and major adverse cardiovascular events recorded as predefined endpoints. Logistic regression analysis was performed to identify independent risk factors for cardiac valve calcification and adverse cardiovascular outcomes. Compared with the non-cardiac valve calcification group, patients in the cardiac valve calcification group were significantly older (67.20 vs. 55.94 years, P < 0.001) and had higher serum p-cresyl sulfate level (466.04 vs. 400.65 µg/mL, P = 0.006). Multivariate logistic regression analysis demonstrated that age [Odds Ratio = 1.083, 95

Despite advancements in dialysis technology, patients with kidney failure who are on maintenance haemodialysis (MHD) continue to experience high morbidity and mortality. Haemoadsorption combined with haemodialysis (HAHD) has emerged as a promising therapy to address these challenges. In light of the increasing adoption of HAHD in patients receiving MHD, there is a pressing need to demonstrate the safety and effectiveness of HAHD treatment. Consequently, a panel of Chinese experts developed a consensus on HAHD on the basis of the published literature and collective clinical experience. The consensus outlines six critical issues concerning HAHD treatment: patient population, contraindications, heparinization and priming procedures, prescription of HAHD, adjustment of medication dosages, and potential treatment-associated adverse events. After evaluation using a Delphi methodology, 19 statements achieved consensus (7 recommendations and 12 practice points). The overarching goal is to provide best-practice recommendations formulated by the HAHD consensus group to guide the use of haemoadsorption in MHD patients.

Chronic kidney disease (CKD) poses a significant global health challenge due to its high prevalence, low awareness, poor prognosis, and substantial medical costs. High-risk factors such as severe proteinuria and hypertension exacerbate CKD progression, leading to adverse kidney outcomes, cardiovascular diseases, hospitalizations, and increased mortality. Despite existing CKD registries in China, comprehensive data on patients at high-risk of CKD progression, such as patient with CKD and high proteinuria (CKD-HP) or hypertension (CKD-HTN) are lacking, highlighting the need for a dedicated registry to amass comprehensive patient data, thereby enhancing disease understanding. The China Chronic Kidney Disease Registry Platform Study (C-INSIGHT) is a national-wide, multicenter, prospective, observational study designed to enroll approximately 5,000 patients at high risk of CKD progression, including severe proteinuria (urine albumin-to-creatinine ratios (UACR) ≥ 700 mg/g or urine protein-to-creatinine ratio (UPCR) ≥ 1000 mg/g) or hypertension (systolic blood pressure (SBP) ≥ 130 mmHg), from 37 clinical centers across China between November 2023 and December 2026. Data collected will include demographic and clinical characteristics, CKD etiology and staging, diagnosis and treatment patterns, clinical outcomes, healthcare resource utilization, and lifestyle factors. Patients will be followed up annually until study end, withdrawal, loss to follow-up, or death. The study will utilize both traditional chart reviews and electronic medical records for data collection, with data governance methods employed at selected centers to enhance efficiency and accuracy of patient screening and data collection. The outcomes of this registry include both disease progression and clinical outcomes. The disease progression refers to the progressive deterioration of renal function, including decline in estimated Glomerular Filtration Rate (eGFR) category and rapid progression. The clinical outcomes are renal outcomes, cardiovascular outcomes, cardio-kidney composite outcomes, and all-cause mortality. C-INSIGHT is the first nationwide initiative in China dedicated to characterizing CKD patients at high-risk for progression, focusing on the unique disease profiles, risk factors, and clinical outcomes of CKD-HP and CKD-HTN subgroups. This registry study will develop predictive models for CKD progression and clinical outcomes and identify gaps between real-world management and guideline-based care of CKD. Large-scale, detailed data on diagnosis, treatment, and outcomes may support the development of enhanced strategies for early intervention, risk stratification, and long-term management, ultimately improving clinical outcomes. This study aims to fill crucial evidence gaps in China, and the findings may provide a reference for CKD management within China or regions with similar populations. First submitted: 2023-10-31; First submitted that met QC criteria: 2023-10-31; First posted: 2023-11-07. NCT06117852 ( ClinicalTrials.gov ).

