Background and Objectives:EUS-guided portal pressure gradient (EUS-PPG) measurement has been proposed as a novel direct manometry to quantify portal hypertension. This study aimed to explore the ability of EUS-PPG measurements to evaluate the severity of portal hypertension. Methods:The clinical features of patients with diagnosed cirrhosis or chronic liver disease who underwent EUS-PPG measurement at a single center were retrospectively analyzed. The correlations between the clinical features of portal hypertension and the EUS-PPG measurements were analyzed, and then receiver operating characteristic curves were used to evaluate the ability of the EUS-PPG measurements to evaluate disease severity. Results:A total of 197 patients were included in this study. The EUS-PPG measurements varied significantly among patients categorized by gastroesophageal varices, red signs, variceal bleeding, ascites, hepatic encephalopathy, thrombocytopenia, hypoproteinemia, prothrombin time, international normalized ratio, or Child-Pugh grade (P < 0.05). The areas under the receiver operating characteristic curves for gastroesophageal varices, decompensated cirrhosis, ascites, and recent variceal bleeding were 0.919, 0.847, 0.813, and 0.804, respectively (P < 0.001). Furthermore, the optimal EUS-PPG cutoff values for gastroesophageal varices, decompensated cirrhosis, ascites, and recent variceal bleeding were 11.5 mm Hg (sensitivity = 80.3%, specificity = 89.5%), 12.75 mm Hg (sensitivity = 77.8%, specificity = 76.7%), 15.75 mm Hg (sensitivity = 66.7%, specificity = 83.1%), and 16.75 mm Hg (sensitivity = 76.2%, specificity = 70.1%), respectively. Conclusions:EUS-PPG measurement seems to be an effective technique for assessing disease severity and risk of variceal bleeding in patients with diagnosed cirrhosis or chronic liver disease.

BACKGROUND:The Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) index serves as a novel composite biomarker reflecting both systemic inflammation and nutritional status in clinical practice. METHODS:This observational cohort study enrolled 892 peritoneal dialysis patients categorized by HALP quartiles (Q1-Q4). Through comprehensive survival analyses including Kaplan-Meier curves and multivariable Cox regression, we systematically evaluated the prognostic value of HALP for mortality outcomes. Predictive performance was rigorously assessed using time-dependent receiver operating characteristic analysis and net reclassification improvement metrics. RESULTS:The analysis revealed clinically significant findings where patients in the highest HALP quartile demonstrated markedly better survival outcomes compared to the lowest quartile, with hazard ratios of 0.43 (95% CI 0.21-0.86) for all-cause mortality and 0.23 (95% CI 0.08-0.69) for cardiovascular mortality. Importantly, incorporating HALP into prediction models yielded meaningful clinical improvements, elevating the 5-year mortality prediction accuracy from an AUC and achieving a statistically significant net reclassification improvement of 15%. CONCLUSIONS:These findings establish HALP as a practical and robust prognostic indicator in peritoneal dialysis patients that not only independently predicts mortality risk but also provides substantial incremental value beyond conventional risk factors, offering potential clinical utility for risk stratification and patient management decisions.

Peritoneal dialysis (PD) is an effective alternative treatment for patients with end-stage renal disease (ESRD) and is increasingly being adopted and promoted worldwide. However, as the duration of peritoneal dialysis extends, it can expose problems with dialysis inadequacy and ultrafiltration failure. The exact mechanism and aetiology of ultrafiltration failure have been of great concern, with triggers such as biological incompatibility of peritoneal dialysis solutions, uraemia toxins, and recurrent intraperitoneal inflammation initiating multiple pathways that regulate the release of various cytokines, promote the transcription of fibrosis-related genes, and deposit extracellular matrix. As a result, peritoneal fibrosis occurs. Exploring the pathogenic factors and molecular mechanisms can help us prevent peritoneal fibrosis and prolong the duration of Peritoneal dialysis.

