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Background: The utilization of ultrapure dialysate has been shown to decrease dialysate contamination and mitigate inflammatory responses. The central dialysate delivery system (CDDS) has the potential to attain a level of purity similar to ultrapure dialysate. Nevertheless, there is limited research examining the impact of CDDS on inflammation in comparison to single-patient dialysis fluid delivery system(SPDDS). This study aims to investigate the effects of CDDS utilizing ultrapure dialysate on ameliorating the microinflammatory state in hemodialysis patients. Method: A retrospective cohort clinical study enrolled a total of 125 hemodialysis patients, with 58 patients from the CDDS unit and 67 patients from the SPDDS unit. Each participant was monitored for a period of 6 months, and the repeated measurement data was analyzed using a generalized linear mixed models (GLMM). Results: The average age of the studty cohort was 56.22 ± 12.64 years. The GLMM analysis showed a significant time*group interaction effect on hs-CRP changes over the follow-up period (β = -1.966, FTime* CDDS group = 13.389, P < 0.001). A linear mixed model analysis with random slope showed that a different slope was observed between CDDS group and SPDDS group (βCDDS =—0.793; βSPDDS = 0.791), indicating a decreased hs-CRP levels in CDDS group, while increased in the SPDDS group over the follow-up period. However, no significant time*group interaction effect were observed on albumin and β2-microglobulin levels during follow-up period(β2-microglobulin: β = -0.658, FTime* CDDS group = 1.228, P = 0.269; albumin: β = 0.012, FTime* CDDS group = 1.429, P = 0.233). Conclusion: Using ultrapure dialysate in the CDDS is associated with an improvement in hs-CRP levels compared to standard dialysate, which might confer long-term clinical advantages. [ABSTRACT FROM AUTHOR]

Objectives: To analyse the elements that influence oral frailty in elderly maintenance hemodialysis patients and to comprehend the present state of this condition. Methods: A survey of 325 elderly maintenance hemodialysis patients from three hospitals in Huzhou City was conducted using a general information questionnaire, the Oral Health Assessment Tool, the Knowledge, Attitude, and Practice of Oral Health Questionnaire, the Social Frailty, the Frail Scale, and the Oral Frailty Index. Results: In elderly maintenance hemodialysis patients, the prevalence of oral frailty was 45.2%. Factors influencing it include the Oral Health Knowledge Score (OR = 0.84, 95% CI 0.72–0.98), Oral Health Behavior Score (OR = 0.95, 95% CI 0.92–0.98), insufficient dialysis (OR = 0.30, 95% CI 0.14–0.63), social frailty (OR = 3.72, 95% CI 1.57–8.83), physical frailty (OR = 3.12, 95% CI 1.55–6.30), number of missing teeth (OR = 1.09, 95% CI 1.03–1.15), swallowing abnormalities (OR = 2.84, 95% CI 1.26–6.38), and oral health scores (OR = 1.34, 95% CI 1.14–1.57) (P < 0.05). Conclusion: Patients on elderly maintenance hemodialysis are more susceptible to oral frailty. Nursing staff should develop scientifically sound, effective, and targeted oral management strategies for these patients. [ABSTRACT FROM AUTHOR]

Background: Skin conditions are common in patients on maintenance hemodialysis and those with pancreatitis. However, there is a lack of research on dermatological issues in patients who have both hemodialysis and pancreatitis concurrently. Case presentation: A 62-year-old male patient with a 4-year history of maintenance hemodialysis (MHD) presented with pain and was diagnosed with acute pancreatitis and gallbladder stones. Markedly elevated blood amylase, creatine kinase, and myoglobin were noted, alongside a purplish-red skin discoloration. Treatment included inhibition of digestive fluid secretion, anti-infection measures, blood purification, fasting, rehydration, and symptomatic care. Notably, continuous renal replacement therapy (CRRT) combined with hemoperfusion (HP) was employed. The patient's dialysis effluent initially appeared red. Upon examination of the patient's peripheral blood smear, red blood cell debris was not observed. The dialysis effluent (on Day 0) was analyzed, revealing no hemoglobin (0 g/L) but an elevated myoglobin concentration of 80.4 U/L. After the therapeutic intervention, the indicators, including the blood amylase, C-reactive protein, total bilirubin, creatine kinase, and myoglobin were improved. The patient experienced resolution of sternal and upper abdominal pain within two days. After four consecutive days of CRRT and HP treatment, the skin color returned to normal, alongside improved clarity of the dialysis effluent. Subsequently, the patient's method of blood purification was reverted to conventional hemodialysis. On the eighth day of hospitalization, the patient resumed normal diet and was discharged. Conclusions: In the case of the current patient with acute pancreatitis undergoing MHD, it is noteworthy to report the observation of a unique purplish-red skin discoloration. This phenomenon may be attributable to inflammation resulting from acute pancreatitis, and the retention of myoglobin within the body. [ABSTRACT FROM AUTHOR]

Objective To analyze the status quo and related influencing factors of suicidal ideation in maintenance hemodialysis (MHD) patients with uremia. Methods A total of 119 patients with maintenance hemodialysis uremia admitted to the hospital from September 2020 to October 2022 were selected. The Self-rating Idea of Suicide Scale was used to evaluate whether the patients had suicidal ideation. The relevant data of the patients were investigated and the possible influencing factors were included. Logistics regression model was used to analyze the related influencing factors of suicidal ideation. Results Among the 119 patients, 24 (20.17%) had suicidal ideation. Education level of junior high school and below, dialysis time greater than or equal to five years, poor psychological resilience, poor psychological status, and low social support were the influencing factors of suicidal ideation in patients with maintenance hemodialysis uremia, and the difference was statistically significant (OR 1,P<0.05). Conclusion The suicidal ideation of uremic patients with maintenance hemodialysis is higher. Education level, dialysis time, psychological resilience, poor psychological status and social support are the influencing factors of suicidal ideation. [ABSTRACT FROM AUTHOR]

Background: Patients on maintenance hemodialysis (MHD) have been disproportionately affected by COVID-19. Identifying factors associated with disease severity and viral clearance times can inform better clinical management for this high-risk group. Methods: We retrospectively analyzed clinical and hematological data from 85 COVID-19 positive MHD patients. Disease severity was classified as non-severe (mild/moderate) or severe (severe/critical). Logistic regression was used to evaluate factors associated with disease severity. The time to viral clearance was assessed and correlated with clinical variables. Results: Cardiovascular disease (OR=11.19, 95% CI 2.35–53.38), neutrophilia (OR=1.24, 95% CI 1.01–1.53), and elevated inflammatory markers (procalcitonin and white blood cell count) were independent predictors of severe COVID-19. A prognostic model incorporating these factors showed good discrimination for severity risk (AUC=0.835). The median time to viral clearance was 19 days. Delayed clearance was associated with higher levels of C-reactive protein, troponin, and N-terminal pro-B-type natriuretic peptide. Conclusions: We identified key prognostic factors for COVID-19 severity and characterized the time to viral clearance in MHD patients. These findings can aid in risk stratification and optimize management for this vulnerable population. Further research through multicenter collaborative studies is warranted to validate these results. [ABSTRACT FROM AUTHOR]

Objective: Maintenance hemodialysis (MHD) patients suffer from enormous physical, mental stress and poor quality of life, so an increasing number of patients are in a long-term state of depression. A prominent feature of MHD patients is chronic persistent inflammation, which is also an important mechanism for the onset of depression. Therefore, finding economically convenient inflammatory markers to predict and diagnose the onset of depression in MHD patients is of great value. As a novel inflammatory marker, systemic immune inflammation index (SII) can more comprehensively reflect the inflammation and immunity level of patients. This study aims to explore the relationship between SII and depressive symptoms in MHD patients. Methods: A cross-sectional studywas conducted on 206MHD patients fromthree dialysis centers. Based on the Hospital Anxiety and Depression Scale (HADS) scores, patients were divided into non-depression and depression groups. Inter group comparison and multivariate logistic regression analysis were performed to determinewhether SII is an independent risk factor for depression inMHD patients. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of SII on depression symptoms in MHD patients. Results: According to the HADS scale score, 38.83% of the included patients were in a state of depression. After adjusting for all confounding factors, MHD patients with SII>963.93 had a 4.709 times higher risk of depression than those with SII = 478.32 (OR=4.709, 95% CI 1.821-12.178, P<0.01). ROC analysis showed that SII>685.11 was the best cutoff value for MHD depression patients, and the area under the curve (AUC) was 0.681. Conclusions: High SII is an independent risk factor for depressed MHD patients and an ideal inflammatory marker for predicting and identifying depression in MHD patients as assessed by the HADS scale. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Results Conclusions The purpose of this study is to investigate the prevalence and risk factor of cognitive frailty in patients undergoing maintenance hemodialysis.Systematically searched PubMed, EmBase, Web of Science, Cochrane Library, SinoMed, China Knowledge Resource Integrated Database, Wanfang Database, and Weipu Database from inception until January 1, 2024. Two researchers were independently screened and cross‐checked. Stata 15.1 software was used to perform the meta‐analysis.A total of 15 articles were included, including 5398 patients. The results showed that the prevalence of cognitive frailty in patients undergoing maintenance hemodialysis was 24%. Among them, age (odds ratio [OR] = 1.33, 95% CI [1.16, 1.53]), waist circumference (OR = 1.05, 95% CI [1.03, 1.08]), malnutrition (OR = 2.91, 95% CI [1.94, 4.35]), comorbidities (OR = 1.93, 95% CI [1.47, 2.54]), stroke history (OR = 2.94, 95% CI [1.72, 5.03]), and depression (OR = 3.26, 95% CI [1.91, 5.57]) were the main risk factors for cognitive frailty in patients undergoing maintenance hemodialysis. Education level (OR = 0.48, 95% CI [0.31, 0.73]) was protective factors for cognitive frailty in patients undergoing maintenance hemodialysis.Current evidence showed that the prevalence of cognitive frailty in patients undergoing maintenance hemodialysis was high, and there were many risk factors. Therefore, early identification and intervention of cognitive frailty in maintenance hemodialysis patients should be carried out, which may be helpful to reduce the prevalence rate and occurrence of adverse events and improve the prognosis of patients. [ABSTRACT FROM AUTHOR]