OBJECTIVE:This study aims to evaluate the effects of exercise therapy combined with nutritional intervention on muscle strength, muscle mass, and physical function in maintenance hemodialysis (MHD) patients with sarcopenia (SP) through a systematic review and meta-analysis. METHODS:We searched multiple databases for RCTs published up to November 2024. Inclusion criteria: patients aged ≥18 with end-stage renal disease receiving MHD and diagnosed with SP; experimental group receiving combined exercise and nutrition intervention, and control group receiving either intervention alone; outcome measures including muscle strength, muscle mass, and physical function. Meta-analysis was performed using Stata 15.1. RESULTS:Nine high-quality RCTs involving 513 MHD-SP patients (256 experimental, 257 control) were included. The combined intervention group showed significantly greater improvements in handgrip strength (WMD = 3.78, 95% CI: 2.02-5.53), leg power score (WMD = 5.52, 95% CI: 1.47-9.58), skeletal muscle index (WMD = 0.82, 95% CI: 0.62-1.03), lean body mass (WMD = 2.53, 95% CI: 0.45-4.61), walking speed (WMD = 0.11, 95% CI: 0.01-0.22), 6-minute walk test (WMD = 41.37, 95% CI: 20.16-62.58), and 30-second sit-to-stand test (WMD = 3.37, 95% CI: 1.67-5.07). Heterogeneity analysis showed I2 ≤ 50% for all outcomes, indicating robust results. Sensitivity and publication bias analyses confirmed the reliability of the findings. CONCLUSION:Combined exercise therapy and nutritional intervention significantly improve muscle strength, mass, and physical function in MHD patients with sarcopenia, offering important clinical benefits.

BACKGROUND:Sarcopenia due to abnormal muscle metabolism and osteoporosis due to abnormal bone metabolism are common complications in maintenance hemodialysis (MHD) patients. The aim of this study was to investigate the association between volumetric bone mineral density (vBMD) and trunk muscle density, as assessed by quantitative computed tomography (QCT) in MHD patients. METHODS:A total of 108 patients were included. Patients were categorized into a nonosteopenia (n = 38) and an osteopenia group (n = 70) on the basis of vBMD. Multivariate logistic regression was employed to adjust for potential confounding factors. RESULTS:Patients in the osteopenia group were older (65.03 ± 10.05 vs. 53.16 ± 13.52 years, p < 0.001). Trunk muscle density (24.97 ± 7.14 vs. 32.04 ± 5.79, p < 0.001) were lower in the osteopenia group than in the nonosteopenia group. Multiple linear regression revealed a positive correlation between trunk muscle density and lumbar vBMD (B = 2.362; 95% CI (1.325-3.399), p < 0.001). Logistic regression analysis revealed that patients with greater trunk muscle density had a lower risk of osteopenia (odds ratio [OR] = 0.842; 95% CI (0.713-0.995), p = 0.043). The predictive value of trunk muscle density for osteopenia in MHD patients was 0.779 (p < 0.001). CONCLUSIONS:We found that the greater the trunk muscle density is, the greater is the vBMD of the lumbar spine in MHD patients. This may indicate that trunk muscle density serves as a protective factor against osteopenia in this population.