Inflammation plays an essential role in the development liver fibrosis.The Cyclic guanosine monophosphate-adenosine monophosphate synthase (cGAS) is a central cytoplasmic DNA sensor which can recognize cytoplasmic DNA, known to trigger stimulator of interferon genes (STING) and downstream proinflammatory factors. Here, we investigated the role of cGAS-STING signaling pathway in the pathogenesis of liver fibrosis.Differentially expressed genes (DEGs) in human liver tissue were identified using RNA-Seq analysis. As models of liver fibrosis, chronic Carbon tetrachloride (CCl4) exposure were applied in cGAS-knockout mice. LX-2 cells were co-cultured with human liver sinusoidal endothelial cells (LSECs) to explore the underlying mechanisms of hepatic sinusoidal microthrombosis in an inflammatory microenvironment. The endoscopic ultrasound-guided portal vein pressure gradient (EUS-PPG) method was used to analyze the associations between hepatic sinusoidal microthrombosis and PPG in patients with liver fibrosis and portal hypertension (PTH). The RNA-seq analysis results showed that DEGs were enriched in inflammation and endothelial cell activation. The upregulation of the cGAS-STING signaling exacerbated liver fibrosis and intrahepatic inflammation. It also exacerbated LSECs impairment and increased the contribution of hepatic sinusoidal microthrombosis to liver fibrosis in vivo and in vitro. Prothrombotic mediators and proinflammatory factors were associated with PPG in patients with liver fibrosis and portal hypertension. Therefore, activating cGAS-STING signaling pathway promotes liver fibrosis and hepatic sinusoidal microthrombosis, which may lead to increased portal vein pressure.

KEY MESSAGES BCR was associated with clinical manifestations and pathological changes in patients with IgAV-N, particularly crescents. The ISKDC classification was related to clinical manifestations of patients with IgAV-N, but it wasn't associated with prognosis. The Oxford MEST-C score was correlated to clinical presentations and prognosis of patients with IgAV-N, while BCR can improve its predictive ability. Objective Bowman's capsule rupture (BCR) is a glomerular pathological change, but it is still not well recognized in immunoglobulin A vasculitis nephritis (IgAV-N). The Oxford MEST-C score is a classification for IgA nephropathy; however, its clinical correlation and prognostic value in adult patients with IgAV-N are unclear. Methods A retrospective study of 145 adult patients with IgAV-N diagnosed by renal biopsy was conducted. Clinical manifestations, pathological changes and the prognosis of IgAV-N patients were compared depending on the presence or absence of BCR, International Study of Kidney Disease in Children (ISKDC) classification and MEST-C score. The primary endpoint events were end-stage renal disease, renal replacement therapy and all-cause death. Results In total, 51 of 145 (35.17%) patients with IgAV-N presented with BCR. Patients with BCR had more proteinuria, lower serum albumin, and more crescents. Compared with IgAV-N patients with crescents only, 51/100 patients with crescents combined with BCR had a higher proportion of crescents in all glomeruli (15.79% vs. 9.09%; p = 0.003). Patients with higher ISKDC grades had more severe clinical presentation, but it did not reflect the prognosis. However, the MEST-C score not only reflected clinical manifestations but also predicted prognosis (p < 0.05). BCR contributed to the effectiveness of the MEST-C score in predicting the prognosis of IgAV-N (C-index: 0.845 to 0.855). Conclusions BCR is associated with clinical manifestations and pathological changes in patients with IgAV-N. The ISKDC classification and MEST-C score are related to the patient's condition, but only the MEST-C score is correlated with the prognosis of patients with IgAV-N, while BCR can improve its predictive ability.

PURPOSE:Music and animation are the most common and affordable distraction strategies to reduce preoperative anxiety in children; however, their effects are inconsistent. This study aimed to examine the effectiveness of two distraction strategies (music or animation) in reducing preoperative anxiety in children. DESIGN AND METHODS:In this randomized controlled trial, 183 children who underwent surgery were divided into music, animation, and control groups using a single-blind block randomized design. Children in the control group underwent routine preoperative visits. Meanwhile, the children in the intervention groups could choose their favorite music and cartoons as intervention content. Study outcomes included anxiety levels, degree of cooperation, heart rate, and blood pressure. Data were collected before entering the operating room, entering the operating room, and before the induction of anesthesia; only the degree of cooperation was collected before the induction of anesthesia. RESULTS:Only animation significantly reduced preoperative anxiety in the children (P < 0.05) upon entering the operating room. Both music and animation reduced the level of preoperative anxiety before induction of anesthesia; however, there was no significant difference between them (P > 0.05). The induction compliance score was significantly lower in the music and animation groups than in the control group (P < 0.05). Heart rates differed significantly between the three groups from before entering the operating room to before induction of anesthesia. Children in the control group had the highest systolic blood pressure upon entering the operating room (P < 0.05). CONCLUSIONS:Music and animation strategies can significantly reduce preoperative anxiety in children and improve surgical cooperation during anesthesia induction. TRIAL REGISTRATION:Clinical. TRIALS:gov NCT05285995.