Background: Serum lipoprotein(a) [Lp(a)] is an independent risk factor for atherosclerotic cardiovascular disease (ASCVD) in the general population, its association with ASCVD incidence in Chinese maintenance hemodialysis (MHD) patients remains unclear. We aimed to evaluate the relationship between Lp(a) levels and ASCVD incidence among MHD patients in Beijing, China. Methods: This retrospective, observational cohort study included MHD patients at Beijing Tongren Hospital from January 1, 2013 to December 1, 2020, and followed until December 1,2023. The primary outcome was ASCVD occurrence. Kaplan-Meier survival analysis was used to evaluate ASCVD-free survival in MHD patients, with stratification based on Lp(a) levels. Cox regression analyses were conducted to assess the association between Lp(a) levels and the occurrence of ASCVD. Results: A total of 265 patients were enrolled in the study. The median follow-up period were 71 months.78 (29.4%) participants experienced ASCVD events, and 118 (47%) patients died, with 58 (49.1%) deaths attributed to ASCVD. Spearman rank correlation analyses revealed positive correlations between serum Lp(a) levels and LDL-c levels, and negative correlations with hemoglobin, triglyceride, serum iron, serum creatinine, and albumin levels. Multivariate Cox regression analysis showed that Lp(a) levels ≥ 30 mg/L, increased age, decreased serum albumin levels, and a history of diabetes mellitus were significantly associated with ASCVD incidence. Conclusions: This study demonstrated an independent and positive association between serum Lp(a) levels and the risk of ASCVD in MHD patients, suggesting that serum Lp(a) could potentially serve as a clinical biomarker for estimating ASCVD risk in this population. [ABSTRACT FROM AUTHOR]

The current research focuses on the effects of nutritional supplementation and exercise on dialysis patients, but whether physical activity (PA) can reduce the risk of adverse outcomes for patients with different nutritional status is not clear. The maintenance hemodialysis (MHD) patients were recruited from April 2021 to April 2022. The information of PA was obtained from the international physical activity questionnaire (IPAQ). The outcomes were cardiovascular death, myocardial infarction, stroke, heart failure, atrial fibrillation, tumor and all-cause death. We used COX proportional risk model to estimate the association between PA and the outcomes of MHD patients. Patients are classified into two groups based on geriatric nutritional risk index (GNRI) and classified by age, and we used COX proportional risk model to estimate the association of PA and outcomes in subgroups. The isotemporal substitution model (ISM) was used to estimate the effects of replacing light physical activity (LPA) with moderate physical activity (MPA) or vigorous physical activity (VPA) on risk of cardiovascular events, tumors, and all-cause death in different subgroups. The effects of PA on ankle-brachial index (ABI) and body fat content were analyzed in different IPAQ groups. A total of 241 maintenance hemodialysis patients were included, 105 peoples developed cardiovascular death, myocardial infarction, stroke, heart failure, atrial fibrillation, tumor and all-cause death (43.6%). The median follow-up time was 12 months. MPA reduced the risk of outcome in MHD patients or high GNRI patients (40% vs 39%).In MHD patients who was under 65 years with high GNRI, MPA reduced cardiovascular death, myocardial infarction, stroke, heart failure, atrial fibrillation, tumor and all-cause death by 55%.PA reduced the risk of cardiovascular event by 65%, but did not reduce the risk of tumor or all-cause death. Replacing LPA with VPA did not improve clinical outcomes. It actually increases the risk of heart failure 0.4%. MPA reduced the risk of cardiovascular death, myocardial infarction, stroke, heart failure, atrial fibrillation, tumor, all-cause death in MHD patients under 65 years, while VPA had no health benefit. Trial registration: ChiCTR210050998. [ABSTRACT FROM AUTHOR]

Background: Regional anticoagulation in hemodialysis avoids the use of heparin, which is responsible for both hemorrhagic and non‐hemorrhagic complications. Typically, blood is decalcified by injecting citrate into the arterial line of the extracorporeal circuit. Calcium‐free dialysate improves anticoagulation efficacy but requires injection of a calcium‐containing solution into the venous line and strict monitoring of blood calcium levels. Recent improvements have made regional anticoagulation with calcium‐free dialysate safer and easier. Observations: (1) Adjusting the calcium injection rate to ionic dialysance avoids the risk of dyscalcemia, thus making unnecessary the monitoring of blood calcium levels. This adjustment could be carried out automatically by the hemodialysis monitor. (2) As calcium‐free dialysate reduces the amount of citrate required, this can be supplied by dialysate obtained from currently available concentrates containing citric acid. This avoids the need for citrate injection and the risk of citrate overload. (3) Calcium‐free dialysate no longer needs the dialysate acidification required for avoiding calcium carbonate precipitation in bicarbonate‐containing dialysate. Conclusions: Regional anticoagulation with calcium‐free dialysate enables an acid‐ and heparin‐free procedure that is more biocompatible and environmentally friendly than conventional bicarbonate hemodialysis. The availability of specific acid‐free concentrates and adapted hemodialysis monitors is required to extend this procedure to maintenance hemodialysis. [ABSTRACT FROM AUTHOR]

Background Lack of evaluations of the dietary phosphorus and dialysis phosphorus removal in daily clinical practice are common obstacles to assessing phosphorus balance and controlling phosphorus in hemodialysis patients. We aimed to investigate whether individualized therapy using a phosphorus balance calculator improves phosphorus control. Methods A randomized, open-label, multicenter, 4-week clinical trial was conducted. A total of 119 maintenance hemodialysis patients aged 18–85 years old and with serum phosphorus level >1.45 mmol/L from three university teaching hospitals in Shanghai were enrolled. Patients were randomized in a 1:1 ratio to individualized therapy (n  = 60) or conventional therapy (n  = 59). The primary outcome was the serum phosphorus concentration after 4-week treatment. Secondary outcomes included the serum calcium and parathyroid hormone (PTH) concentrations, changes in serum phosphorus, calcium and PTH concentrations, and the proportion of patients achieving target ranges of serum phosphorus, calcium and PTH after 4-week treatment. Results Among 119 randomized participants [mean age 62 years; 68 male (57%)], 116 completed the trial. Using the phosphorus balance calculator, the individualized group achieved a better phosphorus balance state and significantly reduced serum phosphorus (1.62 ± 0.45 mmol/L versus 1.85 ± 0.45 mmol/L, P  = .006), increased the proportions of patients achieving target serum phosphorus range (41% versus 18%, P  = .006) and had greater adjusted mean difference in change in serum phosphorus over the 4 weeks (−0.47 versus −0.23 mmol/L, P  = .010) when compared with conventional therapy. No significant changes were observed in serum calcium and PTH levels, the proportion of patients achieving target serum calcium or PTH levels, or the adjusted mean difference of serum calcium and PTH levels over the treatment period. Conclusion Phosphorus balance calculator was proved to improve serum phosphorus control in patients undergoing maintenance hemodialysis, offering a new tool for managing hyperphosphatemia. [ABSTRACT FROM AUTHOR]

To investigate current status of quality of life and the association between depression and symptom burden in a sample of Chinese maintenance hemodialysis (MHD) patients. Methods: A self-designed patient general information questionnaire, disease-related information questionnaire, dialysis patient symptom burden scale, depression scale, and quality of survival scale were used to investigate 380 maintenance haemodialysis patients in haemodialysis centres. A regression model of the factors affecting the quality of survival was established using structural equation modelling. Results: The regression model data had a high goodness of fit: c2/df = 4.736, RMSEA = 0.099, GFI = 0.918, CFI = 0.972, TLI = 0.962, SRMR = 0.0469. Structural equation model analysis showed that depression had a positive predictive effect on symptom burden, β = 0.398, P < 0.001; Symptom burden had a negative predictive effect on the quality of life, β =− 0.851, P < 0.001; and Depression had a negative predictive effect on the quality of life, β =− 0.151, P < 0.001. Depression indirectly affects the quality of life through symptom burdens. Conclusion: Depression and symptom burden directly or indirectly affect the quality of life in patients with maintenance hemodialysis. Symptom burden moderates the relationship between depression and quality of life as a mediating variable. [ABSTRACT FROM AUTHOR]

Objective: To explore the influencing factors of concurrent skin pruritus in maintenance hemodialysis patients and its correlation with serum inflammatory factors in β2-MG. Methods: 100 maintenance hemodialysis patients from our hospital from January 2019 to December 2023, compared with general data and laboratory indicators of patients with and without pruritus, and statistically significant indicators for Logistic-analysis. The scores of pruritus patients were evaluated according to the 5D-IS scale, and the pruritus patients were divided into mild, moderate and severe groups according to the scores, and the serum inflammatory factors and β2-MG levels of the three groups were compared. The therapeutic effect of pregabalin was analyzed, and the serum levels of β2-MG, CRP, TNF-α and IL-6 in the effective and ineffective groups were compared before and after treatment. Results: In the itching group, age, blood creatinine level, dialysis age, calcium and phosphorus product, blood phosphorus level, parathyroid hormone level, dry skin disease, serum β2-MG, CRP, TNF-α, and IL-6 levels were significantly higher than in the no itching group, while SF level and Kt / V 1.2 proportion were significantly lower than in the no itching group(P<0.05). Binary Logistic regression analysis found that The risk factors of maintenance hemodialysis complicated with itching were age≥60 years, dialysis duration≥1 year, calcium-phosphorus product ≥65 (mg²/dl²), Kt/V<1.2, parathyroid hormone level ≥300 pg/mL, dry skin disease, serum β2-MG≥4.06 mg/L, serum CRP≥10 mg/L, and serum TNF-α≥1.54 ng/mL, serum IL-6≥0.46 ng/L (P<0.05). Among 45 patients with maintenance hemodialysis complicated with pruritus, 28 cases were mild, 10 cases were moderate, and 7 cases were severe. Serum levels of β2-MG, CRP, TNF-α and IL-6 in severe group were higher than those in mild and moderate groups, and the above indexes in moderate group were higher than those in mild group (all P<0.05). Among 45 patients with pruritus caused by maintenance hemodialysis, 15 cases had complete remission, 10 cases had obvious effect, 10 cases were effective, and 10 cases were ineffective. After treatment, the levels of serum β2-MG, CRP, TNF-α and IL-6 in the effective group were lower than those before treatment(P<0.05). There was no significance in the ineffective group before and after treatment (P>0.05). After treatment, the above indexes in effective group were lower than those in ineffective group (P<0.05). Conclusion: The risk factors for pruritosis in maintenance hemodialysis patients included age≥60 years, dialysis duration≥1 year, calcium-phosphorus product≥65 (mg²/dl²), Kt/V<1.2, parathyroid hormone level ≥300 pg/mL, dry skin disease, serum β2-MG≥4.06 mg/L, serum CRP≥10 mg/L Serum TNF-α≥1.54 ng/mL, serum IL-6≥0.46 ng/L, serum CRP, TNF-α, IL-6 and β2-MG were correlated with the severity and prognosis of skin itching complicated by maintenance hemodialysis patients. [ABSTRACT FROM AUTHOR]