INTRODUCTION:Current guidelines recommend limiting hemoadsorption (HA) duration to 2 h during hemodialysis (HD) sessions due to theoretical concerns about adsorbent saturation and clotting risks. This multicenter prospective cohort study evaluated the long-term safety and efficacy of a novel "4Hs" protocol (4-h HA-HD with blood flow >250 mL/min). METHODS:78 maintenance HD patients from four centers underwent 26 weeks of 4Hs therapy. Key outcomes included dialysis adequacy (spKt/V, urea reduction ratio [URR]), uremic toxin (UT) clearance (indoxyl sulfate [IS], p-cresyl sulfate, β2 microglobulin [B2MG]), clotting rates, and adverse events. Statistical comparisons were made against pre-study conventional HA+HD (2-h HA) data using paired t-tests and repeated-measures ANOVA. RESULTS:The 4Hs protocol demonstrated non-inferior safety to conventional HA+HD, with comparable clotting rates (1.79% vs. 1.62%, p = 0.665) and no significant differences in anemia markers or hypoalbuminemia. Dialysis efficacy improved significantly: spKt/V increased by 0.28 (p = 0.012), URR by 1.18% (p = 0.003), and UT reduction rates (IS: 56.17% vs. 40.14%, p < 0.001; pCS: 47.39% vs. 35.91%, p < 0.001; B2MG: 55.82% vs. 48.41%, p < 0.001). Albumin loss remained comparable between protocols (Δ 0.5 g/L, p > 0.05). CONCLUSION:Extending HA duration to 4 h with high-flow hemodynamics (Qb >250 mL/min) is safe and enhances toxin clearance without increasing clotting risks. These findings challenge current SOP limitations on HA duration and support protocol optimization in maintenance HD patients.

Background:Muscle fat infiltration (MFI) is increasingly recognized as a critical factor influencing muscle function and metabolic health. Accurate quantification of MFI is essential for diagnosing and monitoring various muscular and metabolic disorders. Quantitative Dixon (Q-Dixon) magnetic resonance imaging (MRI) and high-speed T2-corrected multi-echo (HISTO) magnetic resonance spectroscopy (MRS) are both advanced imaging techniques that offer potential for detailed assessment of MFI. However, the validity and reliability of these methods in measuring volumetric changes in muscle composition, particularly in both thigh and paravertebral muscles, have not been thoroughly compared. This study aims to validate volumetric measurements using Q-Dixon MRI against HISTO MRS in thigh and paravertebral muscles, taking into account the heterogeneity of MFI. Methods:A retrospective study was conducted with 54 subjects [mean age, 60 years; 38 male (M)/16 female (F)] for thigh muscle and 56 subjects (mean age, 50 years; 22 M/34 F) for paravertebral muscle assessment using a 3-Tesla MRI. The proton density fat fraction (PDFF) was measured with Q-Dixon MRI and HISTO MRS within the upper-middle part of quadriceps femoris and paravertebral muscles at L4/5 level in volumes-of-interest (VOIs). The corresponding volumetric Q-Dixon freehand VOI PDFF was measured. Scatterplots, Bland-Altman plots, Spearman correlation coefficients, and Wilcoxon signed rank test with Bonferroni correction were employed. The Kruskal-Wallis H tests followed by Bonferroni-corrected post hoc tests were analyzed to compare parameter differences with visual MFI grades. Results:Q-Dixon cubic VOI PDFF correlated positively with HISTO MRS PDFF in thigh (r=0.96, P<0.001) and paravertebral groups (r=0.98, P<0.001), with insignificant differences (P=0.29, 0.82, respectively). Both PDFF values from cubic VOIs in Q-Dixon and HISTO MRS differed from the freehand Q-Dixon PDFF (all P<0.001). Only for <5% HISTO MRS PDFF, there was a difference between HISTO MRS PDFF and Q-Dixon cubic VOI PDFF (P=0.002). Conclusions:Volumetric Q-Dixon cubic VOI PDFF exhibited good correlation and consistency with HISTO MRS PDFF for quantitative fat assessment in thigh and paravertebral muscles except for muscles with fat fraction <5%, and the Q-Dixon freehand VOI PDFF offers a more comprehensive assessment of the actual MFI compared to cubic VOI.