BackgroundThe 2019 novel coronavirus (COVID-19) pandemic remains rampant in many countries/regions. Improving the positive detection rate of COVID-19 infection is an important measure for the control and prevention of this pandemic. This meta-analysis aims to systematically summarize the current characteristics of the computed tomography (CT) auxiliary screening methods for COVID-19 infection in the real world.MethodsWeb of Science, Cochrane Library, Embase, PubMed, CNKI, and Wanfang databases were searched for relevant articles published prior to 1 September 2022. Data on specificity, sensitivity, positive/negative likelihood ratio, area under curve (AUC), and diagnostic odds ratio (dOR) were calculated purposefully.ResultsOne hundred and fifteen studies were included with 51,500 participants in the meta-analysis. Among these studies, the pooled estimates for AUC of CT in confirmed cases, and CT in suspected cases to predict COVID-19 diagnosis were 0.76 and 0.85, respectively. The CT in confirmed cases dOR was 5.51 (95% CI: 3.78–8.02). The CT in suspected cases dOR was 13.12 (95% CI: 11.07–15.55).ConclusionOur findings support that CT detection may be the main auxiliary screening method for COVID-19 infection in the real world.

Diabetic nephropathy (DN) causes serious renal tubule and interstitial damage, but effective prevention and treatment measures are lacking. Abnormal mitophagy may be involved in the progression of DN, but its upstream and downstream regulatory mechanisms remain unclear. Melatonin, a pineal hormone associated with circadian rhythms, is involved in regulating mitochondrial homeostasis. Here, we demonstrated abnormal mitophagy in the kidneys of DN mice or high glucose (HG)-treated HK-2 cells, which was accompanied by increased oxidative stress and inflammation. At the same time, the melatonin treatment alleviated kidney damage. After mitochondrial isolation, we found that melatonin promoted AMPK phosphorylation and accelerated the translocation of PINK1 and Parkin to the mitochondria, thereby activating mitophagy, reducing oxidative stress, and inhibiting inflammation. Interestingly, the renal protective effect of melatonin can be partially blocked by downregulation of PINK1 and inhibition of AMPK. Our studies demonstrated for the first time that melatonin plays a protective role in DN through the AMPK-PINK1-mitophagy pathway.

Background Studies investigating chemokines in gestational diabetes mellitus (GDM) have yielded mixed results. The purpose of this meta-analysis was to explore whether concentrations of chemokines in patients with GDM differed from that of the controls. Methods Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically searched Web of Science, Embase, Cochrane Library, and PubMed databases for articles, published in any language, on chemokines and GDM through August 1st, 2021. The difference in concentrations of chemokines between patients with GDM and controls was determined by a standardized mean difference (SMD) with a 95% confidence interval (CI), calculated in the meta-analysis of the eligible studies using a random-effects model with restricted maximum-likelihood estimator. Results Seventeen studies met the inclusion criteria for the meta-analysis. Altogether, they included nine different chemokines comparisons involving 5,158 participants (1,934 GDM patients and 3,224 controls). Results showed a significant increase of these chemokines (CCL2, CXCL1, CXCL8, CXCL9, and CXCL12) in the GDM patients compared with the controls. However, there was a significant decrease of the chemokines, CCL4, CCL11 and CXCL10, in the GDM patients compared with the controls. Moreover, subgroup analysis revealed a potential role of chemokines as biomarkers in relation to laboratory detection (different sample type and assay methods) and clinical characteristics of GDM patients (ethnicity and body mass index). Conclusion GDM is associated with several chemokines (CCL2, CCL4, CCL11, CXCL1, CXCL8, CXCL9, CXCL10 and CXCL12). Therefore, consideration of these chemokines as potential targets or biomarkers in the pathophysiology of GDM development is necessary. Notably, the information of subgroup analysis underscores the importance of exploring putative mechanisms underlying this association, in order to develop new individualized clinical and therapeutic strategies.