Abstract Objectives To analyse the elements that influence oral frailty in elderly maintenance hemodialysis patients and to comprehend the present state of this condition. Methods A survey of 325 elderly maintenance hemodialysis patients from three hospitals in Huzhou City was conducted using a general information questionnaire, the Oral Health Assessment Tool, the Knowledge, Attitude, and Practice of Oral Health Questionnaire, the Social Frailty, the Frail Scale, and the Oral Frailty Index. Results In elderly maintenance hemodialysis patients, the prevalence of oral frailty was 45.2%. Factors influencing it include the Oral Health Knowledge Score (OR = 0.84, 95% CI 0.72–0.98), Oral Health Behavior Score (OR = 0.95, 95% CI 0.92–0.98), insufficient dialysis (OR = 0.30, 95% CI 0.14–0.63), social frailty (OR = 3.72, 95% CI 1.57–8.83), physical frailty (OR = 3.12, 95% CI 1.55–6.30), number of missing teeth (OR = 1.09, 95% CI 1.03–1.15), swallowing abnormalities (OR = 2.84, 95% CI 1.26–6.38), and oral health scores (OR = 1.34, 95% CI 1.14–1.57) (P

Abstract Background Skin conditions are common in patients on maintenance hemodialysis and those with pancreatitis. However, there is a lack of research on dermatological issues in patients who have both hemodialysis and pancreatitis concurrently. Case presentation A 62-year-old male patient with a 4-year history of maintenance hemodialysis (MHD) presented with pain and was diagnosed with acute pancreatitis and gallbladder stones. Markedly elevated blood amylase, creatine kinase, and myoglobin were noted, alongside a purplish-red skin discoloration. Treatment included inhibition of digestive fluid secretion, anti-infection measures, blood purification, fasting, rehydration, and symptomatic care. Notably, continuous renal replacement therapy (CRRT) combined with hemoperfusion (HP) was employed. The patient’s dialysis effluent initially appeared red. Upon examination of the patient’s peripheral blood smear, red blood cell debris was not observed. The dialysis effluent (on Day 0) was analyzed, revealing no hemoglobin (0 g/L) but an elevated myoglobin concentration of 80.4 U/L. After the therapeutic intervention, the indicators, including the blood amylase, C-reactive protein, total bilirubin, creatine kinase, and myoglobin were improved. The patient experienced resolution of sternal and upper abdominal pain within two days. After four consecutive days of CRRT and HP treatment, the skin color returned to normal, alongside improved clarity of the dialysis effluent. Subsequently, the patient’s method of blood purification was reverted to conventional hemodialysis. On the eighth day of hospitalization, the patient resumed normal diet and was discharged. Conclusions In the case of the current patient with acute pancreatitis undergoing MHD, it is noteworthy to report the observation of a unique purplish-red skin discoloration. This phenomenon may be attributable to inflammation resulting from acute pancreatitis, and the retention of myoglobin within the body.

Xinyuan Zhou,1,2,&ast; Fuxiang Zhu3,&ast; 1Department of Nephrology, the First People’s Hospital of Pinghu, Jiaxing, Zhejiang, People’s Republic of China; 2Jiaxing University Master Degree Cultivation Base, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China; 3Department of Nephrology, Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing, Zhejiang, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Fuxiang Zhu, Department of Nephrology, Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing, Zhejiang, People’s Republic of China, Email zfxywh@163.comPurpose: Depression is a major concern in maintenance hemodialysis. However, given the elusive nature of its risk factors and the redundant nature of existing assessment forms for judging depression, further research is necessary. Therefore, this study was devoted to exploring the risk factors for depression in maintenance hemodialysis patients and to developing and validating a predictive model for assessing depression in maintenance hemodialysis patients.Patients and Methods: This cross-sectional study was conducted from May 2022 to December 2022, and we recruited maintenance hemodialysis patients from a multicentre hemodialysis centre. Risk factors were identified by Lasso regression analysis and a Nomogram model was developed to predict depressed patients on maintenance hemodialysis. The predictive accuracy of the model was assessed by ROC curves, area under the ROC (AUC), consistency index (C-index), and calibration curves, and its applicability in clinical practice was evaluated using decision curves (DCA).Results: A total of 175 maintenance hemodialysis patients were included in this study, and cases were randomised into a training set of 148 and a validation set of 27 (split ratio 8.5:1.5), with a depression prevalence of 29.1%. Based on age, employment, albumin, and blood uric acid, a predictive map of depression was created, and in the training set, the nomogram had an AUC of 0.7918, a sensitivity of 61.9%, and a specificity of 89.2%. In the validation set, the nomogram had an AUC of 0.810, a sensitivity of 100%, and a specificity of 61.1%. The bootstrap-based internal validation showed a c-index of 0.792, while the calibration curve showed a strong correlation between actual and predicted depression risk. Decision curve analysis (DCA) results indicated that the predictive model was clinically useful.Conclusion: The nomogram constructed in this study can be used to identify depression conditions in vulnerable groups quickly, practically and reliably.Keywords: nomogram, depression, maintenance hemodialysis, risk factors, prediction

Background Maintenance hemodialysis (MHD) patients have a high incidence of silent brain infarction (SBI) and are in the preclinical stage of symptomatic stroke and vascular dementia. Therefore, there is a great need to explore the risk of SBI in patients with MHD for early detection and reduction of poor prognosis. Objective To explore the risk factors for the occurrence of SBI in MHD patients, a predictive model was constructed and its performance was evaluated. Methods 486 MHD patients from 4 centers (Nanchong Central Hospital Affiliated to North Sichuan Medical College, Guangyuan Central Hospital, Suining Central Hospital, and Pengan County People's Hospital) from January 2017 to October 2022 were included. Patients with MHD were divided into an SBI group (n=102) and a non-SBI group (n=384) using the presence or absence of SBI as the outcome event, and the baseline characteristics of the two study groups were compared. Patients were randomized in a 7∶3 ratio to the modeling set (n=340) and the validation set (n=146). The predictor variables were identified through LASSO regression and multifactorial Logistic regression analyses, and a risk prediction model for the occurrence of SBI in patients with MHD was constructed and presented as a nomographic chart. The predictive performance, accuracy, and clinical utility of the model were evaluated using area under the ROC curve, calibration curve, and decision curve analysis. Results In the modeling set, 70 cases (20.6%) of MHD patients experienced SBI, while in the validation set, 32 cases (21.9%) of patients experienced SBI. The results of LASSO regression combined with multifactor logistic regression analysis showed that age (OR=1.027, 95%CI=1.005-1.050), history of alcohol consumption (OR=4.487, 95%CI=2.075-9.706), BMI (OR=1.082, 95%CI=1.011-1.156), insufficient sleep or excessive sleep (OR=6.286, 95%CI=3.560-11.282), history of chronic disease (chronic obstructive pulmonary disease, diabetes, chronic hepatitis B) (OR=1.873, 95%CI=1.067-3.347), serum lactate level (OR=1.452, 95%CI=1.152-1.897), urea reduction ratio (URR) (OR=0.922, 95%CI=0.875-0.970), and history of antiplatelet medication (OR=0.149, 95%CI=0.030-0.490) were independent influences on the occurrence of SBI in MHD patients (P

ObjectiveTo construct an early warning model of maintenance hemodialysis （MHD） capacity overload based upon basic dialysis data, ultrasound and routine blood biochemistry and examine its clinical effectiveness. Methods From January 2023 to December 2023, 603 patients on MHD were retrospectively reviewed. They were assigned into two sets of modeling （n = 402） and validation （n = 201） according to a ratio of 2:1. The relevant clinical were collected. And the influencing factors of MHD capacity overload in modeling set were analyzed by univariate and LASSO-Logistic regression. The risk prediction nomogram model was constructed. And consistency index, calibration curve, receiver operating characteristic （ROC） curve and decision curve were utilized for verifying the prediction model internally and externally. Results Serum albumin, Kt/V, RRF and left ventricular ejection fraction （LVEF） in overload group were lower than those in normal group. NT-proBNP, ultrasonic lung B-line and right atrial diameter were higher than those in normal group （P＜0.05）. LASSO results indicated that serum albumin, Kt/V, RRF, LVEF, NT-proBNP, ultrasonic lung B-line and right atrial internal diameter were Top 7 characteristic variables of volume overload in MHD. Logistic regression results revealed that Kt/V, serum albumin, RRF and LVEF were the protective factors for MHD volume overload. And NT-proBNP, ultrasonic lung B-line and right atrial diameter were the risk factors for MHD volume overload （P＜0.05）. The risk prediction nomogram model of capacity overload was constructed according to the influencing factors of Logistic regression. Consistency index in modeling and validation sets was 0.860 and 0.814, respectively. Calibration curve showed that the incidence of MHD capacity overload predicted by the model in modeling and validation sets was basically consistent with the actual incidence. ROC curve indicated that the area under the curve as predicted by the model in modeling and validation sets was 0.917（95%CI: 0.886-0.948） and 0.916（95%CI: 0.869-0.962）. Decision curve revealed that when the high-risk threshold of modeling set was 0-0.7 and the high risk threshold of validation set 0-0.7. The model had an excellent clinical net benefit. Conclusion In MHD patients, the occurrence of volume overload is affected by serum albumin, Kt/V, RRF, LVEF, NT-proBNP, ultrasonic lung B-line and right atrial diameter. The early warning model built according to the factors related to volume overload has excellent predictive capability and clinical benefit.