Background: Muscle fat infiltration (MFI) is increasingly recognized as a critical factor influencing muscle function and metabolic health. Accurate quantification of MFI is essential for diagnosing and monitoring various muscular and metabolic disorders. Quantitative Dixon (Q-Dixon) magnetic resonance imaging (MRI) and high-speed T2 2-corrected multi-echo (HISTO) magnetic resonance spectroscopy (MRS) are both advanced imaging techniques that offer potential for detailed assessment of MFI. However, the validity and reliability of these methods in measuring volumetric changes in muscle composition, particularly in both thigh and paravertebral muscles, have not been thoroughly compared. This study aims to validate volumetric measurements using Q-Dixon MRI against HISTO MRS in thigh and paravertebral muscles, taking into account the heterogeneity of MFI. Methods: A retrospective study was conducted with 54 subjects [mean age, 60 years; 38 male (M)/16 female (F)] for thigh muscle and 56 subjects (mean age, 50 years; 22 M/34 F) for paravertebral muscle assessment using a 3-Tesla MRI. The proton density fat fraction (PDFF) was measured with Q-Dixon MRI and HISTO MRS within the upper-middle part of quadriceps femoris and paravertebral muscles at L4/5 level in volumes-of-interest (VOIs). The corresponding volumetric Q-Dixon freehand VOI PDFF was measured. Scatterplots, Bland-Altman plots, Spearman correlation coefficients, and Wilcoxon signed rank test with Bonferroni correction were employed. The Kruskal-Wallis H tests followed by Bonferroni-corrected post hoc tests were analyzed to compare parameter differences with visual MFI grades. Results: Q-Dixon cubic VOI PDFF correlated positively with HISTO MRS PDFF in thigh (r=0.96, P<0.001) and paravertebral groups (r=0.98, P<0.001), with insignificant differences (P=0.29, 0.82, respectively). Both PDFF values from cubic VOIs in Q-Dixon and HISTO MRS differed from the freehand Q-Dixon PDFF (all P<0.001). Only for <5% HISTO MRS PDFF, there was a difference between HISTO MRS PDFF and Q-Dixon cubic VOI PDFF (P=0.002). Conclusions: Volumetric Q-Dixon cubic VOI PDFF exhibited good correlation and consistency with HISTO MRS PDFF for quantitative fat assessment in thigh and paravertebral muscles except for muscles with fat fraction <5%, and the Q-Dixon freehand VOI PDFF offers a more comprehensive assessment of the actual MFI compared to cubic VOI.

Background: The status of mineral and bone disorder (MBD) after kidney transplantation is not fully understood, and the assessment of abnormal mineral and bone metabolism in kidney transplant recipients (KTRs) has not been standardized. Materials and methods: We performed a retrospective analysis of 292 KTRs in our center. The levels of biochemical markers of bone metabolism and bone mineral density (BMD) were assessed. We evaluated the influencing factors of BMD using linear regression analysis. And correlation test was used for the correlation analysis between bone metabolism indicators and other indicators. Results: Postoperative MBD mainly manifested as hypercalcemia (8.9%), hypophosphatemia (27.1%), low levels of 25-hydroxyvitamin D(25(OH)vitD) (67.0%), hyperparathyroidism (50.6%), and high levels of bone turnover markers (BTMs). The prevalence of osteopenia/osteoporosis in the femoral neck (FN) and lumbar spine (LS) was 20.1%/2.8% and 26.1%/3.6%, respectively. Multivariate analysis indicated that FN BMD was positively associated with body mass index (BMI) and negatively associated with acute rejection history (p < 0.05); while LS BMD was positively associated with BMI, and negatively associated with intact parathyroid hormone (iPTH) (p < 0.05). Biochemical markers of bone metabolism were affected by age, sex, preoperative dialysis mode and time, time, kid ney function, and iPTH levels. LS BMD was negatively correlated with iPTH and BTMs (p < 0.05). Conclusion: MBD persisted after kidney transplantation. Decreased bone mass was associated with persistent hyperparathyroidism, acute rejection history, low BMI, advanced age, and menopause. Dynamic monitoring of bone metabolism index and BMD helps to assess MBD after kidney transplantation.