Objective:The number of elderly patients on peritoneal dialysis (PD) has rapidly increased in the past few decades. We sought to explore the microbiology and outcomes of peritonitis in elderly PD patients compared with younger PD patients.Methods:We conducted a retrospective study to analyze the clinical characteristics, causative organism distribution, and outcome of all PD patients who developed peritonitis between September 1, 2014 and December 31, 2020, from Second Xiangya Hospital, Central South University, China. Patients who experienced peritonitis were separated into elderly and younger groups. The elderly was defined as ≥ 65 years old at the initiation of PD.Results:Among 1,200 patients, 64(33.9%) in elderly (n = 189) and 215 (21.3%) in younger (n = 1,011) developed at least one episode of peritonitis. A total of 394 episodes of peritonitis occurred in 279 patients. Of these, 88 episodes occurred in 64 elderly patients, and 306 episodes occurred in 215 younger patients. Gram-positive bacteria were the main causative organisms in elderly and younger patients (43.2% and 38.0%, respectively). Staphylococcus and Escherichia coli were the most common gram-positive and gram-negative bacteria, respectively. Fungal peritonitis in elderly patients was higher compared with younger patients (χ2 = 6.55, P = 0.01). Moreover, Acinetobacter baumannii (χ 2=9.25, P = 0.002) and polymicrobial peritonitis (χ 2 = 6.41, P = 0.01) in elderly patients were also significantly higher than that in younger patients. Additionally, elderly PD patients had higher peritonitis-related mortality than younger patients (χ 2 = 12.521, P = 0.000), though there was no significant difference in catheter removal between the two groups. Kaplan-Meier analysis showed that cumulative survival was significantly lower in elderly patients than younger patients (log rank = 7.867, p = 0.005), but similar technical survival in both groups (log rank = 0.036, p = 0.849).Conclusions:This retrospective study demonstrated that elderly PD patients were more likely to develop Acinetobacter baumannii, fungal and polymicrobial peritonitis than younger PD patients. In addition, peritonitis-related mortality was significantly higher in elderly patients, whereas peritonitis-related catheter removal was comparable between elderly and younger PD patients. Understanding microbiology and outcome in elderly patients will help to reduce the incidence of PD-associated peritonitis and improve the quality of life.

BackgroundThe 2019 novel coronavirus (COVID-19) pandemic remains rampant in many countries/regions. Improving the positive detection rate of COVID-19 infection is an important measure for control and prevention of this pandemic. This meta-analysis aims to systematically summarize the current characteristics of the auxiliary screening methods by serology for COVID-19 infection in real world.MethodsWeb of Science, Cochrane Library, Embase, PubMed, CNKI, and Wangfang databases were searched for relevant articles published prior to May 1st, 2022. Data on specificity, sensitivity, positive/negative likelihood ratio, area under curve (AUC), and diagnostic odds ratio (dOR) were calculated purposefully.ResultsSixty-two studies were included with 35,775 participants in the meta-analysis. Among these studies, the pooled estimates for area under the summary receiver operator characteristic of IgG and IgM to predicting COVID-19 diagnosis were 0.974 and 0.928, respectively. The IgG dOR was 209.78 (95% CI: 106.12 to 414.67). The IgM dOR was 78.17 (95% CI: 36.76 to 166.25).ConclusionOur findings support serum-specific antibody detection may be the main auxiliary screening methods for COVID-19 infection in real world.

BackgroundPrevious studies suggested that chemokines may play an important role in the formation and mediation of immune microenvironments of patients affected by Type 1 Diabetes Mellitus (T1DM). The aim of this study was to summarise available evidence on the associations of different chemokines with T1DM. MethodsFollowing PRISMA guidelines, we systematically searched in PubMed, Web of Science, Embase and Cochrane Library databases for studies on the associations of different chemokines with T1DM. The effect size of the associations were the standardized mean differences (SMDs) with corresponding 95% confidence intervals (CIs) of the chemokines concentrations, calculated as group differences between the T1DM patients and the controls. These were summarized using network meta-analysis, which was also used to rank the chemokines by surface under cumulative ranking curve (SUCRA) probabilities. ResultsA total of 32 original studies on the association of different chemokines with T1DM were identified. Fifteen different chemokine nodes were compared between 15,683 T1DM patients and 15,128 controls, and 6 different chemokine receptor nodes were compared between 463 T1DM patients and 460 controls. Circulating samples (blood, serum, and plasma) showed that concentrations of CCL5 and CXCL1 were significantly higher in the T1DM patients than in the controls (SMD of 3.13 and 1.50, respectively). On the other hand, no significant difference in chemokine receptors between T1DM and controls was observed. SUCRA probabilities showed that circulating CCL5 had the highest rank in T1DM among all the chemokines investigated. ConclusionThe results suggest that circulating CCL5 and CXCL1 may be promising novel biomarkers of T1DM. Future research should attempt to replicate these findings in longitudinal studies and explore potential mechanisms underlying this association.