Objective To explore the changes in serum levels of growth differentiation factor 11 （GDF11） and cell division cycle 42 （Cdc42） in maintenance hemodialysis （MHD） elders and examine their correlations with events and occurrence of major adverse cardiovascular events （MACE）. Methods From June 2019 to June 2021, 164 MHD elders were selected as observation subjects （hemodialysis group） while 150 ESRD elders undergoing no hemodialysis during the same period as non-hemodialysis group. And 148 healthy elders receiving physical examinations were designated as control group. According to whether or not MACE occurred within 2 years, they were assigned into two groups of non-MACE （n = 92） and MACE （n = 72）. Enzyme-linked immunosorbent assay （ELISA） was utilized for determining serum levels of GDF11 and Cdc42. Multivariate Logistic regression was applied for examining the influencing factors of 2-year MACE and receiver operating characteristic （ROC） curve for determining the predictive value of GDF11 and Cdc42 levels for MACE. Results As compared with control, non-hemodialysis and hemodialysis groups, serum level of GDF11 [（640.38 ± 137.55）vs（851.56 ± 215.61），（785.27 ± 174.62）μg/L]declined obviously in hemodialysis group （t = 10.414, P＜0.001） while Cdc42 level rose sharply [（57.22 ± 11.34） vs （35.61 ± 10.25）, （43.58 ± 10.72） μg/L] （t = 17.589, P＜0.001）. Cdc42 levels [（65.31 ± 21.22） vs （50.89 ± 15.56） μg/L] were obviously higher in MACE group than those in non-MACE group. GDF11 level [（576.56 ± 125.71） vs （690.33 ± 159.84） μg/L] was obviously lower than that in non-MACE group and the differences were statistically significant （P＜0.05）. AUC of GDF11/Cdc42 level and their combined prediction for MACE was 0.762, 0.794 and 0.868 respectively. The value of combined prediction was better than that of individual prediction （Z = 3.183, 3.047; P = 0.002, 0.002）. Conclusion In MHD elders, lower serum level of GDF11 and higher level of Cdc42 are correlated closely with the occurrence of MACE. GDF11 and Cdc42 may be used as markers for managing and assessing ESRD MHD elders.

Abstract Background Serum lipoprotein(a) [Lp(a)] is an independent risk factor for atherosclerotic cardiovascular disease (ASCVD) in the general population, its association with ASCVD incidence in Chinese maintenance hemodialysis (MHD) patients remains unclear. We aimed to evaluate the relationship between Lp(a) levels and ASCVD incidence among MHD patients in Beijing, China. Methods This retrospective, observational cohort study included MHD patients at Beijing Tongren Hospital from January 1, 2013 to December 1, 2020, and followed until December 1,2023. The primary outcome was ASCVD occurrence. Kaplan-Meier survival analysis was used to evaluate ASCVD-free survival in MHD patients, with stratification based on Lp(a) levels. Cox regression analyses were conducted to assess the association between Lp(a) levels and the occurrence of ASCVD. Results A total of 265 patients were enrolled in the study. The median follow-up period were 71 months.78 (29.4%) participants experienced ASCVD events, and 118 (47%) patients died, with 58 (49.1%) deaths attributed to ASCVD. Spearman rank correlation analyses revealed positive correlations between serum Lp(a) levels and LDL-c levels, and negative correlations with hemoglobin, triglyceride, serum iron, serum creatinine, and albumin levels. Multivariate Cox regression analysis showed that Lp(a) levels ≥ 30 mg/L, increased age, decreased serum albumin levels, and a history of diabetes mellitus were significantly associated with ASCVD incidence. Conclusions This study demonstrated an independent and positive association between serum Lp(a) levels and the risk of ASCVD in MHD patients, suggesting that serum Lp(a) could potentially serve as a clinical biomarker for estimating ASCVD risk in this population.

Yong-Yao Wu,1,&ast; Jun-Yuan Li,1,&ast; Qiao-Jing Xia,1 Yi-Yi Gao,1 Chao Zhang,1 Peng-Jie Xu,1 Jiang Liu,1 Hao-Jie Zhang,1 Ri-Zhen Yu2 1Department of Nephrology, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang Province, 315099, People’s Republic of China; 2Urology & Nephrology Center, Department of Nephrology, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang Province, 310014, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Hao-Jie Zhang, Department of Nephrology, Ningbo Medical Center Lihuili Hospital, No. 1111 Jiangnan Road, Yinzhou District, Ningbo City, Zhejiang Province, 315099, People’s Republic of China, Email zhang_haojie843@outlook.com Ri-Zhen Yu, Urology & Nephrology Center, Department of Nephrology, Affiliated People’s Hospital, Hangzhou Medical College, No. 158 Shangtang Road, Gongshu District, Hangzhou, Zhejiang, 310014, People’s Republic of China, Tel +86 571-85893889, Fax +86 571-85131448, Email rizhen_3180yu83@126.comObjective: Sarcopenia is more common in maintenance hemodialysis (MHD) patients, and the aim of this study is to analyze the risk factors associated with sarcopenia in MHD patients, along with its correlation to emotional status and quality of life.Methods: This is a cross-sectional cohort study. A total of 111 MHD patients who were treated in the Department of Nephrology of our hospital were selected as the study subjects by convenience sampling. The quality of life and emotional status were evaluated by health survey scale (SF-36), self-rating anxiety scale (SAS) and self-rating depression scale (SDS). Regression analysis was used to explore the influencing factors of sarcopenia. Correlation analysis was used to investigate the correlation between sarcopenia and quality of life and emotional status.Results: The prevalence of sarcopenia was 59.8%. The results showed that age, gender, body mass index (BMI), dialysis time, economic status, marital status and pre-dialysis creatinine were significant factors affecting the development of sarcopenia in hemodialysis patients (p< 0.05). The SF-36 total score was significantly lower in the sarcopenia group (72.05± 12.28 vs 78.03± 10.55) than in the non-sarcopenia group, but the anxiety scale score (52.97± 4.67 vs 36.2± 3.36) and depression scale score (57.67± 4.58 vs 38.71± 3.77) were significantly higher than those in the non-sarcopenia group (p< 0.001). Correlation analysis showed that sarcopenia was positively correlated with SAS and SDS scores and negatively correlated with SF-36 total score (p < 0.05).Conclusion: The risk of sarcopenia was higher among MHD patients who were older, male, single, with a longer MHD duration, lower economic status, lower BMI, comorbid diabetes and lower levels of creatinine.Keywords: maintenance hemodialysis, sarcopenia, quality of life, risk factors, cross-sectional studies

Abstract The current research focuses on the effects of nutritional supplementation and exercise on dialysis patients, but whether physical activity (PA) can reduce the risk of adverse outcomes for patients with different nutritional status is not clear. The maintenance hemodialysis (MHD) patients were recruited from April 2021 to April 2022. The information of PA was obtained from the international physical activity questionnaire (IPAQ). The outcomes were cardiovascular death, myocardial infarction, stroke, heart failure, atrial fibrillation, tumor and all-cause death. We used COX proportional risk model to estimate the association between PA and the outcomes of MHD patients. Patients are classified into two groups based on geriatric nutritional risk index (GNRI) and classified by age, and we used COX proportional risk model to estimate the association of PA and outcomes in subgroups. The isotemporal substitution model (ISM) was used to estimate the effects of replacing light physical activity (LPA) with moderate physical activity (MPA) or vigorous physical activity (VPA) on risk of cardiovascular events, tumors, and all-cause death in different subgroups. The effects of PA on ankle-brachial index (ABI) and body fat content were analyzed in different IPAQ groups. A total of 241 maintenance hemodialysis patients were included, 105 peoples developed cardiovascular death, myocardial infarction, stroke, heart failure, atrial fibrillation, tumor and all-cause death (43.6%). The median follow-up time was 12 months. MPA reduced the risk of outcome in MHD patients or high GNRI patients (40% vs 39%).In MHD patients who was under 65 years with high GNRI, MPA reduced cardiovascular death, myocardial infarction, stroke, heart failure, atrial fibrillation, tumor and all-cause death by 55%.PA reduced the risk of cardiovascular event by 65%, but did not reduce the risk of tumor or all-cause death. Replacing LPA with VPA did not improve clinical outcomes. It actually increases the risk of heart failure 0.4%. MPA reduced the risk of cardiovascular death, myocardial infarction, stroke, heart failure, atrial fibrillation, tumor, all-cause death in MHD patients under 65 years, while VPA had no health benefit. Trial registration: ChiCTR210050998.

Plasma homocysteine (Hcy) is an amino acid causing vascular injury. It is closely associated with endothelial cell injury, vascular smooth muscle proliferation, inflammatory responses, thrombosis and vascular calcification. An elevated level of Hcy may affect normal function of renal vasculature and glomeruli, thereby accelerating the progression of chronic kidney disease to end-stage renal disease. In maintenance hemodialysis (MHD) patients, the incidence of hyperhomocysteinemia (HHcy) is 33 folds that of normal individuals so that it becomes a common yet complex health issue. For accurately identifying HHcy and improving patient prognosis, this review summarized the common causes of HHcy in MHD patients and introduced various preventive and therapeutic measures.