Background and purposeSarcopenia is highly prevalent (28.5–40.3%) in patients undergoing hemodialysis and leads to poor clinical outcomes. However, the association between muscle quality and sarcopenia in patients receiving hemodialysis remains unclear. Therefore, we aimed to explore the association between muscle cross-sectional area (CSA) and proton-density fat-fraction (PDFF) in patients with sarcopenia undergoing hemodialysis.MethodsSeventy-six patients undergoing hemodialysis for > 3 months were enrolled. Their handgrip strength (HGS), short physical performance battery (SPPB) performance, and appendicular skeletal muscle mass index (ASMI) were measured. Sarcopenia was defined using the Asian Working Group for Sarcopenia 2019 consensus update. All patients underwent quantitative magnetic resonance imaging. CSA and PDFF were measured for the thigh, trunk, and gluteus muscles.ResultsThe prevalence of probable, confirmed, and severe sarcopenia in this study was 73.7%, 51.3%, and 22.4%, respectively. Older age (OR: 1.061, P < 0.003); lower body mass index (BMI) (OR: 0.837, P = 0.008), albumin (OR: 0.765, P = 0.004), prealbumin (OR: 0.987, P = 0.001), predialysis blood urea nitrogen (BUN) (OR: 0.842, P < 0.001), predialysis creatinine (OR: 0.993, P < 0.001), phosphorus (OR: 0.396, P = 0.047); lower CSA of the thigh (OR: 0.58, P = 0.035), third lumbar (L3) trunk (OR: 0.37, P = 0.004), gluteus minimus and medius (OR: 0.28, P = 0.001), and gluteus maximus (OR: 0.28, P= 0.001); and higher PDFF of the thigh (OR: 1.89, P = 0.036) and L3 trunk (OR: 1.71, P = 0.040) were identified as sarcopenia risk factors. The gluteus minimus and medius CSA was lower in patients with sarcopenia than in those without after adjusting for age and BMI (OR: 0.37, P = 0.017). Higher thigh (P = 0.031) and L3 trunk (P = 0.006) muscle PDFF were significantly associated with lower HGS. Furthermore, higher thigh (P = 0.011) and L3 trunk (P = 0.010) muscle PDFF were also inversely correlated with lower ASMI.ConclusionOur findings demonstrate the high prevalence of sarcopenia and myosteatosis in patients undergoing hemodialysis and might trigger a paradigm shift in intervention strategies for patients receiving hemodialysis.

Abstract Objective: To determine the underlying mechanism for how circulating exosomes with micro-RNA (Exo-miRNA) cargos promote medial arterial calcification (MAC) in maintenance hemodialysis (MHD) patients. Methods and Results: Plasma samples and fistular vascular tissues were collected from 12 MHD patients. Histological examinations and Exo-miRNA aberrant expression assays were conducted on the samples. The Exo-miRNAs in supernatants of human umbilical vein endothelial cells (HUVECs) treated with asymmetric dimethylarginine (ADMA) were compared with those in control HUVECs. Two similar miRNAs between patient plasma samples and cell culture supernatants, miR-93-5p and miR-3613-5p, were selected for cell culture experiments in vitro. Human aortic smooth muscle cells (HASMCs) were incubated with mimics of these miRNAs or cocultured with ADMA-treated HUVECs using a transwell system. Target proteins in the cell lysates were detected by western blotting. The histological examinations provided images of MAC Compared with control HASMCs, up-regulation of S100A11a, PI3K p110α, NF-κB, p38 MAPK, Rab11a, and F-actin was observed in the miR-93-5p mimic group, while up-regulation of Rab11a and F-actin was noted in the miR-3613-5p mimic group. Conclusion: MiRNA-93-5p and miRNA-3613-5p in exosomes released from vascular endothelial cells enter into vascular smooth muscle cells and regulate MAC in MHD patients.