Background: Hyponatremia is one of the most common disorders of electrolytes. Some research studies reported that hyponatremia was closely associated with mortality in patients with dialysis. However, this viewpoint remains controversial. Objective: We aimed to do a systematic review and meta-analysis to assess the influence of hyponatremia on mortality in patients with dialysis. Methods: We identified the eligible studies that investigated the association between hyponatremia and mortality risk in patients under dialysis by searching systematically a series of databases including PubMed, Embase, Cochrane, Web of science, and Ovid from January 2011 to June 2020. Adjusted hazard ratios (HRs) with 95% confidence intervals (95% CIs) were pooled. Results: From 1,116 records identified, 12 studies including prospective and retrospective cohort studies met our inclusion criteria. We found hyponatremia both at baseline (HR: 1.50 and 95% CI: 1.41-1.59) and in time-varying (HR: 1.63 and 95% CI: 1.44-1.84) were significantly correlated to all-cause mortality after multivariable adjusted. By the subgroup analysis, the same results were presented in hemodialysis (HR: 1.48 and 95% CI: 1.38-1.59) or peritoneal dialysis patients (HR: 1.52 and 95% CI: 1.37-1.70). We also observed that lower serum sodium was independently associated with cardiovascular death. Conclusions: Hyponatremia was independently associated with all-cause and cardiovascular mortality, and it might predict adverse outcomes of patients under dialysis.

BackgroundThe micro-inflammatory state is important for the occurrence of diabetic kidney disease (DKD). Here, we aimed to explore the expression of pyroptosis related indicators and ultrastructural characteristics in DKD, and investigate pyroptosis in renal tubular epithelial cells induced by high glucose.MethodsImmunohistochemistry was used to detect expression of the inflammation-related protein NOD-like receptor protein 3 (NLRP3) and pyroptosis key protein gasdermin D (GSDMD) in kidney tissues of DKD patients. HK-2 cells were cultured in vitro and stimulated with different concentrations of glucose. The changes in HK-2 cell ultrastructure were observed using electronmicroscopy, and western blot was used to detect NLRP3, caspase-1 p20, GSDMD-N, interleukin (IL)-1β, and IL-18 expression.ResultsNLRP3 and GSDMD expression in kidney tissues of DKD patients was higher than that in control subjects. Further, GSDMD expression was positively correlated with that of NLRP3 (r = 0.847, P = 0.02). After stimulating HK-2 cells for 24 h with different glucose concentrations, compared with the control group, the 15 and 30 mmol/L glucose groups showed typical ultrastructural changes of pyroptosis. The protein expression of NLRP3, caspase-1 p20, GSDMD-N, IL-1β, and IL-18 expression in high glucose group increased significantly compared with the control group, and was glucose-concentration-dependent.ConclusionHigh glucose can activate inflammasome, cause inflammatory cytokines release, and induce pyroptosis in HK-2 cells. NLRP3-caspase-1 may be involved in GSDMD-mediated pyroptosis. This study shows a novel relationship between glucose concentration and pyroptosis, which can be studied further to design better therapies for patients with DKD.

We read with great interest the recent article by Kim and colleagues in The Journal of Rheumatology on disease flares in patients with systemic lupus erythematosus (SLE) with endstage renal disease (ESRD) on dialysis.1 The authors reached the conclusion that continued follow-up and appropriate therapy, including immunosuppressants, should be considered for patients with SLE receiving dialysis.