Background Chronic kidney disease has become a major global concern, and the prevalence of kidney disease in China is the highest in the world. About 89.5% of patients require hemodialysis. In recent years, the prevalence of frailty in maintenance hemodialysis (MHD) patients has risen significantly, seriously affecting the quality of life and prognosis of patients. Objective To explore the prevalence of frailty and the influencing factors of maintenance hemodialysis patients in China through Meta-analysis. Methods Cross-sectional and cohort studies on the prevalence and influencing factors of frailty in Chinese MHD patients were systematically searched in CNKI, VIP, CBM, Wanfang Data, Web of Science, PubMed, Cochrane Library, Embase, and CINAHL databases. The search deadline was from the respective databases to July 2023. Literature screening, data extraction and quality assessment were performed independently by two researchers. Stata 15.0 was used for meta-analysis. Results Thirty-two papers were included, and including 6 746 patients, among which 2 566 experienced frailty, involving 37 influencing factors. Meta-analysis showed that the prevalence of frailty in MHD patients in China was 37.4% (95%CI=30.3%-44.5%). Age (OR=1.09, 95%CI=1.06-1.13), age>60 years (OR=3.81, 95%CI=2.31-6.30), female (OR=2.13, 95%CI=1.47-3.08), living alone (OR=2.42, 95%CI=1.22-4.80), sleep (OR=1.28, 95%CI=1.08-1.50), depression (OR=1.97, 95%CI=1.26-3.08), age on dialysis (OR=3.25, 95%CI=1.82-5.79), social support (low level) (OR=1.99, 95%CI=1.39-2.86), comorbidities (OR=1.79, 95%CI=1.40-2.30), malnutrition (OR=1.17, 95%CI=1.07-1.28), Charlson Comorbidity Index (CCI) (OR=1.32, 95%CI=1.01-1.71), C-reactive protein (CRP) (OR=1.15, 95%CI=1.09-1.21), hemoglobin (Hb

Background Maintenance hemodialysis (MHD) and peritoneal dialysis (PD) are main treatment methods for uremic patients. It remains an important content of clinical research on better developing treatment protocols to address overhydration (OH) in dialysis patients, and the effect of applying body composition monitor (BCM) on the prognosis of dialysis patients treated with different dialysis models is still controversial. Objective To explore the relationship between OH parameters of BCM and prognosis in patients treated with MHD and PD. Methods From October 2017 to March 2022, 334 patients on maintenance dialysis in Beijing Jishuitan Hospital affiliated to Capital Medical Medical University, Beijing Boai Hospital, Aviation General Hospital, Beijing Changping District Hospital and Beijing Changping Hospital of Integrated Traditional Chinese and Western Medicine were included as the study objects and divided into MHD group (n=188) and PD group (n=146) according to their renal replacement therapy mode. The general data of and BCM related parameters were collected through the electronic medical record system. Patients included in the study were followed up, dialysis treatment parameters, body weight, systolic blood pressure and diastolic blood pressure were recorded, and the average of multiple follow-up results were calculated. Endpoint events were recorded during follow-up period, with the primary endpoint event as all-cause death (ACM), secondary endpoint events as cardiovascular events (CVE), combined adverse events (CAE), surgery or fracture (SOF). Spearman rank correlation analysis was used to explore the correlation between endpoint events and BCM parameters, and stepwise multiple Logistic regression analysis was used to explore the influencing factors of secondary endpoint events in patients. The ACM survival curve was plotted by Kaplan-Meier method, and the difference of survival curve between the two groups was compared by Log-rank test. Multivariate Cox regression analysis was used to explore the influencing factors of ACM. Results A total of 311 patients completed follow-up, with a median follow-up time of 29.9 (18.0, 36.0) months, including 176 patients in MHD group and 135 patients in PD group. Dialysis age, body weight, target body weight, adipose tissue content and adipose tissue index in MHD group were higher than those in PD group, and OH was lower than that in PD group (P

Background Neutrophil-to-lymphocyte ratio (NLR) has been shown to have significant predictive value for all-cause mortality risk in patients with maintenance hemodialysis (MHD) in previous studies, however, whether C-reactive protein-to-albumin ratio (CAR) and the combination of NLR and CAR can enhance the predictive value for all-cause mortality risk in patients with MHD has not been investigated. Objective To investigate the combined predictive value of NLR and CAR for all-cause mortality of MHD patients, and to provide evidence for improving the quality of life of MHD patients. Methods The case data of 175 MHD patients in the Blood Purification Center of Hainan General Hospital in January 2017 were included, the deadline was December 31, 2021, with the outcome of all-cause death. Receiver operating characteristic (ROC) curves were plotted for the predictive value of NLR+CAR, NLR, and CAR for the risk of all-cause death in MHD patients. Kaplan-Meier survival curve was used to compare the cumulative survival rate between the two groups. Cox regression analysis was used to analyze the independent risk factors of 5-year all-cause death in MHD patients. Results The area under the ROC curve (AUC) of NLR for predicting the risk of all-cause death in MHD patients was 0.743 (95%CI=0.669-0.817, P4.93 had lower cumulative survival than patients with NLR ≤4.93 (χ2=32.753, P0.795 had a lower cumulative survival than patients with CAR≤0.795 (χ2=38.091, P4.93 (HR=2.071, 95%CI=1.226-3.499) and CAR>0.795 (HR=1.903, 95%CI=1.155-3.136) were independent risk factors for all-cause death in 5-year MHD patients (P

Background Erythropoietin (EPO) hypo-responsiveness is one of the main reasons for the low compliance rate of renal anemia in maintenance hemodialysis (MHD) patients, and it is also an independent risk factor for death in MHD patients. Early identification and early intervention is the key to improve prognosis. Blood inflammatory markers may be associated with EPO hypo-responsiveness in MHD patients. Objective To explore the correlation between systemic immune-inflammation index (SII) and EPO hypo-responsiveness in MHD patients. Methods A total of 180 patients who underwent regular MHD at the hemodialysis center of Henan Province Hospital of Traditional Chinese Medicine from June 2022 to June 2023 were selected as the study objects. EPO resistance index (ERI) was used to evaluate the EPO reactivity of the patients, and they were divided into EPO hypo-responsiveness group and non-EPO hypo-responsiveness group according to the ERI value. The general data and laboratory index data of the two groups were compared. Pearson correlation analysis and Spearman rank correlation analysis were used to assess the correlation of ERI with other various indicators. Multivariate Logistic regression analysis was used to explore the independent correlation factors of EPO hypo-responsiveness in MHD patients. The predictive value of SII for EPO hypo-responsiveness in MHD patients was analyzed using receiver operating characteristic (ROC) curves. Results A total of 180 patients with MHD were included, including 104 males (57.8%) and 76 females (42.2%), aged (56.1±8.6) years. There were 52 cases (28.9%) in EPO hypo-responsiveness group and 128 cases (71.1%) in non-EPO hypo-responsiveness group. There were significant differences in dialysis age, post-dialysis body weight, weekly rHuEPO dosage, white blood cells, neutrophils, lymphocytes, red blood cells, hemoglobin, platelets, albumin, parathyroid hormone, triglyceride, ERI, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and SII between EPO hypo-responsiveness group and non-EPO hypo-responsiveness group (P

Background: Recent studies have shown that the baseline values of absolute aortic root diameter (ARD) and indexed diameter are associated with all-cause mortality and cardiovascular events in the general population, even in the absence of aneurysmal aortic disease. However, there is limited available data on the association between ARD and prognosis in end-stage renal disease (ESRD) patients receiving maintenance hemodialysis (MHD). Accordingly, the purpose of this study is to investigate the predictive value of ARD for all-cause mortality and cardiovascular events in this specific population.Methods: ARD was measured by echocardiography at the level of the sinuses of Valsalva at end diastole and indexed to body surface area (BSA). The primary endpoint was all-cause mortality. The secondary endpoint was major adverse cardiovascular events (MACE), including cardiovascular mortality, myocardial infarction and stroke. Cox proportional hazards models were conducted to evaluate the association between baseline ARD/BSA and clinical outcomes.Results: A total of 391 patients were included in this study. The primary endpoint occurred in 95 (24.3%) patients while the secondary endpoint occurred in 71 (18.2%) patients. Multivariate Cox regression analysis showed that ARD/BSA was an independent prognostic factor for all-cause mortality (HR, per 1-SD increase, 1.403; 95% CI, 1.118–1.761; p = 0.003) as well as MACE (HR, per 1-SD increase, 1.356; 95% CI, 1.037–1.772; p = 0.026).Conclusions: Our results show that ARD/BSA is predictive of all-cause mortality and MACE in MHD patients with ESRD and support the view that assessment of ARD/BSA may refine risk stratification and preventive strategies in this population. [ABSTRACT FROM AUTHOR]

To delineate the efficacy and safety profile of hemodiafiltration with endogenous reinfusion (HFR) for uremic toxin removal in patients undergoing maintenance hemodialysis (MHD). Patients who have been on MHD for a period of at least 3 months were enrolled. Each subject underwent one HFR and one hemodiafiltration (HDF) treatment. Blood samples were collected before and after a single HFR or HDF treatment to test uremic toxin levels and to calculate clearance rate. The primary efficacy endpoint was to compare uremic toxin levels of indoxyl sulfate (IS), λ-free light chains (λFLC), and β2-microglobulin (β2-MG) before and after HFR treatment. Secondary efficacy endpoints was to compare the levels of urea, interleukin-6 (IL-6), P-cresol, chitinase-3-like protein 1 (YKL-40), leptin (LEP), hippuric acid (HPA), trimethylamine N-oxide (TMAO), asymmetric dimethylarginine (ADMA), tumor necrosis factor-α (TNF-α), fibroblast growth factor 23 (FGF23) before and after HFR treatment. The study also undertook a comparative analysis of uremic toxin clearance between a single HFR and HDF treatment. Meanwhile, the lever of serum albumin and branched-chain amino acids before and after a single HFR or HDF treatment were compared. In terms of safety, the study was meticulous in recording vital signs and the incidence of adverse events throughout its duration. The study enrolled 20 patients. After a single HFR treatment, levels of IS, λFLC, β2-MG, IL-6, P-cresol, YKL-40, LEP, HPA, TMAO, ADMA, TNF-α, and FGF23 significantly decreased (p < 0.001 for all). The clearance rates of λFLC, β2-MG, IL-6, LEP, and TNF-α were significantly higher in HFR compared to HDF (p values: 0.036, 0.042, 0.041, 0.019, and 0.036, respectively). Compared with pre-HFR and post-HFR treatment, levels of serum albumin, valine, and isoleucine showed no significant difference (p > 0.05), while post-HDF, levels of serum albumin significantly decreased (p = 0.000). HFR treatment effectively eliminates uremic toxins from the bloodstream of patients undergoing MHD, especially protein-bound toxins and large middle-molecule toxins. Additionally, it retains essential physiological compounds like albumin and branched-chain amino acids, underscoring its commendable safety profile. [ABSTRACT FROM AUTHOR]