Background Hypertension is a leading preventable risk factor for cardiovascular disease in hemodialysis patients. Pre-dialysis systolic blood pressure (SBP) more than 160 mmHg was thought to be associated with increased risk of cardiovascular events and all-cause mortality. The present study was performed to explore the clinical characteristics and management of hemodialysis patients with pre-dialysis SBP ≥ 160 mmHg.Methods A total of 1233 patients undergoing hemodialysis from nine hemodialysis centers were enrolled. Pre-dialysis and home BP were measured and clinical data were collected. The characteristics of patients with pre-dialysis SBP ≥ 160 mmHg were explored. Clinical parameters between hypertensive and non-hypertensive patients were compared. The partial correlation analyses performed to identify the associations between BP and clinical parameters.Results There were 24.6% of the hemodialysis patients had pre-dialysis SBP ≥ 160 mmHg and the average SBP was 173.8 ± 10.9 mmHg. Only 21.4% of the patients achieved dry weight after dialysis and up to 30.2% of patients were not given combination therapies of antihypertensive drugs. Compared to patients with pre-hemodialysis SBP < 160 mmHg, patients with pre-dialysis SBP ≥ 160 mmHg had lower target-reaching rate of Kt/v and higher incidences of intradialytic hypotension and muscle spasm. Most patients (96%) with pre-dialysis SBP ≥ 160 mmHg had home SBP≥ 135 mmHg. Patients with home SBP ≥ 160 mmHg had higher left ventricular weight index and lower hemoglobin levels when compared to their counterparts with home SBP <160 mmHg.Conclusions Pre-dialysis SBP ≥ 160 mmHg is common in clinical practice and most of the patients could diagnosed to be hypertensive according to their home SBP. Patients with pre-dialysis SBP ≥ 160 mmHg are more likely to be subjected to dialysis insufficiency and intradialytic complications. Achieving dry weight and sufficient pharmacologic interventions should be strengthened to improve BP control in the hemodialysis population.

治疗性血浆置换(therapeutic plasma exchange,TPE)通过分离并清除血浆中可溶的治病物质,并以置换液补充体液、电解质和血浆成分,从而达到治疗的目的.妊娠期出现红细胞同种免疫(red cell alloimmunization,RCA)、血栓性微血管病(thrombotic microangiopathy,TMA)、自身免疫性疾病、脂代谢疾病时,需要考虑应用TPE治疗,本文对妊娠期进行TPE治疗的指征、并发症等进行文献综述,供临床实践参考.

目的 探讨终末期肾脏病维持性透析期间发生心力衰竭患者应用沙库巴曲缬沙坦治疗后心力衰竭症状缓解及血压控制情况.方法 终末期肾脏病维持性透析期间发生心力衰竭患者46例,23例口服沙库巴曲缬沙坦钠片治疗者为观察组,23例给予常规治疗者为对照组.记录2组治疗前及治疗6个月收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)、干体质量、每周超滤量、血红蛋白、血清白蛋白、血清钾、血清铁蛋白、血浆脑钠肽(brain natriuretic peptide,BNP)、左室射血分数(left ventricular ejection fraction,LVEF)、堪萨斯城心肌病问卷(Kansas City Cardiomyopathy Questionnaire,KCCQ)评分,并进行比较;记录2组随访期间不良事件及终点事件发生情况.结果 观察组治疗前血浆BNP水平[(26145.22±11107.35)ng/L]高于对照组[(17109.65±12604.41)ng/L] (P＜0.05),LVEF[(48.17±9.04)％]低于对照组[(53.70±8.97)％](P＜0.05),SBP,DBP,干体质量,每周超滤量,血红蛋白、血清白蛋白、血清钾、血清铁蛋白水平,KCCQ评分与对照组比较差异均无统计学意义(P＞0.05).观察组治疗6个月KCCQ评分[(57.01±14.91)分]高于对照组[(43.17±7.29)分](P＜0.05),SBP,DBP,干体质量,每周超滤量,血红蛋白、血清白蛋白、血清钾、血清铁蛋白、血浆BNP水平,LVEF与对照组比较差异均无统计学意义(P＞0.05).观察组治疗6个月SBP[(139.83土16.88)mm Hg]、DBP[(79.87±16.88) mm Hg]均低于治疗前[(150.09±26.34)、(90.00±16.64)mm Hg](P＜0.05),KCCQ评分高于治疗前[(44.99±9.05)分](P＜0.05),干体质量,每周超滤量,血红蛋白、血清白蛋白、血清钾、血清铁蛋白、血浆BNP水平,LVEF与治疗前比较差异均无统计学意义(P＞0.05);对照组治疗6个月各指标与治疗前比较差异均无统计学意义(P＞0.05).观察组治疗6个月SBP降低值[6.00(0.00,17.00) mm Hg]、DBP降低值[7.00 (3.00,19.00) mm Hg]、KCCQ评分增加值[10.00 (6.36,19.09)分]均高于对照组[0.00(-13.00,8.00)mm Hg、-1.00(-7.00,6.00)mm Hg、-2.00(-4.64,5.00)分](P＜0.05),血浆BNP水平降低值[0.00(0.00,10216.00) ng/L]、LVEF增加值[1.00(-2.00,6.00)％]与对照组[826.00(-1800.00,1000.00)ng/L、-1.00(-10.00,3.00)％]比较差异均无统计学意义(P＞0.05).随访至2020年12月,观察组和对照组发生持续不卧床腹膜透析相关感染各1例,2组患者均未发生高钾血症、死亡等终点事件.结论 终末期肾脏病维持性透析期间发生心力衰竭患者应用沙库巴曲缬沙坦治疗可明显缓解心力衰竭症状,降低血压,安全性好.