Introduction Serum albumin levels at a single time point have been shown to predict mortality in peritoneal dialysis (PD) patients. However, we believe that the dynamic change in albumin after PD may be more significant. In this study, we investigated the relationship between dynamic serum albumin and the clinical outcome of patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Methods The participants in this study enrolled 586 patients who underwent CAPD at the peritoneal dialysis center of Second Xiangya Hospital in China. We retrospectively reviewed medical records from January 1, 2010, to December 31, 2019. Baseline serum albumin (Alb), time-averaged albumin level (TA-ALB) and serum albumin reach rate (SR: defined as the percentage of serum albumin measurements that reached ≥ 35 g/L) were applied as the predictor variables. All-cause mortality and cardiovascular mortality were used as the outcome variables. Hazard function of all-cause mortality and cardiovascular mortality in the study participants were examined by using Cox proportional hazard regression models. Results Age (HR = 1.03, 95% CI 1.00–1.05), cardiovascular disease (HR = 1.80, 95% CI 1.07–3.03) and TA-ALB (HR = 0.92, 95% CI 0.85–0.99) were independent risk factors for all-cause mortality in PD patients. Patients with TA-ALB of <33 g/L (HR = 2.33, 95% CI 1.17–4.62) exhibited a higher risk for all-cause mortality than those with TA-ALB ≥ 36 g/L. Stratified SR showed a similar trend. Patients with a <25% SR exhibited a significantly increased risk for all-cause mortality (HR = 2.72, 95% CI, 1.24–5.96) by fully adjusted analysis. However, neither TA-ALB nor SR were associated with the risk of cardiovascular mortality after adjusted analysis. Conclusion This study demonstrated that age, cardiovascular disease, and TA-ALB were independent risk factors for all-cause mortality in PD patients. TA-ALB and SR can better predict the prognosis of PD patients than baseline Alb. Dynamic changes in Alb are more clinically significant than baseline Alb in predicting mortality risk.

The isolated perfused rat kidney was used to determine whether sex differences in gentamicin nephrotoxicity are related to intrinsic differences in renal response to gentamicin. Acute exposure to gentamicin decreased fractional reabsorption of water and electrolytes without changes in glomerular filtration rate in both sexes. Gentamicin decreased the tubular reabsorption of lysozyme but not glomerular permeability to lysozyme. No sex differences in renal responses were observed following in vitro exposures to gentamicin, suggesting that sex differences in susceptibility to gentamicin in vivo may be attributable to extrarenal factors, such as pharmacokinetics.

Dear Editor,The recent outbreak of coronavirus disease 2019 (COVID-19) in Wuhan, China, caused by the newly identified SARS-CoV-2 has claimed more than 80,000 people in China. This virus has posed a huge threat to the global public health and has affected >60 million people worldwide. Hunan Province of China declared the first level response to public health emergency from 24 January to 10 March 2020. This led to the sudden increase in the hospital burden, and hence, estimating the cost of hemodialysis facility in February 2020 of our center was crucial. We estimated that there was an increase in the cost of in-center hemodialysis facility with disinfection, protective equipment, manpower, and the COVID-19 PCR test for every patient in the center as compared to February 2019. The protective equipment included face masks for every patient, gloves, eye protection (face shields and goggles), and isolation gowns for every dialysis staff. It was estimated that the cost increased 2.57 times than that evaluated in the last year. The environmental disinfection costs were also considered which were also found to be 1.34 times higher than the previous year. Furthermore, there was twice as much health workers required to screen the patients (Fig. 1a). Overall, the human resources and the COVID-19 PCR test accounted for 89% of the total increased cost (Fig. 1b).The human coronaviruses are transmitted mainly by the respiratory route or by contact with the infected person. As patients on hemodialysis are required to visit the hospital frequently, that is, 2–3 times a week, they are highly exposed to the virus and are susceptible to the infection. The COVID-19 outbreak in the hemodialysis center has been reported in severe infectious places [1-3]. In China, a vast number of public health interventions have been imposed to control the epidemic [4]. Due to the closure of public transport, it has created a trouble for the patients to travel to the dialysis center. However, the cost of peritoneal dialysis has not increased, giving a modest relief to the patients. The patients undergoing peritoneal dialysis have their home modality, thus not increasing risk of infection at the dialysis center. In the meantime, the training by physicians and nurses to the patients are ongoing through telephones. To summarize, the home modalities of peritoneal dialysis have overall lowered the maintenance costs during the COVID-19 pandemic. The restriction measures have not significantly affected the ESRD patients on peritoneal dialysis as compared to the patients undergoing hemodialysis at hospital facility.The authors thank all nurses in our hemodialysis center for helping in manuscript preparation.The authors have no conflicts of interest to declare.This work was supported by a research grant (81770714) from the National Natural Science Foundation of China.Conceived and designed the experiments: Hong Liu and Xia Tan. Analyzed the data: Xia Tan, Guochun Chen, Fang Yuan, and Yinghong Liu. Wrote the paper: Xia Tan and Guochun Chen.