The relationship between serum total cholesterol (TC) and triglyceride (TG) levels and mortality in maintenance hemodialysis (MHD) patients remains inconsistent. We aimed to explore the individual and combined association of TC and TG levels with the risk of mortality in Chinese MHD patients. 1036 MHD patients were enrolled in this multicenter, prospective cohort study. The serum levels of total cholesterol and triglycerides were measured at baseline. The primary outcome was all-cause mortality and secondary outcome was cardiovascular disease (CVD) mortality. During a median follow-up duration of 4.4 years (IQR= 2.0–7.9 years), 549 (53.0%) patients died, and 297 (28.7%) deaths were attributed to CVD. Compared with patients with TC levels in the first three quartiles (<182.5 mg/dL), a significantly higher risk of all-cause mortality was found in participants with TC in the fourth quartile (hazard ratio [HR], 1.43; 95% confidence interval [CI], 1.17–1.76). However, a significantly lower risk of all-cause mortality was observed in participants with TG in the fourth quartile (≥193.9 mg/dL) (HR, 0.78; 95%CI: 0.63–0.98), compared with participants with TG in the first three quartiles. Similar trends were observed in CVD mortality. When analyzed jointly, patients with lower TC (<182.5 mg/dL) and higher TG (≥193.9 mg/dL) levels had the lowest risk of all-cause mortality and CVD mortality. Conclusions: In MHD patients in southern China, higher TC levels were associated with higher risk of mortality, while higher TG levels were related to lower risk of mortality. Patients with lower TC and higher TG levels had the best survival prognosis. [ABSTRACT FROM AUTHOR]

To examine the effectiveness of psychoeducational interventions on depression, anxiety, and health-related quality of life (HRQOL) for people undergoing maintenance hemodialysis (MHD). This review used systematic review and meta-analysis as the research design. Nine databases, including PubMed, Web of Science, Embase, CINAHL Complete, Cochrane Library, CNKI, WanFang, VIP, and Chinese Biomedical Literature Database, were searched from the inception to the 8th of July 2023. Two reviewers independently identified randomized controlled trials (RCT) examining the effects of psychoeducational interventions on MHD patients. Fourteen studies involving 1134 MHD patients were included in this review. The results of meta-analyses showed that psychoeducational intervention had significant short-term (< 1 m) (SMD: −0.87, 95% CI: −1.54 to −0.20, p = 0.01, I2 = 91%; 481 participants), and medium-term (1–3 m) (SMD: −0.29, 95% CI: −0.50 to −0.08, p = 0.01, I2 = 49%; 358 participants) on anxiety in MHD patients, but the effects could not be sustained at longer follow-ups. Psychoeducational interventions can also have short-term (< 1 m) (SMD: −0.65, 95% CI: −0.91 to −0.38, p < 0.00001, I2 = 65%; 711 participants) and medium-term (1–3 m) (SMD: −0.42, 95% CI: −0.76 to −0.09, p = 0.01, I2 = 69%; 489 participants) effects in reducing depression levels in MHD patients. Psychoeducational interventions that use coping strategies, goal setting, and relaxation techniques could enhance the QOL in MHD patients in the short term (< 1 m) (SMD: 0.86, 95% CI: 0.42 to 1.30, p = 0.02, I2 = 86%; 241 participants). Psychoeducational interventions have shown great potential to improve anxiety, depression, and quality of life in patients with MHD at the short- and medium-term follow-ups. Trial registration number: CRD42023440561. [ABSTRACT FROM AUTHOR]

Anemia is a common complication of chronic kidney disease with major option treatment of erythropoiesis-stimulating agents (ESAs). This study aimed to investigate the influencing factors of erythropoietin resistance index (ERI) and its association with mortality in maintenance hemodialysis (MHD) patients. Patients enrolled from China Dialysis Outcomes and Practice Patterns Study (DOPPS) 5 were included. ERI was calculated as follows: ESA (IU/week)/weight (kg, post-dialysis)/hemoglobin level (g/dL). The Cox regression model was used to analyze the influencing factors on survival outcomes. Stepwise multivariate logistic regression was used to identify the related risk factors, and subgroup analyses were performed. A total of 1270 MHD subjects (687 males and 583 females) were included, with an average age of 60 (49.0, 71.0) years. All subjects were divided into two groups by the median ERI of 14.03. Multivariate logistic regression showed that dialysis vintage (OR 0.957, 95% CI: 0.929–0.986), white blood cells (OR 0.900, 95% CI: 0.844–0.960), high flux dialyzer use (OR 0.866, 95% CI: 0.755–0.993), body mass index (OR 0.860, 95% CI: 0.828–0.892), males (OR 0.708, 95% CI: 0.625–0.801), and albumin (OR 0.512, 95% CI: 0.389–0.673) had a negative association with high ERI baseline (all p < 0.05). There were 176 (13.9%) deaths in total including 89 cardiac/vascular deaths during follow-up. Cox regression analysis showed that ERI was positively associated with all-cause mortality, especially in some subgroups. ERI was associated with increased all-cause mortality in MHD patients, indicating the possibility of death prediction by ERI. Patients with high ERI warrant more attention. [ABSTRACT FROM AUTHOR]

Objective To explore the current status of serum phosphorus level in patients on maintenance hemodialysis （MHD）, examine its relationship with clinical parameters and determine the influencing factors of serum phosphorus level. Methods For this multicenter cross-sectional study, 2667 patients on MHD at 27 domestic dialysis centers were recruited from 2019 to 2020. Demographic profiles, primary diseases and laboratory tests were recorded. According to serum phosphorus （P） level, they were assigned into three groups of low blood phosphorus （P

Objective To explore the risk factors for sleep disorders in maintenance hemodialysis （MHD） patients and construct a risk prediction model. Methods A retrospective study was conducted among 198 patients who underwent MHD between January 2018 and December 2022. Based upon whether or not there were complications of sleep disorders, they were assigned into two groups of sleep disorder （n = 134） and non-sleep disorder （n = 64）. Uni/multivariate Logistic regression analyses were performed for identifying the risk factors for sleep disorders in MHD patients. A nomogram model for sleep disorders in MHD patients was constructed with software R. The discrimination and calibration of this model were tested using the receiver operating characteristic （ROC） curve and calibration curve. Internal validation of this model was conducted byBootstrap. Results The total PSQI score was （10.32 ± 1.34）. There were 134 patients with PSQI score ≥7 and the incidence of sleep disorders was 67.68%（134/198）. Uni/multivariate Logistic regression analyses revealed that dialysis duration （OR = 1.573）, skin pruritus （OR = 3.044）, restless leg syndrome （RSL）（OR = 2.722） and serum parathyroid hormone （PTH）（OR = 1.030） were risk factors for sleep disorders in MHD patients （P

Abstract Background Social alienation refers to the state of feeling isolated, helpless, and unsatisfied due to maintaining distance from others or avoiding social interaction and activities. This phenomenon is caused by a lack of social skills, social anxiety, physical health problems, and other reasons. Older maintenance hemodialysis patients are exposed to a higher risk of social alienation. However, previous studies have been performed using the total score of the scale, which does not allow the identification of the characteristics of various patient groups with different levels of social alienation. In contrast, latent profile analysis can classify individuals into different categories based on continuous observational indicators, which improves accuracy and provides a more objective assessment by accounting for the uncertainty of variables. Given the concealed nature of social alienation and the differences in characteristics and treatment measures between different profiles, developing a predictive model for social alienation in older maintenance hemodialysis patients holds significance. Objective To explore the latent profile analysis of social alienation in older maintenance hemodialysis patients and to develop and validate a predictive model for social alienation in this population. Methods A total of 350 older maintenance hemodialysis patients were selected as the study subjects using convenience sampling. A cross-sectional survey was conducted using a general information questionnaire, the Generalized Alienation Scale, and the Self-Perceived Burden Scale. Based on the results of the Generalized Alienation Scale, a latent profile analysis was performed, followed by univariate analysis and multinomial logistic regression to develop a predictive model. The effectiveness of the predictive model was evaluated in terms of its authenticity, reliability, and predictive ability. Results Three hundred nineteen valid questionnaires were collected. The social alienation of older maintenance hemodialysis patients based on latent profile analysis were divided into three profiles, which were named the low/medium/high-symptom groups, comprising 21%, 38.9%, and 40.1% of participants, respectively. Based on male, monthly social activity hours, Age-Adjusted Charlson Comorbidity Index, dialysis age, and Self-Perceived Burden Scale, a predictive model of social alienation for older maintenance hemodialysis patients was developed, and the Hosmer–Lemeshow tests showed no statistical significance (P > 0.05). The model has high predictive efficiency in authenticity, reliability and predictability. Conclusion Older maintenance hemodialysis patients exhibited moderate to high levels of social alienation. The latent profile analysis based method was used to divide patients into low/medium/high-symptom profiles, and the predictive model demonstrates excellent authenticity, reliability, and predictability.

Objective: The objective of this study was to analyze the current status of barriers to exercise participation (EP) among patients on maintenance hemodialysis (MHD). Materials and Methods: A cross-sectional study was conducted on 277 outpatients undergoing MHD in 2 tertiary first-class hospitals in Beijing from February 2023 to June 2023 who were selected using convenience sampling method. The data of patients on MHD were collected using the general information questionnaire, Physical Activity Rating Scale, Exercise Benefits/Barriers Scale (EBBS), and Exercise Self-Efficacy Scale (ESES). The relationship between EP and barriers to EP was analyzed through univariate and multivariate linear regression models. Results: Patients on MHD had a low exercise volume score of 13.71 ± 0.68 points and a medium EBBS score of 63.36 ± 0.40 points. Multivariate logistic analysis showed that exercise volume was significantly related to the following four aspects, including low monthly household income per capita (odds ratio [OR] = 86.741, 95% confidence interval [CI] [1.164–6.465], P = 0.042), primary underlying disease of diabetic nephropathy (OR = 45.993, 95% CI [1.353–1.564], P = 0.033), the belief that “fatigue in lower extremities hinders exercise” (OR = 4.697, 95% CI [1.127–19.585], P = 0.034), and the belief that “physical exercise bringing optimistic and positive life attitude” (OR = 0.074, 95% CI [0.007–0.830], P = 0.035). Conclusions: Since patients on MHD had low physical exercise volume, the health-care provider should pay more attention on the controllable factors that affect the EP of patients on MHD. Therefore, feasible and effective intervention measures can be formulated based on ESES in clinical nursing.