Target: To compare the ultrasound characteristics between functional, mature arteriovenous fistulas and functional, non-mature arteriovenous fistulas and to identify the predictors of arteriovenous fistula maturation in the forearm. Methods: Patients with newly set-up functional arteriovenous fistulas were enrolled in this prospective cohort study. Ultrasound examinations were conducted pre-operatively and post-operatively. The inner vessel diameter, blood flow volume, and resistance index were measured and compared between the maturation group (Group M) and non-maturation group (Group N). Baseline parameters were calculated to determine the predictors of non-maturation of arteriovenous fistulas. Results: All 52 patients with functional arteriovenous fistulas, who were categorized into Group M (25 patients, 48.08%) and Group N (27 patients, 51.92%), finished 24 weeks of follow-up after arteriovenous fistula surgery. The arteriovenous fistulas displayed a significant and rapid increase in the vessel diameter (mean increase of 1.34 times in the arteries and 1.92 times in the veins) and blood flow volume (mean increase of 9.29 times of the arteries and 43.66 times of the veins) and a decrease in the resistance index (mean decrease in 48.00% in the arteries) 8 weeks after surgery. Group N had a lesser increase in the vessel diameters (1.78 times vs 2.06 times, t = -3.136, p = 0.003) and blood flow volume (33.98 times vs 54.11 times, t = -2.383, p = 0.021) of the cephalic vein draining segments (a6) than Group M. The baseline diameter of a6 was the only independent predictor (regression coefficient = 26.229, p = 0.008) of maturation of the functional arteriovenous fistulas after correcting for sex, age, diabetes kidney disease, weight, and height. Conclusion: The baseline diameter of the cephalic vein was the only predictor of arteriovenous fistula maturation based on the pre-operative ultrasound measurements in Chinese hemodialysis patients.

Chronic kidney disease (CKD) has received increased attention as a leading public health problem worldwide. Globally surveillance systems for kidney disease are still lacking, especially in developing countries like China, which constitutes an obstacle to develop effective preventive strategies. China Kidney Disease Network (CK-NET) was initiated in 2014 and further developed in accordance with the national strategy of prompting Big Data application in China. One major output of CK-NET is to generate an Annual Data Report (ADR) providing resourceful information regarding kidney disease in China. Entering the second cycle of ADR, we have expanded the scope and depth of our research based on the previous ADR. There are 2 sections in the current ADR, generated from data from 2015 from various sources. Section I is based on a dataset of national hospitalized patients and describes the characteristics regarding hospitalized patients with CKD. Section II focuses on patients receiving renal replacement therapy based on 2 nationwide claims databases. There is also a chapter that focuses on patients on the waiting list for renal transplantation based on the China Organ Transplant Response System. Certain findings, including the effect of metabolic disease on the spectrum of CKD, the underdiagnoses of CKD and acute kidney injury among hospitalized patients, and the less-optimal treatment of complications among dialysis patients, will inspire the following research as well as changes in health policy. By integrating and mining national patient-level administrative or claim databases, we are able to provide a comprehensive description of the burden of CKD and end stage kidney disease in China, which could be used by multiple stakeholders with interests in kidney disease.