Abstract Background and aims Patients undergoing maintenance hemodialysis (MHD) experience increased mortality and cardiovascular disease (CVD) risks; however, the potential connection between pinch strength (PS) and the prognosis of these patients remains unknown. Consequently, this study aimed to comprehensively assess the influence of PS and handgrip strength (HGS) on both survival and cardiovascular events (CVE) in patients undergoing MHD. Methods Data were gathered from patients undergoing MHD at the Hemodialysis Center of Guangzhou Red Cross Hospital in March 2021. We performed a retrospective follow-up spanning 24 months, with death serving as the primary endpoint for observation and CVE as the secondary endpoint. Multifactorial Cox regression analysis, Kaplan–Meier survival curves, trend tests, and restricted cubic spline were applied to explore the association. Results During a 24-month follow-up, data were collected from 140 patients undergoing MHD with an average age of 66.71 ± 12.61 years. Among them, 52 (37.14%) experienced mortality, whereas 36 (40.00%) had CVE without baseline CVD. Kaplan–Meier survival curves demonstrated better survival rates and reduced CVE risk for patients in the second, third, and fourth quartiles compared with those in the first quartile for PS. Adjusted analyses in different models revealed higher PS levels were independently associated with all-cause mortality (major model, model 4, HR, 0.78; 95% CI, 0.64–0.95) but not with CVE risk (unadjusted HR, 0.90; 95% CI, 0.77–1.05). Compared with lower quartile PS levels, higher PS levels significantly reduced all-cause mortality (HR, 0.31; 95% CI, 0.10–1.02), and this trend remained consistent (P for trend = 0.021). Finally, the restricted cubic spline method using different models showed a linear relationship between PS and all-cause mortality (P > 0.05), when PS exceeded 4.99 kg, the all-cause mortality of MHD patients significantly decreased. Conclusions PS was independently associated with all-cause mortality but not with CVE in patients undergoing MHD.

Abstract Objective Restless legs syndrome (RLS) stands as a prevalent neurological complication within maintenance hemodialysis (MHD) patients. However, the alterations in cerebral blood flow (CBF) among MHD-RLS patients remain uncharted. Through the utilization of the arterial spin labeling (ASL) technique, we evaluated the fluctuations in CBF within distinct brain regions and analyzed the risk factors for the development of RLS in MHD patients in the context of the clinic. Methods Thirty-one MHD patients with concomitant RLS (MHD-RLS group) and thirty-one non-RLS patients matched based on age, gender, as well as cognitive function (MHD-nRLS group) were included. Through image preprocessing and data analysis, the changes in CBF values in distinct brain regions were obtained, and the CBF values of brain regions with substantial differences between the two groups were correlated with the RLS scores. Furthermore, the differences in baseline data were compared, and through the utilization of multifactorial logistic regression, the independent risk factors for the development of RLS were examined. Results Compared with the MHD-nRLS group, the MHD-RLS group had increased CBF in the right superior temporal gyrus, reduced CBF in the right hippocampus, left middle frontal gyrus, inferior frontal gyrus of right triangle, middle frontal gyrus of left orbit, left precentral gyrus, and left precuneus. Only left precentral gyrus CBF were negatively correlated with RLS scores after correction for dialysis duration(r = -0.436, P = 0.016). Accordingly, multifactorial regression analysis by stepwise method yielded that the left precentral gyrus CBF values(OR: 0.968, 95%CI: 0.944–0.993, P = 0.012) remained an independent risk factor for RLS in MHD patients. In addition, the results showed that hemodialysis duration (OR: 1.055, 95%CI: 1.014–1.098, P = 0.008) and serum iron levels (OR: 0.685, 95%CI: 0.551–0.852, P = 0.001) were also risk factors for the development of RLS. Conclusion Patients afflicted with MHD-RLS exhibit alterations in CBF across several brain regions. Notably, the left precentral gyrus might serve as a pivotal region influencing the onset of RLS among MHD patients. Furthermore, extended hemodialysis duration and a relative insufficiency in serum iron levels independently contribute as risk factors for RLS development within the MHD patient population.

Psychological resilience plays an important role in overcoming emotional distress among people receiving maintenance hemodialysis (MHD). This study aimed to investigate how social support and family resilience interact to influence psychological resilience among Chinese people receiving MHD. This was a prospective longitudinal study with three time points: baseline (T1), 3 months (T2), and 6 months (T3) later. A convenience sample of 252 participants (67.1% male; 57.6 ± 13.8 years of age) from Zhejiang Province, China, who completed baseline measures of social support, family resilience, and psychological resilience, were further assessed for psychological resilience at T2 and T3. Polynomial regression (PR) and response surface analysis (RSA) were used to analyze the data. At all time points, and in the case of agreement between social support and family resilience, the combined effect of both variables manifested as a positive linear association with psychological resilience. Instead, at baseline, and in case of disagreement, the same combined effect manifested as a negative linear relationship related to psychological resilience. The findings highlighted the importance of considering the conjoint influence of social support and family resilience when developing interventions to improve the psychological resilience of people receiving MHD. [ABSTRACT FROM AUTHOR]

Background: Social alienation refers to the state of feeling isolated, helpless, and unsatisfied due to maintaining distance from others or avoiding social interaction and activities. This phenomenon is caused by a lack of social skills, social anxiety, physical health problems, and other reasons. Older maintenance hemodialysis patients are exposed to a higher risk of social alienation. However, previous studies have been performed using the total score of the scale, which does not allow the identification of the characteristics of various patient groups with different levels of social alienation. In contrast, latent profile analysis can classify individuals into different categories based on continuous observational indicators, which improves accuracy and provides a more objective assessment by accounting for the uncertainty of variables. Given the concealed nature of social alienation and the differences in characteristics and treatment measures between different profiles, developing a predictive model for social alienation in older maintenance hemodialysis patients holds significance. Objective: To explore the latent profile analysis of social alienation in older maintenance hemodialysis patients and to develop and validate a predictive model for social alienation in this population. Methods: A total of 350 older maintenance hemodialysis patients were selected as the study subjects using convenience sampling. A cross-sectional survey was conducted using a general information questionnaire, the Generalized Alienation Scale, and the Self-Perceived Burden Scale. Based on the results of the Generalized Alienation Scale, a latent profile analysis was performed, followed by univariate analysis and multinomial logistic regression to develop a predictive model. The effectiveness of the predictive model was evaluated in terms of its authenticity, reliability, and predictive ability. Results: Three hundred nineteen valid questionnaires were collected. The social alienation of older maintenance hemodialysis patients based on latent profile analysis were divided into three profiles, which were named the low/medium/high-symptom groups, comprising 21%, 38.9%, and 40.1% of participants, respectively. Based on male, monthly social activity hours, Age-Adjusted Charlson Comorbidity Index, dialysis age, and Self-Perceived Burden Scale, a predictive model of social alienation for older maintenance hemodialysis patients was developed, and the Hosmer–Lemeshow tests showed no statistical significance (P > 0.05). The model has high predictive efficiency in authenticity, reliability and predictability. Conclusion: Older maintenance hemodialysis patients exhibited moderate to high levels of social alienation. The latent profile analysis based method was used to divide patients into low/medium/high-symptom profiles, and the predictive model demonstrates excellent authenticity, reliability, and predictability. [ABSTRACT FROM AUTHOR]

Introduction: This study aims to analyze the risk factors for severe fatigue in maintenance hemodialysis (MHD) patients and develop a clinical prediction model to help doctors and patients prevent severe fatigue. Methods: Multicentre MHD patients were included in this study. The objective was to investigate the risk factors for severe fatigue in MHD patients and develop a prediction model. Results: A total of 243 MHD patients were included in the study, and the incidence of severe fatigue was found to be 20.99%. Using age, body mass index, total cholesterol, and albumin levels, a predictive nomogram for fatigue was constructed. In the training set, the nomogram had an area under the curve of 0.851, sensitivity of 82.86%, specificity of 81.76%, and c‐index of 0.851. The nomogram was accurate in calibration and proved to be clinically useful. Conclusion: The nomogram developed in this study is a practical and reliable tool for quickly identifying severe fatigue in MHD patients. [ABSTRACT FROM AUTHOR]

This study aimed to examine the impact of individualized dietary guidance on the recovery of patients with chronic renal failure undergoing maintenance hemodialysis. This study included 124 patients undergoing maintenance hemodialysis at the Second Affiliated Hospital of Dalian Medical University between March 2020 and March 2023. The patients were divided into an observation group and a control group using a random number table method, with 62 patients in each group. Patients in the observation group received individualized dietary guidance, while those in the control group received conventional dietary guidance. After the intervention, patients in the observation group had higher Renal Adherence Behavior Questionnaire scores, transferrin, albumin, and prealbumin levels, Generic Quality of Life Inventory-74 scores, and fasting blood glucose levels than those in the control group. Furthermore, patients in the observation group had lower subjective global assessment scores, blood phosphorus levels, and incidence of hypoglycemia than those in the control group. Individualized dietary guidance can help improve dietary compliance in patients with chronic renal failure undergoing maintenance hemodialysis, improve their nutritional status, enhance the effectiveness of blood phosphorus and blood glucose management, and elevate their quality of life. [ABSTRACT FROM AUTHOR]

This study examined the effects of internet-based cognitive behavioral therapy on the nutritional status and scores from the Knowledge, Attitude, and Practice questionnaire in maintenance hemodialysis patients. Patients in the traditional therapy group received standard health education, whereas those in the experimental group participated in three months of this therapy. Clinical and nutritional indicators, including blood biomarkers and Knowledge, Attitude, and Practice questionnaire scores, were recorded for both groups before and after the treatment. Post-treatment, the group receiving internet-based cognitive behavioral therapy exhibited higher blood calcium levels, increased upper arm circumference, and reduced levels of potassium and phosphorus. They also showed comparatively lower scores in Nutritional Risk Screening 2000 and Malnutrition Inflammation, along with higher Visual Analog Scale scores (P < 0.05). The internet-based cognitive behavioral therapy group exhibited higher albumin and prealbumin levels, reduced transferrin, total cholesterol, creatinine, and urea levels, and modified quantitative subjective global assessment scores than the traditional therapy group (P < 0.05). They also scored higher on the Knowledge, Attitude, and Practice questionnaire (P < 0.05). These results indicate that internet-based cognitive behavioral therapy can improve the nutritional status, Knowledge, Attitude, and Practice questionnaire scores, and overall quality of life in maintenance hemodialysis patients, highlighting its potential benefit in patient outcomes. [ABSTRACT FROM AUTHOR]

Objective: To analyze the levels of serum soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), and superoxide dismutase (SOD) activity in the patients with maintenance hemodialysis (MHD), and to discuss their relationships with coronary artery calcification (CAC). Methods: The clinical materials from 102 MHD patients (MHD group) were retrospectively analyzed. Additionally, 74 volunteers underwent routine health examination at the same time (health examination group) were selected. The CAC scores (CACs) of the patients in MHD group were detected by multi-slice computed tomography (MSCT), and the patients were categorized into non-calcification group, mild calcification group, moderate calcification group, and severe calcification group. The general data and serum levels of sICAM-1, sVCAM-1, and SOD activities of the subjects in two groups were compared. The levels of calcium (Ca), phosphorus (P), parathyroid hormone (PTH), sICAM-1, sVCAM-1, and SOD activities in serum of the patients with different degrees of calcification were analyzed. Pearson's correlation analysis was used to analyze the correlations between the levels of sICAM-1, sVCAM-1, and SOD activity in serum of the MHD patients and CACs. Results: Compared with health examination group, the levels of sICAM-1 and sVCAM-1 in serum of the patients in MHD group were significantly increased (P<0. 01), and the SOD activity was significantly decreased (P< 0. 01). Compared with non-calcification group, the levels of PTH, sICAM-1, and sVCAM-1 in serum of the MHD patients in mild, moderate, and severe calcification groups were significantly increased (P< 0. 05), and the SOD activities were significantly decreased (P<0. 05); the levels of P in serum of the MHD patients in moderate and severe calcification groups were significantly increased (P<0. 05). Compared with mild calcification group, the levels of P, PTH, sICAM-1, and sVCAM-1 in serum of the MHD patients in moderate and severe calcification groups were significantly increased (P<0. 05), and the SOD activities significantly decreased (P<0. 05). Compared with moderate calcification group, the levels of sICAM-1, sVCAM-1, and P in serum of the MHD patients in severe calcification group were significantly increased (P<0. 05), and the SOD activity was significantly decreased (P<0. 05). The SOD activity in serum of the MHD patients was negatively correlated with CACs (r =-0. 484, P<0. 01), while the levels of sICAM-1 and sVCAM-1 were positively correlated with CACs (r =0. 441, P< 0. 01; r = 0. 561, P<0. 01). Conclusion: The levels of sICAM-1 and sVCAM-1 and activity of SOD in serum of the MHD patients are abnormal. With the decreasing of the SOD activity and increasing of the levels of sICAM-1 and sVCAM-1, the degree of CAC in the MHD patients is aggravated. [ABSTRACT FROM AUTHOR]

BACKGROUND: The main treatment method for end-stage renal disease (ESRD) is maintenance hemodialysis (MHD). With the continuous improvement of dialysis technology, the survival period of MHD patients has been effectively prolonged, but dialysis technology still cannot completely replace renal function. OBJECTIVE: To study the dietary compliance and its correlation with thirst in MHD patients and to provide guidance for clinical development of corresponding intervention countermeasures. METHODS: A total of 90 patients who received MHD treatment from March 2021 to March 2022 were selected as objects. The Renal Adherence Attitudes Questionnaire (RAAQ) and the Renal Adherence Behaviour Questionnaire (RABQ) were used to analyze the dietary compliance and thirst status of patients. Pearson correlation analysis was used to analyze the correlation between diet compliance and thirst. RESULTS: Positive correlations were found between VAS and DTI, SXI and TDS (P < 0.05). Social restrictive attitude was positively correlated with VAS, DTI, SXI, TDS, acceptance attitude and compliance in facing difficulties (P < 0.05), and negatively correlated with self-care compliance (r = - 0.35, P < 0.05). Health attitude was positively correlated with VAS, DTI and SXI (P < 0.05). Acceptance attitude was positively correlated with DTI, SXI and TDS (P < 0.05). High RAAQ was associated with high VAS (b = 0.11, 95% CI: 0.05, 0.18), DTI (b = 0.28, 95% CI: 0.17, 0.38), SXI (b = 0.24, 95% CI: 0.14, 0.34) and TDS (b = 0.26, 95% CI: 0.13, 0.4). CONCLUSION: The overall performance of dietary compliance in patients with MHD is at a moderate level, and dietary compliance is negatively correlated with disease perception. [ABSTRACT FROM AUTHOR]

Background and aims: Patients undergoing maintenance hemodialysis (MHD) experience increased mortality and cardiovascular disease (CVD) risks; however, the potential connection between pinch strength (PS) and the prognosis of these patients remains unknown. Consequently, this study aimed to comprehensively assess the influence of PS and handgrip strength (HGS) on both survival and cardiovascular events (CVE) in patients undergoing MHD. Methods: Data were gathered from patients undergoing MHD at the Hemodialysis Center of Guangzhou Red Cross Hospital in March 2021. We performed a retrospective follow-up spanning 24 months, with death serving as the primary endpoint for observation and CVE as the secondary endpoint. Multifactorial Cox regression analysis, Kaplan–Meier survival curves, trend tests, and restricted cubic spline were applied to explore the association. Results: During a 24-month follow-up, data were collected from 140 patients undergoing MHD with an average age of 66.71 ± 12.61 years. Among them, 52 (37.14%) experienced mortality, whereas 36 (40.00%) had CVE without baseline CVD. Kaplan–Meier survival curves demonstrated better survival rates and reduced CVE risk for patients in the second, third, and fourth quartiles compared with those in the first quartile for PS. Adjusted analyses in different models revealed higher PS levels were independently associated with all-cause mortality (major model, model 4, HR, 0.78; 95% CI, 0.64–0.95) but not with CVE risk (unadjusted HR, 0.90; 95% CI, 0.77–1.05). Compared with lower quartile PS levels, higher PS levels significantly reduced all-cause mortality (HR, 0.31; 95% CI, 0.10–1.02), and this trend remained consistent (P for trend = 0.021). Finally, the restricted cubic spline method using different models showed a linear relationship between PS and all-cause mortality (P > 0.05), when PS exceeded 4.99 kg, the all-cause mortality of MHD patients significantly decreased. Conclusions: PS was independently associated with all-cause mortality but not with CVE in patients undergoing MHD. [ABSTRACT FROM AUTHOR]

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Objective: Restless legs syndrome (RLS) stands as a prevalent neurological complication within maintenance hemodialysis (MHD) patients. However, the alterations in cerebral blood flow (CBF) among MHD-RLS patients remain uncharted. Through the utilization of the arterial spin labeling (ASL) technique, we evaluated the fluctuations in CBF within distinct brain regions and analyzed the risk factors for the development of RLS in MHD patients in the context of the clinic. Methods: Thirty-one MHD patients with concomitant RLS (MHD-RLS group) and thirty-one non-RLS patients matched based on age, gender, as well as cognitive function (MHD-nRLS group) were included. Through image preprocessing and data analysis, the changes in CBF values in distinct brain regions were obtained, and the CBF values of brain regions with substantial differences between the two groups were correlated with the RLS scores. Furthermore, the differences in baseline data were compared, and through the utilization of multifactorial logistic regression, the independent risk factors for the development of RLS were examined. Results: Compared with the MHD-nRLS group, the MHD-RLS group had increased CBF in the right superior temporal gyrus, reduced CBF in the right hippocampus, left middle frontal gyrus, inferior frontal gyrus of right triangle, middle frontal gyrus of left orbit, left precentral gyrus, and left precuneus. Only left precentral gyrus CBF were negatively correlated with RLS scores after correction for dialysis duration(r = -0.436, P = 0.016). Accordingly, multifactorial regression analysis by stepwise method yielded that the left precentral gyrus CBF values(OR: 0.968, 95%CI: 0.944–0.993, P = 0.012) remained an independent risk factor for RLS in MHD patients. In addition, the results showed that hemodialysis duration (OR: 1.055, 95%CI: 1.014–1.098, P = 0.008) and serum iron levels (OR: 0.685, 95%CI: 0.551–0.852, P = 0.001) were also risk factors for the development of RLS. Conclusion: Patients afflicted with MHD-RLS exhibit alterations in CBF across several brain regions. Notably, the left precentral gyrus might serve as a pivotal region influencing the onset of RLS among MHD patients. Furthermore, extended hemodialysis duration and a relative insufficiency in serum iron levels independently contribute as risk factors for RLS development within the MHD patient population. [ABSTRACT FROM AUTHOR]

Obejective: To investigate the clinical efficacy of relationship between serum 25-hydroxyvitamin D [25 (OH)D], neutrophil gelatinase-associated lipocalin (NGAL), Hepcidin （Hepcidin）and roxadustat capsules in the treatment of renal anemia in maintenance hemodialysis (MHD) patients. Methods: 137 MHD patients with renal anemia who were treated with roxadustat capsules in the Affiliated Hospital of Xuzhou Medical University from October 2020 to October 2022 were selected, and patients were divided into effective group (86 cases) and ineffective group (51 cases) according to the effect of 12 weeks of treatment. The serum levels of 25(OH) D, NGAL and Hepcidin were detected before treatment, the factors affecting the efficacy of roxadustat capsules were analyzed by multivariate Logistic regression model, the value of 25(OH)D, NGAL and Hepcidin in predicting the efficacy of roxadustat capsules were analyzed by receiver operating characteristic (ROC) curve. Results: The level of serum 25 (OH)D in ineffective group before treatment was lower than that in effective group (P<0.05), and the levels of NGAL and Hepcidin were higher than those in effective group (P<0.05). High level of NGAL and high level of Hepcidin were risk factors for ineffective treatment of renal anemia in MHD patients with roxadustat capsules (P<0.05), high level of 25 (OH)D, combined with hemofiltration or hemoperfusion, and urea clearance index (Kt/v) >1.2 were protective factors (P<0.05). The area under the curve (AUC) of 25 (OH)D, NGAL, and Hepcidin combined to predict the efficacy of rosastat capsules was 0.853, which was higher than the prediction of individual indicators. Conclusion: The serum 25 (OH) D level decreased and NGAL and Hepcidin level increased in patients with MHD renal anemia before treatment with roxadustat capsules, the above level changes were related to the treatment effect of roxadustat capsules, the combination of 25 (OH)D, NGAL and Hepcidin could improve the predictive value of the therapeutic effect of roxadustat capsules. [ABSTRACT FROM AUTHOR]