目的 调查维持性血液透析(maintenance hemodialysis,MHD)患者的睡眠质量,并分析其影响因素.方法 采用匹兹堡睡眠质量指数量表(Pittsburg sleep quality index,PSQI),社会支持评定量表(social support rating scale,SSRS)、焦虑自评量表(self-rating anxiety scale,SAS)、抑郁自评量表(self-rating depression scale,SDS)调查112名MHD患者的睡眠情况,根据PSQI评分将≤10分者归为无睡眠严重障碍组,＞10分者归为睡眠严重障碍组,焦虑自评量表(self rating anxiety scale,SAS)、抑郁自评量表(self rating depression scale,SDS)进行焦虑抑郁评价,同时比较各临床参数.结果 112名MHD患者中38名(33.93％)患者PSQI评分＞10分.2组在年龄[(62.20±10.62)比(51.51±15.12)岁,t=4.253,P＜0.001]、透析龄[(78.46±88.96)比(46.12±45.68)月,t=2.028,P=0.048]、白蛋白[(37.94±2.86)比(39.37±2.49)g/L,t=2.542,P=0.013]、甲状旁腺激素[(243.32±158.85)比(327.54±209.34) pg/ml,t=2.324,P=0.022]、抑郁得分分布(x2=7.110,P=0.029)存在统计学差异.建立预测睡眠质量的Logistic回归模型f(x)=1/(1+e0.074289x1+0.055897x2+0.99036)(其中x1为年龄,Z=-2.600,P=0.009;x2为抑郁得分Z=-2.004,P=0.028),准确度71.9％,AUC=0.748.结论 MHD患者普遍存在睡眠质量问题,老年、透析龄长、白蛋白低、甲状旁腺激素偏低、抑郁患者存在严重睡眠质量差.用于预测睡眠质量的Logistic回归模型具有一定的预测能力.

目的:分析同一品牌不同浓度消毒液消毒反渗透(RO)膜后,化学污染物含量变化,以提供安全可靠的消毒液.方法:采用化学消毒方法,对RO膜进行消毒,将两套反渗透系统分组为RO1组和RO2组,在两组水处理设备进水压力、预处理水、系统回收率、水温度和膜材质相等同的情况下,分别配置两种不同浓度的消毒液对水处理RO膜进行消毒,对比两种不同浓度消毒液消毒后的RO膜化学污染物含量,并对反渗透系统产水端细菌及其衍生物结果进行对比.结果:RO1组RO膜化学污染物无明显变化,且差异无统计学意义;RO2组RO膜化学污染物透析溶液中的电解质安全范围值内平均超过10％,已证明有毒性污染物安全范围值内基础上平均上升为3％.无机微量元素污染物安全范围值内基础上平均上升4.5％.RO2组化学污染物增高程度为(0.198±0.165)mg/L,显著高于RO1组的(0.077±0.138)mg/L,差异有统计学意义(t=3.460,P<0.05).结论:过氧乙酸溶液稀释浓度为0.2％消毒RO膜,化学污染物含量无明显变化,细菌及其衍生物均在正常范围内.过氧乙酸溶液≤0.2％适合消毒RO膜的浓度,可为水处理系统提供安全有效的消毒液浓度.

To observe the effect on hemoglobin (Hb) variability with different treatment frequencies of intravenous iron in maintenance hemodialysis (MHD) patients.